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Melissa Harris-Perry: Welcome to The Takeaway. I'm Melissa Harris-Perry.

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Melissa Harris-Perry: There are a lot of things I love about Winston-Salem, North Carolina. That's the midsize city where I live, work, and raise my family. We've got beautiful parks, a thriving arts community, and we're the home of Krispy Kreme Doughnuts. That sweet treat beloved unreservedly by basketball legend Charles Barkley.

Charles Barkley: When you ride by Krispy Kreme and you see that hot doughnut, you got to stop.

Melissa Harris-Perry: I was especially proud of our town in March when the actions of a local church got national attention for all the right reasons. The congregation at Trinity Moravian Church partnered with an organization called RIP Medical Debt to cancel 3,000 local residents' medical debt to the tune of $3.3 million. The congregation bought that debt for just over $15,000. Reverend John Jackman, the Pastor of Trinity Moravian Church, held a symbolic "debt-burning" ceremony to mark the occasion with confetti and hymns.

Reverend John Jackman: The fact that we could buy that much for $15,000 is ridiculous, and silly and crazy, but it tells us how broken the system is.

Melissa Harris-Perry: Back in 2016, John Oliver, the comedian and host of the HBO series Last Week Tonight purchased $15 million in medical debt from 9,000 people, and he bought it for less than half a cent on a dollar.

John Oliver: Are you ready to do this?

Audience: Yes.

John Oliver: You are about to watch me give away $15 million.

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John Oliver: It's done. It is done.

Melissa Harris-Perry: Some state officials like Governor Ned Lamont of Connecticut are currently proposing using Federal Pandemic Aid to cancel billions of dollars in medical debt. Yes, these are happy stories of people working together to help their community members, neighbors, even strangers, but this is also a crisis. Millions of Americans carry the burden of outstanding medical debt. An investigation in 2022 by Kaiser Health News and The Kaiser Family Foundation found that 100 million people across the nation have some type of healthcare debt. Kaiser estimated that, in 2019, the total medical debt in the country was around $195 billion.

With me now is Emily Stewart, Executive Director at Community Catalyst, a national nonprofit focused on health justice. Emily, welcome to The Takeaway.

Emily Stewart: Thank you for having me. I'm glad to be here.

Melissa Harris-Perry: All right. We heard a bunch of the numbers, maybe some of the media attention here, but help us understand the human experience of this. How does medical debt affect everyday folk?

Emily Stewart: I think the most important thing to note about medical debt in the United States is that it's a widespread problem, and it's a problem that has a deep and abiding impact on people's everyday lives. A huge proportion of people with medical debt have exhausted their life savings, have dipped into their retirement accounts. People have taken out-- refinanced their homes as a result of the medical debt. They are making decisions between pursuing continuous healthcare or paying their rent or getting a car or paying their car payment so that they can go to work. It's having a real significant impact on people's overall lives and well-being. It's not just affecting their healthcare, it's affecting their ability to get by day-to-day.

Melissa Harris-Perry: Also affects their credit, right? I know that earlier this year, three major credit bureaus announced medical collections with balances of less than $500 would no longer appear on credit reports, but more than that, that is still going to impact people's ability to get mortgages, home loans, all those kinds of things.

Emily Stewart: Absolutely. Those were important decisions by the credit agencies, but as you know, it didn't cover all of the medical debt that people are carrying. Certainly, people are facing issues where they're not able to purchase homes or get a car in order to live their lives and get to work. It's having a real impact. It's no wonder to me that there are many great organizations out there trying to find a way to give people the immediate relief that they need.

Notably, it's not just issues of getting to work or putting a roof over your head, or being able to buy a home. As everybody out there with medical debt knows, it also causes extreme anxiety and stress related to all of those things. When organizations buy medical debt, and then send those wonderful notices to people, letting them know that their debt is forgiven, it's a huge wave of relief for people. They are incredibly grateful and they should be. I think as many of the organizations who buy medical debt would agree with, it doesn't address the root cause. Relieving medical debt for people today does nothing for the people who are newly incurring medical debt tomorrow.

Melissa Harris-Perry: Why is it that if I owe $100,000 as the patient, you're going to expect me to pay $100,000, but if John Oliver decides to pay it off for me, he can pay it off for $100. What in the world is going on here?

Emily Stewart: Medical debt is a uniquely American problem. As anybody who has ever accessed healthcare in the US can say, and particularly people who have ended up in an emergency room or needed a mammogram or an MRI, healthcare in the United States is extremely expensive. More than that, oftentimes, we don't know what it's costing us until we get that dreaded bill in the mail. Just to put some numbers behind that reality, the average bypass surgery cost $70,000 in the United States as compared to $24,000 in the UK. Your average C-section in the United States cost $15,000 as compared to $7,000 in the UK.

