Federal government employees and contracted employees currently affected by the longest-running government shutdown in U.S. history are putting off doctor’s appointments, asking for help through online fundraisers and considering new career paths as medical bills mount.

Corey Myllenbeck, a hydrologic technician for the U.S. Geological Survey who lives in the Tampa area, has an 8-month-old daughter who has had three surgeries since she was born to address a number of medical issues — one for her heart, one to attach her esophagus to her stomach and another to insert a feeding tube. She had the heart surgery when she was 6 months old, and the bills for that started coming shortly before the shutdown, which began on Dec. 22, took effect. He and his wife owe about $4,800. On a GoFundMe page set up to raise money for his daughter, Myllenbeck asked for $1,500, which will cover the minimum payment for the surgery. So far, the fundraiser has earned a little more than $100.

The tension of being furloughed with a sick child is taking a physical toll on the 30-year-old father.

“My hair’s falling out,” Myllenbeck says. “I’ve lost a lot of weight.”

On top of the surgery are the costs associated with just seeing a doctor. While Myllenbeck has health insurance through his employer, the new year has reset his insurance deductibles. Now, he’s required to pay out of pocket until he hits a deductible of $10,000 — money he most definitely does not have, especially now that he hasn’t been bringing in a paycheck.

“We are more or less putting those appointments off,” Myllenbeck says. He’s been applying for new jobs, and is open to leaving his current position if something opens up. “I can’t go through another shutdown. No matter what, I’m looking for a new job. If it goes longer than mid-Feburary, I can’t. There’s just no way.”

Although President Donald Trump has signed a bill that will guarantee back pay for furloughed federal workers, roughly 800,000 federal employees and potentially millions of contractors affected by the partial government shutdown are set to miss their second paycheck. That lack of income means there is no money for medical bills in the moment, and these government workers are quickly joining the ranks of Americans for whom healthcare is a significant financial burden. One in six Americans carry medical debt on their credit reports, totaling $81 billion in bills owed, according to a 2018 Health Affairs study. In a country where health care spending continues to increase, more than a quarter of Americans between the ages of 18 and 64 reported having trouble paying their medical bills, according to a 2016 survey by the Kaiser Family Foundation and the New York Times. Among those surveyed, about 20% of people who had problems making medical bills had previously declared personal bankruptcy. Financial constraints also push many Americans to delay medical care. According to an Earnin poll in 2018, 54% of Americans delayed getting treatment because they could not afford it.

Putting off appointments has now become habitual for Michelle Maples, whose wife is a Department of Homeland Security employee working without pay. At the start of the shutdown, Maples told TIME she was recovering from heart surgery and could not work.

Now, Maples is waiting for the shutdown to end to go ahead with surgery for lung cancer, along with blood and fluid infusions.

“My medical care is on hold,” she says. “The surgery to remove the lung cancer is on hold.”

Also on pause are the blood and fluid infusions Maples normally receives three times a week. “The doctors and nurses are calling to ask why I’m not getting them. I don’t have the copay,” she says. “It’s $40 each time. I cancelled the doctors’ appointments.”

Growing medical bills for her past procedures will remain unpaid, she says. They were the first payments Maples and her wife decided to defer, as they found it was easier to delay medical bills than it was to put off other monthly payments, like rent.

For other government employees, deferring too many medical bills raises the fear of landing in debt. One Department of Justice employee currently working without pay, who declined to share her name, got her last paycheck about three weeks ago, which enabled her to pay off several bills. But in 2018, she says she underwent four surgeries.

At the moment, she’s on a monthly payment plan that would take care of the bills associated with all the surgeries in a timely manner. But with no salary, she’s not able to make those payments in full, and is currently sticking to only putting the minimum amount down, she says. A family history of landing in medical debt has her frightened about how paying the bills in full will affect her in the long term.

“I’m trying to not get into too much debt,” she says. “I don’t want to go in that hole because it messes up everything. I’m trying my best to make my payments. Right now, it’s minimum payments for everything, minus just getting the mortgage paid.”

Because the DOJ employee is back at work with no pay, she does not have time to look for other jobs that would provide a paycheck. Other employees who are not working under the shutdown say they have no choice but to seek out permanent opportunities elsewhere or part-time work to keep them afloat while they wait. For Karime Moasser, a furloughed remote access mobility engineer with the U.S. Securities and Exchange Commission, a placeholder job may be the only way he can keep up with buying insulin packs for his 16-year-old granddaughter, Jordan.

Moasser says Jordan was diagnosed with Type 1 diabetes last March. His family is still paying the medical bills from that hospital stay, which they’ve deferred during the shutdown. But the most pertinent payment for the family are the insulin packs for Jordan, which typically last for a month and cost about $450.

For the moment, they are OK. A GoFundMe campaign set up by Moasser’s wife, Betty Kitts Moasser, brought in about $300 to help defray the insulin costs. Added to a $100 Christmas gift from his stepson, Moasser was able to buy an insulin pack for Jordan on Jan. 15 that should take her through Feb. 15. He plans to cobble together what he can — through donations, a different job, paychecks coming out of his paid leave and help from his church — to keep buying the medicine if the shutdown continues into mid-February.

“It’s scary, especially with a person with a medical need,” Moasser says about the shutdown. “An ordinary family that doesn’t have that, you don’t have to worry about medical stuff. The stress levels are very high.”

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Write to Mahita Gajanan at mahita.gajanan@time.com.