What is the CURE for medical debt? | RIPMedicalDebt.org

On this episode, Allison Sesso, the CEO & President of RIP Medical Debt talks about their unique approach to alleviating medical debt of Americans. By leveraging medical debt markets and partnering with hospitals, RIP Medical Debt is able to achieve 100X leverage on every dollar donated to wipe out debt at scale.

Resource: Medical debt and health impact – Jama Network.

How big is the problem?

The SIPP survey suggests people in the United States owe at least $195 billion in medical debt. Approximately 16 million people (6% of adults) in the U.S. owe over $1,000 in medical debt and 3 million people (1% of adults) owe medical debt of more than $10,000.

RIP Medical Debt by the numbers:

  • $7,091,262,274 in medical debt relieved so far
  • 3,987,191 individuals and families helped
  • 2021 Annual Report

  The debt relief we provide reduces mental and financial distress for millions of people. Here’s how we got started.  

RIP Medical Debt was founded in 2014 by two former debt collections executives. Over the course of decades in the debt-buying industry they met with thousands of Americans saddled with unpaid and un-payable medical debt and realized they were uniquely qualified to help those in need.

They imagined a new way to relieve medical debt: by using donations to buy large bundles of debt that is erased with no tax consequences to donors or recipients.

From this idea RIP Medical Debt was born, a New York based 501(C)(3). The results have been spectacular—billions in medical debt eradicated so far, providing financial relief for millions of individuals and families.

About Allison Sesso

President / CEO

Allison Sesso became the President / CEO of RIP Medical Debt in January of 2020. RIP Medical Debt was established for the sole purpose of reducing the medical debt burdens of low-income individuals with limited capacity to pay their medical bills by leveraging donations from people across the country. They have abolished $7,091,262,274 to date for over 3,987,191 people.

Under Allison’s leadership and in response to the COVID-19 pandemic, RIP Medical Debt launched the “Helping COVID Heroes Fund” focused on relieving the medical debts of healthcare workers and emergency responders like nurses, home health aids, pharmacists, social workers, hospital technicians, the National Guard and others working on the front lines of the pandemic. It also benefits service workers and others facing financial hardship resulting from the COVID induced economic downturn. Through this effort RIP has abolished over $100 million in medical debt.

Prior to joining RIP Medical Debt, Allison served as the Executive Director of the Human Services Council of New York (HSC), an association of 170 nonprofits delivering 90% of human services in New York City.

Under her leadership HSC pioneered the development of nationally recognized tools designed to illuminate risks associated with government contracts, including an RFP rater and government agency grading system. She led negotiations with New York City and State government on behalf of the sector and successfully pushed for over $500 million in investments to address the nonprofit fiscal crisis.

During her tenure at HSC, Allison also led a commission of experts focused on socialdeterminants of health and value-based-payment structures and published the report,Integrating Health and Human Services: a Blueprint for Partnership and Action, that examines the challenges of operationalizing relationships between health and human services providers, offering several recommendations. She also served on the New York State Department of Health’s Social Determinants and Community Based Organizations (CBO) Subcommittee helping to formulate recommendations around the integration of CBOs into Medicaid managed care.

Allison’s work on behalf of the human services sector led City & State to recognize her as a top nonprofit leader in 2018 and 2019, one of the 25 most influential leaders in Manhattan in 2017, and one of New York City’s 100 “Most Responsible” in 2016. She recently received the 100 “Most Responsible” award for the second time for her efforts at RIP Medical Debt.

Allison also serves as the Vice Chair of the nonprofit “Right to Be,” formerly Hollaback!, a global movement working to end harassment through bystander intervention training and storytelling. 

Rough Transcript

[00:00:00] George Weiner: This week we have an awesome guest who I, I think I promised I would track down somebody from R IP medical Debt because they kept showing up in the news and innovative approach to dealing with, uh, a tremendous. Problem in America around, uh, I’d say healthcare and debt, and none other than Allison Seso, the CEO and President is joining us.

[00:00:52] This means a lot. Thank you, Allison, for, for taking the time today.

