In 2018, postpartum eclampsia kept Jessica McIntyre in the hospital for a week after the birth of her son. McIntyre, a school social worker in Beaufort County, had health insurance, but her plan required her to pay 20% of the cost of her stay. In total, she owed thousands of dollars in medical debt to Vidant Medical Center (now ECU Health).
However, as a new mom, those hospital bills were the last thing on her mind, McIntyre told Carolina Public Press. Eventually, she fell behind on her monthly payments and stopped altogether. That was, until she contacted the hospital some time later to ask about making another payment.
Vidant told McIntyre that it had deemed her debt unrecoverable and sold it to a collections agency. Soon after, her credit score took a plunge.
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“With me having been sick and us not making a lot of money, it was a struggle,” McIntyre said about living with medical debt.
Last year, McIntyre received a curious letter in the mail. It was from a nonprofit organization called Undue Medical Debt, which claimed to have erased all $3,200 of her remaining debt. At first, she was skeptical.
“I was like, ‘this stuff doesn’t happen to me,’” McIntyre said. “This can’t be real.”
But it was very real. McIntyre’s debt had been wiped clean and her credit score rebounded. Her 8-year-old son is happy and healthy, too, she added.
Debt relief at a national scale
Undue, the nonprofit organization which relieved McIntyre of her debt, has bought and erased more than $40 billion of medical debt across the country.
It does so by purchasing large portfolios of unpaid debts for pennies on the dollar — the types of distressed assets that commonly end up in the hands of collections agencies, which attempt to recover the debt at a profit.
People who have their debt erased by Undue don’t need to apply. They are simply notified that they no longer owe that money once Undue has purchased and paid off the debt.
Eva Stahl, who leads policy, engagement and research at Undue, said the impacts of medical debt relief range from the emotional to the pragmatic.
For some, it provides a path toward previously inaccessible lines of credit, such as a home or auto loan. For others, it simply means being able to go out to dinner or buy a Christmas gift free from anxiety or guilt over their medical bills.
“We hear from (recipients) all the time about how, in small and big ways, that really helped them move their life forward and open windows of opportunities,” Stahl said.
“And, importantly, it gives them a sense of hope and relief.”
Medical debt and affordability
Data on medical debt in the United States is limited but suggests a large-scale, pervasive problem.
A 2024 KFF report estimated that Americans were carrying at least $220 billion in debt. That same analysis found that 13.4% of adults in North Carolina reported having medical debt between 2019 and 2021. That was the third-highest percentage among all U.S. states, behind only South Dakota and Mississippi.
Still, those numbers are likely an undercount, Stahl said. The data in the KFF report doesn’t include people incurring credit card debt to pay their medical bills or borrowing from their friends and family.
“Those debts, even though they’re medical debts, tend to be hidden,” Stahl said, “so we know that the scale of the problem is much bigger than that.”
The problem of medical debt could worsen nationwide as forthcoming changes to Medicaid and rising premiums drive up the number of people without health insurance.
But even those who have insurance and are gainfully employed are struggling to keep up with the rising costs of healthcare.
Nearly half (46%) of working-age adults said their families faced difficulties affording healthcare in 2025, according to recent research from the Robert Wood Johnson Foundation.
Although the problem was most prevalent among uninsured adults, it wasn’t much better for those with Medicaid or ACA marketplace plans. Even 39% of respondents with employer-sponsored insurance struggled to pay for their families’ health costs.
Katherine Hempstead, a policy advisor at RWJF, said there are widespread misconceptions about medical debt and who incurs it.
“There’s a tendency to think about medical debt as something that happens to people who are uninsured,” Hempstead said.
“A lot of times, it’s because people are not able to pay for something that’s their responsibility because of their deductible.”
An unexpected visit to the doctor or emergency room could result in a bill that’s unpayable for someone living paycheck-to-paycheck. A debt relief program can alleviate the resulting financial pain, but it’s not a fix for a broken system.
“It’s very much like treating a symptom,” Hempstead said.
North Carolina’s unique approach
Stahl readily acknowledged that debt relief is a “Band-Aid,” but Undue’s partnership with North Carolina’s Department of Health and Human Services sought to accomplish more than that.
Launched in 2024, the program required participating hospitals to relieve all medical debt for individuals who were enrolled in Medicaid or fell under certain income thresholds. Hospitals also agreed to provide discounts to low-income patients and to create a system to automatically screen and enroll them in financial assistance.
Another part of the deal barred hospitals from selling low-income patients’ unpaid debts to collection agencies.
Stahl said these stipulations not only allowed Undue to eliminate $6.5 billion of medical debt in North Carolina, but it also created guardrails meant to protect patients from incurring future debt.
The statewide program erased certain debt owed to hospitals, but plenty of medical debt is held elsewhere, like with ambulance services or physicians’ offices. That’s where smaller, locally focused relief programs come into play.
For example, Chapel in the Pines Presbyterian Church in Chatham County recently organized a campaign with Undue which so far has raised more than $22,000 for debt relief.
That was enough to retire $1.8 million of medical debt in Chatham with some left over, according to Jeff Olson, who leads service initiatives for Chapel in the Pines.
After the campaign quickly surpassed its initial fundraising goal, an anonymous donor further pledged to do a “three-for-one” match of every dollar raised. Together, that’s enough to erase up to $7 million of debt, Olson said.
Any leftover money that doesn’t go to Chatham County residents will help pay off the worst cases of medical debt from across the state. Olson said the campaign’s success reflects how people resonated with the issue.
“It’s personal for people in the church,” he said, “because we all know somebody who’s had an unexpected medical expense affect them.”
“It may not have thrown some of these folks into bankruptcy or cast them out of their homes, but everybody can identify with the fact that unexpected things happen and can drag people’s financial situations down.”
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