InFocus featuring Eva Stahl (Undue Medical Debt)

From the 22 News Plus Studio, this is 22 News in Focus with Patrick Berry. Hello, everyone, and welcome to this edition of InFocus. I am your host, Patrick Berry. I'm going to give you some staggering information. First number is $19 trillion. That's how much debt Americans currently have. The average American has a little bit more than $63,000 in debt. And that can be anything from your car payments, your mortgage, your student loans, whatever it might be. But one of the most crippling elements of debt is becoming medical debt and healthcare debt. You know, your doctor's visits, your hospital stays, and whichever. So I'm excited today because we're having a conversation about medical debt. And joining me across the desk, the Vice President of Policy, Engagement, and Research from the organization called Undo Medical Debt is Dr. Eva Stahl. Ms. Stahl, thank you so very much for joining me today. I appreciate you coming in to talk about medical debt. I'm glad to be here. Is it as overwhelming as I seem to think it is, medical debt? It is. It is. So I would say that broadly, there's about $220 billion worth of medical debt across the country affecting over 100 million people. And those are really big numbers. But when you narrow it down, you can probably think of someone you know that's struggling with a medical bill or nervous about going to the doctor because the copay is too much. So these are issues that people are struggling with every day. Is medical debt? a new problem? Or has this medical debt been around as long as there's been doctors? Or has it changed in the last 5, 10, 20, 40, 50 years? I think it's changed in terms of how much individuals are exposed to the financial burden, right? So when I say that, I mean that our responsibility around out-of-pocket costs, our premiums, our deductibles, our co-pays, right? All of those have gone up. Which means that we are more financially exposed to pay those bills instead of having insurance cover them for us. So I think that people feel it more because they're more, they're exposed to more financial responsibility. So historically, you know, I'm trying to think maybe my parents, you know, when they were of working age, was insurance set up differently? Sure. So that they didn't. The fear of them going into debt over a hospital stay or a doctor's visit wasn't what it is for you and I today. Sure. So, I mean, there's so many factors. The cost of providing care has gone up. Think of technology, think of workforce, think of inflation, right? The complexity of people's health has increased and also can be managed by pharmaceuticals and additional care. So the total cost of providing that care has gone up. And then the design, what we call the benefit design of insurance plans, has changed dramatically over the past 10 or 20 years. We didn't have the Affordable Care Act when our parents were young, and we probably didn't have what we call high-deductible health plans, where people have very high deductibles before insurance even kicks in. And this is going to sound like an odd question, because I think most people understand the health care system in the United States. is extremely vastly different from other countries on earth. So is this a uniquely American thing, this healthcare debt? Broadly, yes. It is a sort of a unique American challenge, right? Carrying this type of medical debt. We operate a system that is reliant on both private markets as well as government payers. It's extraordinarily complex and has been shifting and changing constantly. It's very different than other systems around the country, around the world rather, that where government might play a bigger role in providing and deciding about care. So let's shift now to the organization you work for. It's an organization called Undue Medical Debt. Explain it to me. Sure. So we are a national nonprofit. And we want to end medical debt. We believe that nobody should be fearful about getting the care that they need to be healthy, right, to live their life in this country. And they shouldn't carry medical debt or choose between food and health, right? Medical debt is the result of, it's not a choice, right? It's a necessity. So with that premise, what we do is we buy large portfolios of medical debt from hospitals, from providers, from ambulance countries, ambulance companies, and we bundle it. We buy it at very low cost. We use charitable dollars to do that. And then we erase it for people. So you buy the debt and I'm trying to think of like. Brokers like Wall Street, you buy and sell debt and whatever. But this is kind of different. So the hospitals and doctors everywhere, they're always trying to track down people to get them to pay. So you guys come in on the backside, negotiate a deal. Somebody may owe $20,000 and you say to the doctor, hospital, whatever, we'll give you $15,000. Or something of that nature, and then you guys just pay it? Simplistically, yes. But think about it. Debt is a market. Okay. So debt is bought and sold all the time. Right. And so for healthcare providers, this is debt that just sits around. And so we offer, we say don't sell to a debt buyer, which may be something that they would do. Let us buy it. Debt sells for pennies on the dollar. We can offer a competitive price to a debt buyer. We use charitable dollars, and we want to make sure people return to care and feel the benefit and the weight lifted from them by getting rid of that medical bill. So when you buy that debt, do you then in turn take the burden from the health care provider that had that debt on their