This is a story of Kaiser Health News.

Robert and Tiffany Cano, of San Tan Valley, Arizona, have a new wedding, a new home and a 10-month-old son, Brody, who is excited about his ability to blow raspberries.

They also have a stack of medical bills that threatens to undermine everything.

In the months following the birth of their tough, brown-eyed boy, the Canos took out more than $ 12,000 worth of medical debts – so much so that they need a spreadsheet to track their claims on hospitals and the doctors.

"I am on those payment arrangements that are killing us," said 37-year-old Tiffany Cano, who has spent her lunch hours on the phone negotiating payment plans that now total $ 700 per month. "My husband works four times. I work full time. We are a hard-working family who do their best and go nowhere. "

The couple, who earn nearly $ 100,000 a year, is insured and has not had a serious illness or injury. Yet, the Canos are among the 1 in 4 Americans who have report in several polls that the high cost of health care is the main concern of their families. And they risk joining the 62 percent people who declare bankruptcy related to medical bills.

"Oh, yes, this worry is still in my mind," said Tiffany.

The family is part of a group in trouble: middle-class people who have followed the rules and paid health insurance at the employer's expense, have been faced with soaring costs of health care – combined with high deductibles, high processing fees and surprise medical bills – leave them vulnerable.

"I thought we would not be covered and that's just not enough," she said.

Robert Cano, also 37, had taken out family health insurance for 2018 thanks to his job as a director in a large retail store, for which he pays close to $ 500 a month. The plan's annual deductible of $ 3,000 and co-insurance fees of 40% increased faster than expected by Canos.

We first received a bill of nearly $ 4,000 from Brody Hospital, which was born on January 2nd, followed by separate charges from the anesthetist and the doctor who performed the routine delivery. Then, at 2 months old, Brody was hospitalized for breathing problems, which, according to doctors, could be related to allergies or asthma. In May, Tiffany contracted a stomach virus that sent her urgently to get medication to treat nausea and dehydration. In October, the baby developed a serious case of bacterial conjunctivitis, or pinkeye.

PHOTO: Robert Cano plays with his 10-month-old son, Brody, before going to work.Heidi De Marco / KHN

Robert Cano plays with his 10-month-old son Brody before leaving for work.

"It's about $ 300 here, $ 700 there," said Tiffany. "We had a hospital bill for him to be sick, about $ 1,800." At first, unable to find a pediatrician whom she liked, Tiffany asked for if she was going to use emergencies when Brody got sick. When he got the key, she wondered if he should take it, hoping it would be better all by herself.

Then he got worse, she said, pulling a picture of her son on his phone with a half-moon of flesh red and swollen under his dark eyes.

"I let him suffer like that one," she said.

The Canos lost their first child, a girl, in the middle of her pregnancy in 2016. Tiffany acknowledges that the experience left her more anxious than the average mother for the first time.

"It's so scary that something is happening to her," she said.

With regard to their own health care needs, the couple is placed lower on the list of priorities. Tiffany has been using a prosthesis since childhood, when her left leg was amputated because of a congenital malformation.

She needs a new prosthesis because her body has changed during pregnancy, but she does not see how to afford it.

According to Tom Fise, executive director of the American Orthotic & Prosthetic Association, a model adapted to a working mother's working life would easily cost between $ 10,000 and $ 15,000.

"I'm trying to get through," said Tiffany. "I put that brave face to walk, but it's so painful to walk. I have bruises on my leg. I get blisters all the time. Lately, she was wearing an old prosthetic that she had used in high school, because it was more comfortable.

The Canos do not know exactly how they got into debt because they did everything to make responsible decisions. After meeting three years ago, they quickly realized that they wanted to get married and start a family.

"I waited to find the right guy," said Tiffany, delighted to learn that in 2016, they were able to offer a two-story house of an area 2,500 square feet in an area of ​​stucco and tiles per hour. outside of Phoenix.

But, taken together, medical payment plans and premiums go almost as much as their $ 1,300 monthly mortgage. In total, the Canos spend about 15% of their annual income on health care, almost three times the average for non-Medicare households in the United States

That leaves too little for daycare, car payments, gasoline, food and dozens of other domestic expenses, Tiffany said.

For 17 years, Robert Cano had taken out comprehensive health insurance through his job as a soldier in the Army Reserve and paid little or nothing for medical care. However, he left the army in 2017 after learning that he would be deployed for a long time, away from his wife and his new son.

"I told them," I have to be at home, "he recalls. The Army's insurance ended on December 31, 2017, two days before Brody's birth.

This involved moving to the insurance plan of his employer. As more than 40% of 152 million Americans Underwriting health insurance through work, the Canos are enrolled in a plan that requires thousands of dollars before any coverage takes effect.

The couple discovered that they were earning too much to qualify for financial aid from a health care provider or to subsidies when they transferred their insurance to a regime under the law. federal health insurance. She is responsible for full-time bank compliance. He is a full time store manager.

Tiffany wrote to KHN after seeing extremely high medical bills on TV. Dr. Merrit Quarum, Executive Director of WellRithms, health care consulting firm, reviewed the family's medical bills and the responses of its health care providers.

Quarum had questions about some of the charges listed in the detailed bills – $ 4 for a 600 mg ibuprofen tablet? $ 3,125 to place an epidural? – He concluded that the charges were lawful under the contract between the hospital and the insurer of Canos. Tiffany's only remedy was to establish the five payment plans that she navigates each month.

"I would like to be able to say that this was not the case, but that's the case," said Quarum.

Especially to pay off his health care debt, Robert has been playing several part-time concerts this year. He works as a substitute teacher and night watchman and delivers sandwiches for a chain of fast foods in Scottsdale, 25 miles away, where tips are available. better. He said that he sometimes worked up to 120 hours a week.

PHOTO: Robert Cano of San Tan Valley, Arizona, getting ready for work on October 20, 2018.Heidi De Marco / KHN

Robert Cano of San Tan Valley, Arizona, gets ready for work on October 20, 2018.

"I have no shame or embarrassment, even as old as me, to deliver sandwiches," he said, putting his polo for the retail chain before rushing for a quarter of Saturday morning.

"I know people, they prefer to buy food stamps and feel sorry for themselves. But I am a fighter. I will not give up. … If I can earn $ 400 more a week or $ 800 a month, she can get what she needs for the baby. "

Often coming home after midnight, he keeps the shampoo and shaving cream in his car and naps on the parking lots between jobs while relying on Red Bull and Aspirin to remain alert.

This means that many nights, when Tiffany picks up Brody from the daycare after her 90-minute ride, she takes care of most of the household chores at home.

"Sometimes I feel like a single mother because my husband is never there," she said.

She carefully monitors the family's medical expenses, trying to reconcile them with ordinary expenses that can not wait – like $ 500 for the brakes on her car this month.

At the rate they go, the bills will only be paid when Brody turns 3, said Tiffany. The Canos are getting older and they would like to have another baby before it's too late, but for the moment, that seems impossible.

For 2019, the couple decided to move to a different plan proposed by the regional bank where Tiffany works. The premium is higher – $ 650 per month – but the deductible is $ 1,500 with a co-insurance of only 10%.

"It's going to be a lot more by paycheck, which will hurt us," Tiffany said. "But after what has just happened, I want to make sure we are ready in case something happens."

"How to fix a health system that weighs so heavily on middle-class families, it exceeds it," she said.

"The only thing we can do is just keep working," said Tiffany. "I always wonder: how is everyone doing it?"

Kaiser Health News is a non-profit news service covering health issues. It is an independent editorial program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.