Why NEMT Is More Necessary Than Ever as Affordable Cars Disappear

People usually think transportation problems belong to one category of patient: the very poor.

Sometimes that’s true.

But there’s another group getting stranded now too, according to the New York Times: people who are not destitute, who may even be able to afford treatment itself, but who cannot afford the increasingly brutal cost of car ownership in America.

That matters because this is a car country. If your car fails, a lot of your life fails with it. And for patients, that does not just mean inconvenience. It can mean interrupted care.

The old cheap workhorse car has largely disappeared. The average new car now sells for about $50,000. Finding a new one for under $20,000 has become nearly impossible. Models that once stood for basic, affordable transportation have drifted steadily upward. Fourteen years ago, buyers had roughly a dozen new-car choices around $25,000 or less in today’s dollars. Now there are only four.

For a lot of Americans, the used-car market is not much of an escape hatch. It is often a gamble: high mileage, rising repair risk, and bills that can wreck a monthly budget overnight. Auto repair costs jumped 15% in the last year alone. The average trip to the mechanic now costs about $840. Around 40% of Americans likely could not cover that with cash they have on hand. When a repair bill and a car payment collide, people start making impossible choices. Some lose the car altogether. Repossessions have roughly doubled in the last five years and are projected to pass three million by the end of 2026.

Once that happens, the consequences spread fast.

Work becomes harder to reach. Grocery trips become more complicated. Child care becomes shakier. And medical care becomes easier to miss.

That last part is what interests me most.

On my national Non-Emergency Medical Transportation (NEMT) directory page, I write that transportation is one of the cruelest failures in our health care system: your insurance may cover the treatment, but not the trip required to get it. More than 5.8 million Americans skip or delay medical care each year because they do not have reliable transportation. That statistic can sound abstract until you connect it to the collapse of affordable mobility itself.

A transportation barrier is not always a dramatic emergency. Sometimes it is a person whose used SUV dies six months after purchase. Sometimes it is a repair bill they cannot absorb. Sometimes it is the slow humiliation of asking for ride after ride after ride. Sometimes it is a patient who can pay for the appointment, the infusion, the therapy session, or the prescription, but cannot solve the logistics of getting there and back.

That is one reason I built my national NEMT directory. I also built a Non-Emergency Medical Transportation (NEMT) for Georgia because I live in Atlanta.

The spark was a question I asked on Reddit: what do you do when you can afford treatment, but not the way there and back?

The answers were painful and familiar: missed infusions, canceled therapy, delayed cancer screenings, prescriptions left unpicked up, care abandoned because a round-trip ride cost too much. Once you hear enough of those stories, you stop seeing transportation as a side issue. You start seeing it for what it is: a hidden triage system.

And that system is more fragmented than most people realize.

If you are on Medicaid, transportation may be covered through Non-Emergency Medical Transportation. Some Medicare Advantage plans include ride benefits too. Veterans may qualify for VA transportation help. In some places there are county ride programs, disability services, volunteer driver networks, hospital social workers, paratransit options, or clinic-arranged Uber Health rides.

The problem is not always that help does not exist.

The problem is that it is buried.

It is spread across state agencies, private brokers, county programs, benefit handbooks, social workers, transit systems, and organizations that most patients have never heard of. People who are already sick, stressed, or overwhelmed are expected to navigate that maze on their own.

So this is not just a story about poverty.

It is also a story about fragility.

A person does not need to be poor to become medically stranded. Sometimes all it takes is a failing transmission, a repossession, an unaffordable repair, or the disappearance of the kind of cheap, reliable car that used to give working Americans some margin for error.

That shrinking margin is now showing up in health care.

It shows up when someone delays treatment because the ride home is too expensive. It shows up when a person misses a session not because they lacked motivation, but because mobility itself has become unaffordable. It shows up when the real barrier to care is not the doctor, the clinic, or the insurance card, but the distance between a front door and a parking lot.

That is why I built the directory.

Because if transportation can quietly destroy access to care, then finding a ride is not a side problem. It is part of treatment.

And for too many people, solving that problem now starts not with a doctor, but with a phone number.