balance sheet? Do you then take over the responsibility of contacting the person who owes that money? Correct. Tune in. No, we do not collect debt. We only abolish it. So it's a gift. It's a charity. You sound like Santa Claus. I know. I know. It's a great job. I mean, we have donors all over the country that help raise funds to abolish debt. We have churches that do it. We have communities that do it, individuals. And it's because it's got a great return on investment. If you give me a dollar, I can help abolish $100 worth of medical debt for a patient. So, you know, people get really excited about doing something good in this moment and helping people return to care. People, the stories that we hear are incredible. I mean, people are overwhelmed by the gift that somebody would think of them and not know them, right? The paying it forward component. But also this can be when you remove the debt from someone, there are a range of benefits for them from the mental stress and the heartache of carrying this debt. People really do want to pay their bills. They just can't. These are really quite a weight for them, right? As well as improving their credit score or opening up different opportunities or encouraging them to return to getting care that they need. That is absolutely amazing. We are up on our first commercial break. When we come back, I can't speak. When we come back, we'll dive a little bit more into how you do what you do and then the more of the why. Stay with us, folks. We're back in just a minute. This is 22 News In Focus with Patrick Berry. This is 22 News In Focus with Patrick Berry. Welcome back, everyone, to this edition of In Focus. I'm your host, Patrick Berry. Sitting across the desk from me today is Eva Stahl. She is with an organization called Undue Medical Debt. Just before the break, we were talking about how the organization Undue Medical Debt basically relieves people of their debt, of their medical debt. Let's clarify that. One thing I did not ask you was, How long has this organization been in existence? So it's been a little bit over 10 years. We were actually started by two debt collectors that decided that... Gee, what if we actually don't collect on debt, but we actually relieve it for people and sort of started it as, you know, kind of a fun, charitable, altruistic opportunity. And it evolved into an organization and a mission. And I think it was around 2016, John Oliver, some people remember us from that. Our former name was RIP Medical Debt, and he featured us on their show. And because he thought it was crazy that he could go buy up debt with donated dollars. And he did it as a part of one of his shows, which really kind of launched the concept, I think, for people to think about, oh, we could actually do this for people and help them. It sounds weird that two debt collectors, who that's how they make money, is buying and selling all this debt, that they flipped it. They went from... Being. I'm trying to, you know, I don't know, you know. Doing a job to doing a service. Exactly. That's a great way to put it. Yeah. Kudos to these people who decided to do this. That's absolutely amazing. Yeah, and it's really, we've grown as an organization. This started out just with a handful of people. We're a little under 50 people now, and our current CEO then came on right before COVID, and she has a social service background. So how we've evolved really is to do the debt abolishment, which to be clear, I mean, debt abolishment is great, but alone, it's not enough to really help end medical debt, which is our mission. And so part of what I do is think about how do we match those debt abolishments and that debt relief with having conversations and pushing decision makers to make different decisions? How do we improve insurance? How do we stop, you know, what we call extraordinary debt collection practices, which are garnishing people's wages, you know, taking them to court, taking their things. How do we improve support for people that are using hospitals that have access to support and we call financial assistance. So is that... The other side of the business of what you do is try and change policies in addition to just helping Americans eliminate their debt. That's right. In the office, we call it both and. Okay. Yeah. So how do you do that? How are you changing policy? Because you're a national organization. You're not just here in Massachusetts or New England. Right. Do you start with your local legislatures, legislators, excuse me, or do you just go right to Capitol Hill? Start at the top. It's a little bit of where's the window of opportunity, right? So often, for example, in Massachusetts, there's a foundation, the Atrius Health Equity Foundation, that wanted to invest in a multi-prong approach, which is we want to relieve debt for people because we can do that in the moment. It's something they And they can feel it's tangible. It encourages them to return to care. And then they also support, and we do in partnership, two other organizations, Health Law Advocates and Healthcare for All Massachusetts. And then in partnership, they work to sort of tell the stories of the people that we relieve debt for. And through those stories, we gain access to conversations with decision makers. And I would say when you look at Massachusetts, we started that work in 2024, and Governor Healey took medical debt off credit reports. Oh, wow. So medical debt is no longer on credit reports for people in Massachusetts. That administrative action is being finalized, but that's a step in the right direction where we're treating medical debt differently