[00:00:55] Allison Sesso: Thanks for hunting us down and finding us. We love talking about our work and, and the issue of, of medical debt, so I appreciate every opportu. . Well,

[00:01:05] George Weiner: let’s drive right into it on the front page of r i p medical debt.org. On the front page of the.org site, I see every $100 donated relieves 10,000 in medical debt.

[00:01:19] First off. That gets my attention. What a perfect way to start a conversation. But how does that work exactly?

[00:01:29] Allison Sesso: Yeah. We are a, uh, a unique model and we take advantage of the for profit, uh, debt market, uh, and use it for a mission driven purpose, which is really exciting and, and I think unique. So we do get an incredible return on investment and it’s because there is a market for debt buying, uh, that is, has been established, and That is because, uh, there is a for profit industry that we take advantage of, uh, and they are looking to make money off of the issue of debt. We, on the other hand, are trying to relieve debt, so we take donations from individuals, we take ’em to the debt market, and we buy large portfolios at.

[00:02:10] So, the individuals that are in those portfolios tend to be financially burdened. They are poor, they are, um, in fact, to qualify for our program, you have to be 400% of poverty or below, or the debt birth burden has to be significant compared to your overall income. So it has to be 5% or more of your income.

[00:02:28] We do an analysis of the debt portfolio and we buy all of the accounts that qualify and then we purchase them based on. For profit rates. And so we’re competitive with that market, but because the for profit folks are trying to make money, they have to really depress the prices and they have to have a really deep discount in order to make sure that they’re making their money back.

[00:02:49] And so we don’t have to make our money back. And so we’re able to take, you know, $1 and turn it into a hundred dollars of medical debt relief. And as you pointed out, you can ex expand that. So, you know, $500 gets rid of 50. Um, $50,000 of medical debt. And so that’s how we’re able to, provide massive debt relief to the tune of $7 billion to date and grow.

[00:03:12] George Weiner: Yeah, I think there’s a lot to unpack there. Maybe I, um, wanna poke a little bit more into like, making sure I actually get this. So let’s say I’m, you know, a family living below the, the poverty line meeting your, your standards. There’s an, uh, unexpected accident and injury. I then am in the hospital for a few days and suddenly I’m walking around with 45 grand in debt overnight.

[00:03:34] And because of the way our systems work, this is now. A debt I owe to creditors. Now that debt, as I understand, can first go from the hospital to maybe a secondary buyer, right? There’s like all these markets of like, Oh, I’ll grab that one, I’ll grab that one. And then it seems like they’re, there’s a discount on it cuz it’s not dollar for dollar you’re getting.

[00:03:56] A hundred x leverage on it. So there’s some discounting of my debt with that 45,000. Can you just walk me through like the individual, like I am sitting here, I’ve got 45 grand in debt. I can run off to a sort of like Go fund me type site and be like, Please, please, please, please pay this money. I have a story.

[00:04:19] I have a narrative. And unfortunately I have to compete with other stories around me. What is the alternative path that my 45 K debt takes in your world?

[00:04:29] Allison Sesso: Yeah, so your, I could buy your debt probably for $45. That’s the diff . That’s, that’s the difference. It’s pretty, you know, I’m sorry, I don’t understand.

[00:04:39] I’m sorry For $450. Sorry. Yeah. Okay. Um, Um, Um, so yeah, I could buy your debt for $450 and that is because I’m not just buying your. I am buying the entire provider’s portfolio of bad debt, so it’s more attractive of an option. So basically I’m, I’m a hospital or another healthcare provider. I am serving people who can’t afford to pay.

[00:05:02] They are poor as you just described. And, and by the way, just to be clear, it’s 400% of poverty or below, so it’s not just under poverty, but four times the amount of poverty. So it’s people that are poor but but not necessarily. Oh, so

[00:05:16] George Weiner: four x the whatever, $45,000 Exactly. Anywhere you are. Okay. So

[00:05:21] Allison Sesso: that, that matter.

[00:05:22] So we’re really like helping people that. Really trying to make ends meet but aren’t actually, uh, technically in poverty based on the federal definition. So you, you know, you, there’s, there’s, you have to, In order for our model to work, we’re buying the entire portfolio of many of those individuals who have the 45,000 or a thousand dollars or $2,000 of debt.