What's happening is that people are being charged way more than what they should, and then getting bills as a result that are astronomical, and of course, they can't pay it. Also then collections has to go after people. I think it's well understood that this debt is never going to be paid off because who can afford $100,000 hospital bill? Very few people in this country. The reason why it gets sold at such a discounted rate is essentially an acknowledgment that it shouldn't have been that much, to begin with.

Melissa Harris-Perry: I hear you saying that it's uniquely American, is it also particularly predatory?

Emily Stewart: Absolutely. This is one of the most serious and harmful issues of healthcare in the United States today. One of the things that I think is important to note about this is the disproportionate impact that those predatory collection practices have on people of color in this country. There have been reports showing that, for instance, when you look at the collection practices of some of these agencies, that they are more likely, within the same zip code, to repeatedly harass a person of color as compared to a white person. It is both predatory and when you dig in deeper to these practices, it is also discriminatory.

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Melissa Harris-Perry: All right, we're taking a quick break, and we'll be back with more on the issue of medical debt right after this. We're back with Emily Stewart, Executive Director of Community Catalyst, talking about the burden of medical debt. If you have medical debt, and you don't know John Oliver, or you don't go to Trinity Moravian Church here in the wonderful town of Winston-Salem, North Carolina, what can you do?

Emily Stewart: The first thing that you can do is make sure that you are calling your local hospital system and pressing them, number one, on the actual bill, getting that bill itemized because a lot of times what you'll find on those bills is, for instance, an $80 Advil pill, which is obviously a great illustration of the ways in which that we are being overcharged for our healthcare. Another thing that you can do is inquire about financial assistance policies at those hospitals.

For a lot of people, they are being charged bills that they actually don't owe because they qualify under the law for financial assistance. A lot of hospitals are just not doing their job in terms of making sure that people have access to financial assistance. Those are two important things that you can do. There are organizations out there such as an organization called Dollar For that helps people access financial assistance programs in their community. There's a lot of community-based organizations that do the same to make sure that people are getting the assistance that, not only they need, but they are eligible for.

This is one of the reasons why at Community Catalyst, we have been working with a whole cross-section of organizations at the local, state, and national level to push the Biden administration to put more protections in place for people. Protections, for instance, that make sure that hospitals are giving people access to the financial assistance programs that they should have access to, making sure that those financial assistance policies make sense in terms of giving people who have the lowest of incomes the support that they need.

This is especially important because a lot of the hospitals who are overcharging people and sending people into collection that they shouldn't have are actually non-profit hospitals. Because they're non-profit, they're supposed to in exchange for that non-profit tax-free status that is worth billions of dollars, they're supposed to be giving back to the communities that they're a part of. One of the things that we're doing is calling on the IRS to put stronger protections in place to ensure that those hospitals hold up their end of that bargain.

Melissa Harris-Perry: At the beginning of a medical journey, are there any things that you can do? Are there folks who can help you to navigate this system?

Emily Stewart: Yes. There are in many, many states consumer assistance programs. These are often non-profit organizations that help people with billing and collections. That's one place for people to go to look for consumer assistance programs in their state. Always challenge your bill, always look at the itemized bill, and inquire. A lot of people report that when they ask for the bill, suddenly, the overall amount they owed goes down. I think, again, an acknowledgment of how people are being overcharged.

I also don't want to lose sight of the fact that for so many people, they are confronting a health crisis. They should be, in that moment, only thinking about their health, their physical and their mental well-being. It's so unfair that people are being forced to think about things like my medical bill when I should just be focused on making sure that I'm getting well. One of our storytellers at Community Catalyst named Kailyn tells this in really a beautiful way she needed surgery, and she knew she had to get it. It was really essential to her health. Nearing the surgery, she shared that all she had was Google to try to give her a sense of what it was going to cost.

She had this feeling of dread after the surgery of getting that bill. It was over $20,000. When she tells the story, she wells up in tears, and they're not tears of sadness, they are tears of anger because, as she puts it, it doesn't have to be this way in the United States. Another thing that people can do is join the movement to push the Biden administration and local policymakers to change the laws because it really doesn't have to be this way.

Melissa Harris-Perry: Emily Stewart is the Executive Director of Community Catalyst, a national non-profit focused on health justice. Thanks so much for taking the time with us on The Takeaway, Emily.

Emily Stewart: Thank you for having me. I really appreciate it.

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