because it's not a debt of choice. So however we can support people and think about shaping and improving the policies, whether it's the local or the state or the federal level, it's where we can have those conversations and let the people we help really lead the narrative. They tell the story of the harm of medical debt. So how do you do what you do? Early on, you talked about your organization approaches the healthcare providers that are holding the debt. Do you just buy that debt and just pay it off and then make the phone call to the patient and just say, hey, we wiped away, you know, $10, $1,000, $50,000? Sure. Like, so it works in multiple, we purchase debt from multiple places, as I mentioned before, but usually we talk to hospitals, we talk to large physician practices, we help them understand what we do. It does take some time. They're like, you do what? Right. Right. It's confusing. Um, but then once we launched that partnership, we take on those files from that hospital. We call them, we call them trade lines. So the patient unpaid bills, and we ensure that those individuals meet our criteria. So we help people that earn below at or below around 125, $130,000 a year, right. Or if their bills are more than 5% of their income. So we do that kind of data matching work. We have a big data engine. We called her debt engine. And then we send out letters to all those individuals to let them know they're free and clear of that debt because we purchased it. And so now we're the owners and we don't collect. So we send out all those letters. They're free and clear of that debt. And once they have that notification, then it's an invitation. So then also that's how we launch our engagement with patients to tell their stories. I'm a skeptic. Okay. If, if I'm in that patient's shoes and I get this letter in the mail that just says, Hey, you know, Patrick, right. You know, we just wiped away your $7,000 of medical debt. I'd be like, yeah, right. This is another scam. Right. Right. You know, so how do you. You must get that a lot. A lot of people must be like, yeah, nobody just comes in and wipes away my debt. Right. So that's where we work with people like you. We work with the media. We work with community-based organizations. We work even with our hospital providers and our physician partners to remind people that this is real. You should open this letter. So there is a lot of visibility and trust-building work that needs to happen behind the scenes so that people believe the letter. And when they do, they're shocked. You're absolutely right. I think we had someone in Taunton that we just did like $576 for, but he had been battling colon cancer over multiple years. And you get these tearful stories about just somebody cared. Thank you. That is absolutely amazing. But there's still more to come. We're up on our second commercial break, folks. Stay with us. We're back in just a minute. This is 22 News in Focus with Patrick Berry. This is 22 News In Focus with Patrick Berry. Welcome back, everyone, to this edition of In Focus. I'm your host, Patrick Berry. Today, we are talking about medical debt and an organization that is helping citizens across the Commonwealth and across the country eliminate their medical debt and get their finances back on track. I want to read you a quick little stat. I showed you on screen earlier that there's been, I think it's $53 billion nationally. That has been a medical debt that's been relieved to more than more than 32 million people. But here in Massachusetts, it is it's close to four hundred and fifty five million dollars for three hundred and sixty four thousand people right here in Massachusetts in about a decade, which is. Mind-boggling. So I'm excited today because joining me across the desk from the organization called Undue Medical Debt is Dr. Eva Stahl. She's the Vice President of Policy Engagement and Research, as you can see right there on your screen. So Eva, thank you so very much for joining me. I love the altruistic way that this organization came about. Are there different segments of the population through your research or whether it's just in their debt relief that That you find. Have more debt than others like. Older people, you know, I think older people, you have just have more debt or more medical problems. Is it the unemployed? Is it ethnic groups? I mean, have you been able to like pare it down to? Sort of put a portrait together of who has the most debt? Sure. So, I mean, I think the broad statement is medical debt affects all of us, right? But it does disproportionately affect some people more than others. Really? People who are uninsured, people who are lower income, and black and brown populations across the country, so that have less wealth. from long-standing barriers to accessing wealth, right? So those are the populations that are most affected, but it kind of runs the gamut. And you're not particularly safe from medical debt just because maybe you're a middle-class family. And I think increasingly we're seeing that because it's what we talked about before. It's that financial exposure. So even though you have insurance, we're seeing more and more people with insurance that are carrying medical debt. So think about our own state. Our own state has a very high insurance rate, one of the best in the country, but still one in eight people in our state carry medical debt. So despite insurance, they're still carrying medical debt. And that speaks to a much larger problem, right, around the system and how broken the health care system is for all of us. So as part of the policy side of it, are you