[00:05:43] Uh, that all together. So it’s source driven. So basically I’m going to the hospital or other healthcare provider and I’m saying, Give me the debts. Give me your entire portfolio of debt that you have tried to collect and you have been unable to collect and mostly been able, unable to collect because the individuals are, uh, financially stressed out and can’t.

[00:06:03] Afford to pay this bill. I will look at that portfolio and I will assess what can I pay for that? And this is if I’m a for-profit, not F R P medical debt, but as a for-profit debt buyer, I will say, Okay, I’m gonna pay this. I’m gonna pay you an X amount of dollars for the entire portfolio for thousands of people’s bads.

[00:06:23] On the bet that at least I can squeeze enough out of that. Mm-hmm. , you get to make up for the investment that I’ve made plus, Right. Cuz I’m looking for a profit and I squeeze those individuals either by calling them, by putting it on their credit, you know, and giving them bad credit by sometimes suing them and taking, putting leans out on their.

[00:06:43] Um, on their cars, on their vehicles. So I take different tactic to try and collect on that. And so that establishes this debt market that establishes a price that is very depressed and discounted. And again, that’s what r i p medical debt takes advantage of. So I’m competing with that already depressed price that is driven by the fact that people are trying to make a profit off of these bad debts.

[00:07:05] But in my world, I’ve sort of flipped it on its head and I’m. I will pay the same as the for profits, but I’m not trying to make a profit. I’m just trying to provide relief. So I’m going to take donated dollars, so I don’t need to make any money back. I’m gonna go to that same debt market. I’m gonna say, give me all of the bad debts that you have available.

[00:07:25] I’m gonna pull out the ones that are for, which is most of them, like 80% oftentimes of people who are financially uh, struggling. And I will pay. this amount, and I pay based on, usually the debt is, um, the older it is, the cheaper it is because

[00:07:42] George Weiner: the idea is it pays outstanding, puts a higher discount on the probability

[00:07:46] Allison Sesso: that gets behind.

[00:07:46] I’m, I’m paying like, you know, a million dollars for, you know, $300 million worth of debt in one fail swoop. And so it’s thousands of people that are getting helped.

[00:07:58] George Weiner: Mm-hmm. . Mm-hmm. . So staying with the story here, I have incurred this 45,000. I have not been able to pay it back in thirty, ninety, a hundred eighty days.

[00:08:09] I am within that window of one to four x the poverty level. And do you like show up at my door? Like an oversized check. Is it like, uh, so like how am I notified that? Like, hey, you’re suddenly like, you don’t owe this anymore. Like, how does this final, like I release you of your burden before, Like what, Like is there a confetti?

[00:08:34] I’m like, that would be a lot of, uh, groundwork for us because we’ve helped over 4 million people. So that’d be a lot. Lot

[00:08:40] George Weiner: of confetti. And then we got the environmental problem on that. A lot of conf the

[00:08:43] Allison Sesso: confetti ideas. Yeah, exactly. It would be a lot, lot of champagne, you know, it would be a lot. no, we, what we do, first of all, The debts tend to be at least a year old because the hospital does it is required like by regulation, they have to try to collect that could be sending one letter, it could be sending two letters.

[00:08:59] It depends. And so every hospital is different. And the thing is, when you’ve seen one hospital and their approach to collections, you’ve seen one hospital and their approach to collections. So there is no like, well what’s the standard? There’s some norms, but there’s really differences. Like for example, not while hospitals sell their debt roughly and.

[00:09:17] Like, I’m not even a hundred percent sure, like, but it’s roughly like 30% of hospitals that sell their debt. So not even all hospitals sell their, their debt to begin with. but we do get hospitals to sell to us that don’t normally sell to other for profit debt buyers, which is, I think, important. But So you are that individual.

[00:09:34] We would not have access to your file and your debt and when, until a hospital engages with us and agrees to work with us. So that’s an important element of our model, is that hospitals have to be interested in working with us and say yes to dis debt relief. Once we get a hospital involved, we will get their entire bad debt portfolio.

