Nobody's safe: in Illinois, middle-class families fall through the cracks of health care, causing a rising number of bankruptcy cases.

It was that pain again. Rose-Marie Shaffer popped a couple of Aleve as she had done every night for the previous week and got ready for bed. The longtime nurse assumed the nagging ache in her arm was from using the computer too long at work. At 11:10 that night, she realized it wasn't. As she combed her hair, the pain moved to her chest. "I woke my daughter up and said, 'I think I need to go to the hospital. I think I'm having a heart attack,'" she recalled.

That was in 2000. Five years later, Shaffer is still paying for that two-day stay at Advocate South Suburban Hospital. The bill came to $18,800. At the time, Shaffer was the director of nursing at a west suburban home health care agency. As a full-time employee, she assumed she'd have insurance, but it turned out that she didn't.

Following the heart attack, she couldn't work for six months. She was behind in her mortgage payments, and she was threatened with foreclosure. "Who do you try to pay? Do you try to catch up on the mortgage on your house, or do you pay a hospital bill and sit out in the middle of the street?" Shaffer questioned. With no financial relief in sight, Shaffer did what a growing number of ill-stricken families have done: file for bankruptcy.

A recent Harvard University study estimated that nearly half of all personal bankruptcies nationwide are due to illness and medical bills. Illinois has the fifth-highest estimated number of such cases in the nation, with 40,168 medical-related cases out of 79,777 bankruptcy filings in 2004. Those numbers put Illinois ahead of New York, which has 6.5 million more residents and is estimated to have 1,523 fewer medical-related cases.

"There can be no doubt that there are more families than ever before collapsing into bankruptcy in the aftermath of a serious medical problem," said Elizabeth Warren, co-author of the study.

And things could get worse, experts say. The cost of health care continues to rise, and proposed federal legislation could make filing for personal bankruptcy more difficult this spring.

Now 65, Shaffer uses about 88 percent of her roughly $4,300 monthly take-home pay toward her payments--$2,088 for her creditors and $1,700 for her mortgage. Filing for Chapter 13 bankruptcy, one of two types of personal bankruptcy, allowed Shaffer to keep her home in south suburban Country Club Hills while paying her creditors a reduced amount over a three-year period, which ends in early 2006.

When many people her age are retiring, Shaffer works 60 hours a week as nursing director at Park House Nursing Center on Chicago's Southwest Side. She puts in another 16 hours on the weekends at a nursing home.

"Nobody's safe," Warren said. "I thought the people in bankruptcy because of medical problems would be the people who live at the margins--day laborers, housemaids. But it was solid middle-class folks--people who had done everything right."

In the Harvard study, published in February, researchers examined 1,771 bankruptcy cases, including 450 in Illinois, and estimated that illness and medical bills caused nearly 46 percent of about 1.5 million personal bankruptcies filed nationwide.

Researchers found that single mothers with some college education were most likely to the for medical-related bankruptcy when they or their children got seriously ill. The median age was 42. "Often the mom has to take off work to take care of the kids," said Dr. Steffie Woolhandler, study co-author and associate professor of medicine at Harvard University. "Or, even if she doesn't, there's not enough extra income around to pay the bills of a chronically ill child."

Most of those affected nationwide--76 percent--had medical insurance. One-third of those with private insurance lost their coverage when they couldn't work due to the illness. Another 56 percent of people in bankruptcy owned their homes or had lost them.

"People take on debt for their home or their car, assuming that they're going to be able to work," Woolhandler said. "But, when an illness hits, the income situation changes, and the work situation changes. So not only are they unable to pay their medical bills, they're unable to pay other bills."

The most common ailments that led to bankruptcies were cardio vascular diseases, such as high blood pressure, stroke and heart attack, and orthopedic problems, often from accidents. But it was cancer that hit people's pocketbooks the hardest.

Cancer patients had the highest out-of-pocket medical expenses, at an average of $35,000--more than triple the average patient's bills.

Experts say that the debt is especially difficult to pay when compounded with other debt. "The combination of losing their jobs at the same time, already carrying too much debt and having no savings meant that these families really didn't have a chance once someone got sick," Warren said.

For some, even after bankruptcy, the medical debt continues to accumulate. "If you've developed a chronic illness, and you're not going to be able to go back to work, and you're living on a social security payment, you may never be able to pay back that debt," Woolhandler said.

In 2004, Illinois legislators passed the Health Care Justice Act, which established a commission to come up with ways to provide more affordable health care. But some question the effectiveness of the unfunded, 31-member commission. "While I hope for the best, I have limited optimism," said commission member Dr. Quentin Young, national coordinator for Physicians for a National Health Program and professor of preventive medicine at the University of Illinois College of Medicine.

"The original bill said that this legislative commission should make recommendations to the legislature," Young added. "They watered that down to 'may.'"

Meanwhile, the U.S. Congress is considering a bill that would make it more difficult to file for bankruptcy. It would set an income ceiling, require higher payments to creditors, and mandate immediate payments of outstanding child support and alimony.

Banks and credit card companies have advocated for this legislation for nearly a decade. They say it forces people who can pay off their debts to do so, without taking protection away from the truly bankrupt. "Under the current system, higher-income filers walk away from three or four billion dollars annually they could afford to repay," said Laura Fisher, spokesperson for the American Bankers Association. "The reforms will make the system fair for everyone. Some high-income filers use bankruptcy as a financial planning tool, and stick the rest of us with the tab."

The Senate approved the measure 74-25 in March, with opposing votes from Illinois Democrats Dick Durbin and Barack Obama. The bill is expected to go to the House of Representatives in the spring, with almost certain approval from the president, who has vowed to sign it if approved.

"It's definitely a bad thing," Woolhandler said. "They're going to make the whole bankruptcy process much more expensive, much more punitive. And we feel, based on what we saw, folks have been punished enough."

Contributing: Robert VerBruggen.