helping to fix the system? Or help fix the debt side of the system. So it's a little bit of both, right? So our goals sort of range from let's help people right now because they feel this pain. That's what the relief is about. But then let's also think upstream, where is this debt coming from and where is the system broken? So it could be as granular as helping hospitals review the financial assistance that they give. People might not know that nonprofit hospitals are required by federal law to offer some financial assistance to patients that struggle to afford their bills. And people might not think that that's for them, but it very well could be. So sometimes you can get financial assistance even if you earn $100,000 a year. So it's always important to ask. You know, it's interesting. I did not realize this. Until maybe a decade ago, our biggest healthcare provider out here is Baystate Health Systems. They're a nonprofit. I did not know that. I don't know why I didn't know that, but are most hospitals and hospitals and healthcare systems nonprofit or are they- It's about an even split, but it varies across the country. So more for-profit systems tend to be in the Southern part of the country. More nonprofit systems are sort of in our area, but nonprofit systems- Nonprofit systems are required to offer financial assistance. So I would say for listeners, that's something always and really it's important to remember to always ask and not to think, oh, this isn't for me, right? Because I have insurance or I earn a good income. And it's really about the fact that the insurance system is not serving us. So who do you ask that question to? Obviously, when you're not in the exam room, you have to talk to billing? Sure. On every bill, there is a notice either on the front or the back that gives you instructions about how to contact a hospital about their financial assistance policy. You can also just go on their website and look for it. And then you can look to see who qualifies and see if you fit in that bucket. But there are also all kinds of supports in the state that can support you in navigating that process, advocates and such. Is this something that if I, if I'm, if you were watching this conversation right now, and I'm looking at my medical debt lining up and I'm like, I need help. Do we call you or do you, do you kind of work in the background? Like you're already, you may already be aware of this particular person's debt. Um, so you, you, you don't feel calls to the help me calls. We, because of what we, we do, what we do, as I mentioned before, is we buy in bulk, which means that there's no individual application. So it means that a group of donors come together and they say, we want to abolish debt in this particular community. And then they come to us and say, do you have debt or could you get debt for us to abolish in that community? So then we'll search around and try to hunt and use those donor dollars to match with the debt. It's not something that people can individually apply for. That is kind of cool. So on an individual community level, I live in Westfield. So, if... A group of people or somebody affluent in Westfield said, contacted you and said, this is my situation. Maybe I've come into money. Maybe I make a lot of money, whatever it might be, or I've got a group of people we want to donate half a million dollars to help Westfield residents medical debt. You'll work with that. Yes. Interesting. Right. And it depends on the availability of debt, right? Sometimes we merge counties together. Sometimes we say, let's look at half the state. It depends on how much debt that we have access to. This is mind-boggling to me because maybe I've just jaded in my nearly 60 years on this planet that you don't see this kind of generosity, you know, of people wiping away somebody else's debt. Usually it's like, hey, you got a friend for yourself. You incurred it. You fix it. So you must have great responses when you have conversations with people across the country. I know you work here in New England, but, you know, your partners across the country, when you have that interaction with the person holding that owes the debt, it must just. It's remarkable. And I think what's remarkable to me is I mentioned helping someone in Massachusetts with a bill that's $574, right? And that kind of response is not that much different from the individual with cancer that had brain cancer in Ohio. We just helped pay off a bill that's $30,000. So it speaks to, I think, that people have different emotional responses to carrying this debt, but it is a weight. It is a weight. And so I think that it helps people sleep better. And more importantly, we want them to return to get the care that they need. That is fantastic. We're down to about less than a minute left, but is there anything big that you guys are working on down the road that you can quickly share? You know, I think what we're really concerned about right now is that the people are losing their coverage or their coverage is not helping them as much as it should. And so increasingly, we're working with states to think about not just abolishing debt, but also trying to wrap more coverage around people and protect them from harm. So we're doing that nationally. Fantastic. Dr. Iversall, I can't thank you enough for joining me today. What a wonderful organization. Kudos to you and all of your co-workers for what you do for the American people. We are a people-powered organization. organization. So we are excited to do the work we do. Wonderful chatting with you. Thanks. Thanks. This is 22 News in Focus with Patrick Berry.