[00:09:53] So you, if your debt of that 40, uh, what did you say? $45,000? Mm-hmm. , then we. , uh, send letters in mass like we do to every other individual that’s in that thousands at one time that basically say, We are our IP medical debt. We have relieved your debt. You are free and clear. Check us out. We’re for real.

[00:10:14] Like, believe us. and

[00:10:16] George Weiner: oh yeah, but there’s a lot of, Sure right Where, where’s the timeshare agreement?

[00:10:21] Allison Sesso: Right. And you don’t have to do anything. And the other thing that’s really important is there’s no tax burden associated with it. When, when certain debts are relieved, there can be a tax burden because it’s considered a gift equal to the amount of the debt that’s been released.

[00:10:33] Right, exactly. So could you imagine you get a debt relieved and then you get a tax bill. It’s like when you win a lotto and you have to pay taxes. You’re like, what? ? The good news is soured. but with r p medical debt, that is not the case because we are disinterested third party. So you get this debt relief free and clear.

[00:10:48] And honestly, the, the debt relief happens whether or not you actually pay attention to the letter. They really can

[00:10:53] George Weiner: just continue to do what you were doing, which was ignore the problem and hope it goes away. Which I have to say, never were, I can’t use the word never, because apparently sometimes that works.

[00:11:04] Allison Sesso: Well, I mean, look, the people who were, we are helping though, at the end of the. everyone. I mean, we get the stories back from individuals. Mm. They want so desperately to pay. They really do. And they feel like failures because they haven’t been able to pay. Mm-hmm. . So these aren’t people who are just like, Whoa, let’s hope for the best.

[00:11:25] I’ll just keep ignoring this. And you know, these are individuals. Something happened to them. Either they got sick, they were in an accident, whatever happened to them. Maybe they just are poor, like, and, and have other obligations they have to pay for and they can’t pay this bill. And so we are relieving those debts of individuals who were forced to pay a bill that they should have never been forced to pay because it’s unaffordable.

[00:11:51] George Weiner: Yeah. Cuz clearly they had that desire to pay it back, but not the means by which to do it. What’s more, medical prices are not exactly accurate in the United States.

[00:12:03] Allison Sesso: I don’t know if the word is accurate. They are all over the place because we have this weird system where the insurance company is paying and the prices are ar.

[00:12:16] Yeah.

[00:12:18] George Weiner: Yeah. Uh, when you operate as an individual in a system designed for these large players that are charging what they will, it just breaks, it seems like, and you’re just left with outrageous numbers, and debt burns.

[00:12:32] Allison Sesso: I think that we’ve created a, a. Typical consumer approach to healthcare and it doesn’t work like the economics don’t align when you’re buying healthcare, first of all, you would pay a lot more than you would for any other good or service, right?

[00:12:49] Because it’s your health and your wellbeing. So like your artificially willing to to pay more. And I think we take a little bit of advantage of that in some ways. And, and I think that the fact that we have insurance companies that are negotiating what to pay is. Makes it complicated and it’s really hard to navigate this as an individual, nor I think should we have that expectation that people, while they’re sick, should be navigating what they’re gonna pay for a service that they have Really no real way of doing comparison shopping on.

[00:13:24] George Weiner: this is very different than a lot of other models that I see. And you must, and I see it on the site saying, if you were an individual looking for medical debt relief, that is not us. And that must be hard because you were. You know, behind the curtain that’s behind the curtain running in debt markets, which frankly, you know, this may be the first time many people are hearing about this.

[00:13:51] I’m curious how, how did this organization come about? It’s been around for, for a while.

[00:13:59] Allison Sesso: Well, I mean, actually we’ve only been around since 2014, so it’s not that old considering, I mean, a lot of nonprofits. Just years old. You know, we, we were . We’ve only been around since 2014 and we, we came we came into being, because we have two, uh, former debt buyers who understood the market.

[00:14:17] I think that was a key element of it. Craig and Jerry understood, uh, how the debt market works and what it costs to buy. , they were inspired by Occupy Wall Street, actually. Uh, and they saw that there was this group doing this thing called the Jubilee, where they were trying to do just what r i p does in, in large scale, which is to buy medical debt, and relieve it, but to make a point.

