BAY COUNTY, Fla. (WMBB) — Medical debt, often a pay or die situation, hangs over the heads of millions of Americans. And it continues to grow.

Greg Behan, Lighthouse CPA manager, said that the crushing cost of health insurance has become part of people’s monthly living expenses.

“It’s up to a half of some people’s take-home after tax,” Behan said. “$600 a month when your take-home pay isn’t even $600 a week, you factor in rent $1,200 a month or so, you’re looking at a pretty bad situation. And that’s just supporting yourself. That’s before the cars, before the kids, before the nanny, etc., etc.”

According to RIP Medical Debt, about 33% of Americans have some sort of medical debt.

USA Today cited an analysis by consumer finance company Credit Karma that found that nearly 20 million members in the U.S. have a total of $45 billion of medical debt in collections, or on average, $2,250 in collections per person.

A separate study from Salary Finance reported that 32% of working Americans have outstanding medical debt. Of these people, 54% said they defaulted on it and 23% said they were not confident that they would ever be able to pay it back.

Larry Perry, Perry and Young law firm managing partner, said medical debt collects by the tens of thousands as soon as people walk through a hospital door.

“Over the years we have seen the accumulation of this debt into the literally hundreds of thousands of dollars and each year we’re trying to negotiate and help people with millions of dollars of debt,” Perry said. “It’s a crushing blow to some families.”

Medical debt contributes to 66% of bankruptcies nationwide, according to RIP Medical Debt.

But Behan said that filing for bankruptcy is a viable solution for unpayable medical debt.

“Obviously, if it’s possible, you don’t want to go through bankruptcy. But medical debts, unlike student debt and some other debts, are what’s called forgivable debts,” Behan said. “They won’t be attached to you forever if you end up going through the process.”

Allison Sesso, RIP Medical Debt executive director, said that worries about medical debt can throw people into a cycle of deteriorating health and rising treatment costs.

“It undermines them,” Sesso said. “It puts them into poverty. It makes them not seek medical care because they’re too concerned about their bills. Or it makes them delay medical care, which frankly has a worsening effect not only on their condition but on the medical cost associated with helping that condition.”