[00:14:42] And they recruited actually Jerry’s help in this. And then Jerry referred Craig. Then they sort of made their point as part of the Occupy Wall Street movement, and they were gonna pack up and go home kind of on, on this whole debt relief front. And I think Jerry sort of said to Craig like, We gotta make this a real thing.

[00:15:01] And so they did. They, they really, they, and I think that they have a book that, that they put out talking about this. You can find it on our. , it’s called End Medical Debt, and it tells sort of the origin story of of R I P and and and how they thought about this and one of the key moments that really helped the organization propel forward.

[00:15:20] Was being highlighted on John Oliver, which, you know, I’m a big fan of, I was before I got this role and knew about r i p medical debt, but he really, did some debt relief through the institution and, uh, and that propelled a lot of donors to come to the table. Cuz without donors, this really doesn’t work.

[00:15:38] I mean, I can go to the debt market all I want, but if I don’t have a lot of people supporting my ability to buy the debt, it, it doesn’t, it doesn’t work. So, That’s our story. It was two Defiers who were brave. They took some. They almost went into poverty on, on, on their own because of the fact that they, they took this, uh, this on and they just thought this was too good of an idea to let go.

[00:16:00] And again, John Oliver helped propel us and then the board of directors, you know, said, Let’s take it to the next level. And, and then I came in as a, as a seasoned executive director type and, and we were able to really, uh, propel this work forward and we’re gonna keep doing. .

[00:16:16] George Weiner: Yeah. I mean, 24, I mean, you’ve made it through some, some filter bubbles for sure.

[00:16:22] In terms of like the filtering of can you make it five years, can you make it over a, a certain amount of revenue, but you’re starting to, uh, really pull. Pull through. It also strikes me because medical debt is the number one reason someone declares bankruptcy and it seems like this is, uh, something that may slow that down.

[00:16:45] Uh, but I don’t know how big you need to be, like billions of dollars that you have done. 4 million people. I think you said like those are big numbers. How big do you actually need to be in your mind to, I’m not gonna use the word solve, because you, you are not solving, you are resolving a broken system that will continue to break things.

[00:17:08] But how big do you need to. To take this actually on at the level that you’d imagine?

[00:17:13] Allison Sesso: Yeah, I, it’s a good question and it’s one I often think about as an executive director, or sorry, as a, as a CEO of the institution, it’s one I often think about. What I would say is that, , we need to both be a certain size and relieving a certain amount of debt every year.

[00:17:32] And I don’t know what exactly what that number is. It really depends on the donation size. Maybe it’s 10 million, maybe it’s 20 million. I like the number 25, in terms of our budget size every year, uh, I’d love to grow to that size and, and you know, we’re, we’re more than halfway there already today, in consistent revenue, but, you know, we’ll,

[00:17:51] But the other thing is, I, I loved how you framed it and said, We’re not solving but, but resolving this, the issue. And that’s a hundred percent true. And that is our mantra. What I wanna make sure is that we’re not just trying to grow to a size that picks up and just keeps resolving the issue, but at, in the process of resolving the issue for individual.

[00:18:12] We are very intentional about telling the larger story about the issue of medical debt and how systemic in nature it is, and that we are very intentional about pushing for larger changes that are above our pay grade as an institution. And so to me that is really the key. So our size almost doesn’t matter as much as our.

[00:18:36] And so by growing our voice within this work and growing our expertise and taking the data that we are getting in mass, so we are having a deeper understanding. How many people, uh, we, how many people we’re helping, what their situation is, what is their race? What is their economic situation? Where do they live?

[00:18:56] Is this, is this problem more prevalent at certain types of hospitals, nonprofit versus for profit? I think over time we’ll be able to take a deeper look at our data collectively as we do more and more direct hospital work and contribute to this issue in a larger scale. And be able to hopefully push for, uh, larger solutions that are above again, our pay grade and who we.

[00:19:22] George Weiner: So the debt, we were talking about this before, the debt that a individual incurs, going back to like, here’s a, my $45,000 and surprise debt that I now owe. I have a family, uh, we live, you know, in a house we’re doing right. But this is something that frankly does not fit into the budget, not even by a long shot.

[00:19:42] Uh, I may. Go into bankruptcy, but it seems like there is a like actual adverse medical effect to having debt. There’s like a relationship to having this like held over my head that has negative consequences. We think we were talking about the drama report or other reports out there that suggest that like, I mean, it’s just.

[00:20:09] It hurts my brain to put it in the order of logic that like I went to the hospital to get better and now I’m probably gonna get worse because of the overpriced and debt that now chases me indefinitely. And can you tell me a bit about that relationship of debt distress?

[00:20:23] Allison Sesso: Yeah, absolutely. Uh, it is the number one theme that we see in the letters that come back from individual.

[00:20:29] We help, uh, it’s overwhelming for individuals and, you know, stress is. Undermining of health and financial stress. Stress is one of the biggest things, and we look at poor communities and we see. You know, diabetes, we see all these stress related diseases, heart issues that are all stress related, that are more extreme.

[00:20:54] Uh, and so in, in terms of medical debt, it is in itself a social determinant of health. And the social determinant of health is something that hospitals have increasingly been looking at and are spending. Millions, billion dollars, billions of dollars across the country trying to invest in community programs that address social determinants of health.

[00:21:16] And yet, as this Gemma report that came out just recently shows the medical debt created from going to the hospital itself is a social determinate of health. So if, if we can really look at medical debt, , we can actually get rid of one of the stressors that’s causing people to have to go to the hospital or get care to in the first place.

[00:21:38] So I think it’s a really key issue that you’re raising and one that we wanna make sure that we keep elevating. Cuz again, these providers, these hospitals are investing lots and lots of money into social determinants of health. Those are things like environmental situations family dynamic. You know, lot things that are in the environment, not your own personal health.

[00:21:57] You know, living in a food desert. All those kinds of things contribute to the undermining of health. And it’s a, it determines how well you’re going to be healthy, hence, hence the social determinate of health language. And so the fact that medical debt itself is among those is something we need to really look at.

[00:22:14] And I’m so grateful that there is this new report that points to this because I think it will create, To reexamine billing and practices at.

[00:22:26] George Weiner: and I think this is the Jam and Network, uh, that that put this out. But we’ll put a link in the, the show notes on it cuz there’s a certainly a lot in there and it’s one of those things I’m glad somebody did the research on and I am now forced to think about it, but also, I’m sadly not surprised.

[00:22:44] I’m not surprised that having, uh, you know, the, the threat of somebody putting a lean on the house that, you know, my kid lives in, like wouldn’t cause me stress. Like I go, I went in cuz I broke my ankle, right? I went in cuz I broke my, and I walk out like two years later with diabetes and other stress related disorders that put me back on that bill.

[00:23:05] Like,

[00:23:06] Allison Sesso: well not only that but the other on top of that, the. Stressor is that people don’t go to that hospital because they’re scared. They’re either gonna incur more debt cuz they have had some, or they know of a friend or family member that’s had debt and that it’s put them in a, you know, difficult situation and so they don’t go and get the care that they need.

[00:23:24] People are sitting outside of hospitals waiting to see if the pain dissipates before they walk in. or they’re just ignoring it and, you know, putting, you know, Ben Gay on their knee over and over and over again, and taking Advil and trying to ignore the problem until it gets to a point where it’s actually even more expensive to solve and to adjust.

[00:23:46] George Weiner: Yeah, I mean, the, the size of the problem, it, you know, it’s, what I like is that this is a pretty smart and leveraged play at an intractable problem, like the, the scale that you need to play at. And I’ll just play, I’ll, I’m show my own hand. I don’t think it’s solved by GoFundMe. No. Truly just it is, and you also even brought up the tax issue that I’m pretty sure if I got my 45 grand from people giving me money, and it showed up as a check to me, I now owe at least a third of that I think in taxes, depending on where I

[00:24:19] Allison Sesso: am.

[00:24:21] Yeah, I’m not exactly sure how the GoFundMe works in terms of the tax system, but it’s definitely a popularity contest. How. That’s the problem because what I mean for GoFundMe to work you, you need to tell your story effectively enough to have people give to you over others. GoFundMe is, The number one thing people go to, like they go to GoFund me for medical debt.

[00:24:47] It’s the number one reason to go to GoFund me. And most of them do not work. They do not reach, reach their goals. And certainly you’re not gonna reach your goal if you have an ongoing medical issue. Like what? If you have, uh, a chronic condition, you can’t keep going back to the well and begging your friends and family.

[00:25:02] Not to mention the fact that a lot of people are able to. Money if they have friends with money and people with money tend to have other friends with money. People without money tend to have friends without money. So the, the, the GoFundMe is absolutely not a solution and it really is a popularity contest.

[00:25:18] It’s how well you’re able to tell your sob story. and I just think that’s a freely heartbreaking situation that we’re putting people in to have to put themselves out there in that way in order to solve their medical death. .

[00:25:33] George Weiner: Yeah. The, you know, frankly, it’s, it’s not really the, the individual’s supposed to do everything they can in their power.

[00:25:39] and so if you’re back into the wall, I understand the market force is there pushing there, but there’s only one winner in that. It’s the person that takes 2% of transaction. if you were looking at a macro system, something like r i p, medical debt, uh, I’m wondering if, you know, just to sort of speculate on it, are there other areas where you feel.

[00:25:58] George Weiner: Financial levers, debt markets even are unexplored avenues for this type of impact.

[00:26:08] Allison Sesso: I mean, I think that there’s probably other kinds of unaffordable debt that could be looked at for sure. The thing is, medical debt is unique, and I do think that people are potentially more willing to donate to, uh, medical debt causes because you have such little control over the situation.

[00:26:27] You, you can be insured. Most people actually are insured. 90% of Americans are insured today. yet 41% have medical debt. So it is not a matter of having insurance. So you can do everything right. You can have, I. , you can still and are likely actually to get medical debt. In fact, the, the number one cause of medical debt isn’t, is, or, or directional relationship is not whether or not you have insurance, but whether or not you get sick, like, so you’re, that’s, that’s the number one connector, which is that means you couldn’t be insured.

[00:27:02] So I. At the end of the day, we can’t look at things like GoFundMe for the solutions here. I think you’re right that it is, uh, just creating more profit on top of a, a profitable system. Yeah, we, we have to, we have to look at at bigger solutions beyond beyond this, and I think that, that our model could be used for other areas.

[00:27:25] but I think that people are more likely to give to medical debt because of the fact that there’s so much little control over how much debt you end up in. People are less forgiving if you end up overusing your credit card or, Yeah, even if you can’t pay a utility bill. Honestly. Yeah.

[00:27:40] George Weiner: Yeah, the story obviously, obviously matters, but also, you know, I’d say your ability to, as you came back to it, say like you’re able to go through and understand the data behind the actual communities that you’re choosing to go for, and just to track back on the conversation.

[00:27:56] You’re like in your. Ideal world, you’re like, I think we have about 25 million worth of work you wish you could do every year in this.

[00:28:05] Allison Sesso: Yeah, I think 25 million feels right today. Now, I don’t know. I mean, ask me, you know, in, in a year from now how, how we feel about that. But I think 25 million gives us a pretty steady pace.

[00:28:16] Of doing debt relief, in mass, right, For individuals while also investing in our own ability to tell the story of medical debt. Cuz that’s important, right? Like not every dollar do we only spend on medical debt. We spend a lot, almost every dollar on medical debt relief. But we also are intentional about investing in storytelling so that individuals can be heard and that we’re, we are thinking about what is, what it feels.

[00:28:43] To have medical debt. And what are the implications on your mental health? What are your struggles with the hospital finance system? What is it like for your family every single day when you have this thing looming over your head? How have you avoided care? What other trade offs and decisions have you made?

[00:29:00] Have you borrowed from friends and family? All those kinds of things. So we are investing in different systems, but I think 25 million. Feels good as an annual like rate of our budget size because I think that gives us a large scale ability to relieve debt across the country for a lot of people again, and, and lifting up the stories at the same time.

[00:29:26] Yeah.

[00:29:27] George Weiner: Yeah. Well, just, I mean, I won’t call out your nine 90, but it, it is all public and so you’re, you’re hoping to grow there, it seems.

[00:29:36] Allison Sesso: Yes. We’re hoping to grow there. That’s right. I mean, we’ve had, we’ve been, uh, lucky to get a 50 million gift from McKenzie Scott, uh, which is Jeff Bezos’s ex-wife, and she’s been wonderful in the nonprofit sector and able to.

[00:29:51] push organizations forward. But that’s a one time gift, right? Yeah. We’re able to do those in multiple years, but we have to be careful about you not expanding our staff to have an expectation that that’s gonna be our permanent bottom line. So we pay lot of attention to that reality, and so that’s propelled us forward in a lot of good ways and allowed us to invest in even ways in which we can donate and become more, you know, In which we can maximize our ability to fundraise and then also look at our own systems, become more efficient so that we don’t need as much staff.

[00:30:26] Uh, so we’ve done those two things with those funds, but we need to grow to, I think, a, a permanent, like 25 million size where it’s year after year we’re able to support that.

[00:30:38] George Weiner: And that makes sense. Part of my mind, I keep going back to this $45,000 family that just ran into this just stroke of unlock and, you know, following through the pattern.

[00:30:50] Like it, it is amazing that there is R ip, medical debt that may show up like in some ways, like a lottery ticket that you’re like, I didn’t know I was playing this one, but I won. And like frankly, I’ve lost enough. That’s amazing. I wonder if there’s a world where the probability that I’d have to pay my full debt could be made more publicly known to me.

[00:31:12] And I know there’s also nonprofit hospitals that technically if they’re serving the public benefit actually are. Uh, due to absolve some of that debt as well. But I feel as though you’re not told the full truth when you’re handed that bill for your, you know, scan your PT scan and you’re like the what?

[00:31:29] And your overnight visit. There’s no like, and by the way, you know the probability if you’re in this area and you make this much, that if you just wait, frankly one year and don’t pay this, like nothing battle happen because the converse is true. We’ve been taught to pay every bill that shows up to us.

[00:31:44] Cuz that’s how you are an honest participant in. , uh, economic society, What does that look like? ?

[00:31:52] Allison Sesso: Yeah. So it’s, that’s a difficult question to answer because I don’t think we’re in enough hospitals yet, by any stretch, to, for anyone to feel confident or comfortable to just, you’re just gonna

[00:32:02] George Weiner: run around and catch that fly ball.

[00:32:04] Yeah. Yeah.

[00:32:04] Allison Sesso: Right. And also, we’re still investing in our fundraising abilities. And I don’t know, at some point maybe people are exhausted about paying for this too. And our issue. Not as exciting. You know, we, we are competing, frankly for donate donor dollars with things like Ukraine or abortion rights or gun rights, you know, so there are, there is a limitation to how much I can guarantee that I’m gonna be able to relieve people’s debt.

[00:32:28] And also remember that in order for me to relieve your debt, you have to be financially burdened, right? So you have to be 400% of poverty or below, or the debt has to be large compared to your. So I would be leery of people feeling comfortable with the idea that eventually not

[00:32:45] George Weiner: pay. By the way, this is not financial advice.

[00:32:48] I repeat, this is a nonprofit podcast. This is not financial

[00:32:51] Allison Sesso: advice. Right. And, and, and I will say, frankly, you know, there is some concern on the hospital and provider side that, that if they work with us, that that. That that will happen, right? That if that people will bush think, Well, I don’t have to pay my bill.

[00:33:04] So I don’t think that that’s a good way. Wow.

[00:33:05] George Weiner: I didn’t even think of that, but

[00:33:07] Allison Sesso: Right. That, that’s, that’s a good way of

[00:33:10] George Weiner: not you have thought about this as the ceo. Yeah,

[00:33:13] Allison Sesso: exactly. And it’s not something I would say we’ve experienced. What we’ve experienced is people who can pay their bills do pay their bills.

[00:33:22] There’s people in the middle Right. That also pay their bills, but to a, a large. where it’s a a difficult situation for them to pay the bills. I would like to address those people as well, like they sign up for a payment plan that they can’t afford. What I would advise people, is to not sign up for payment plans that they can’t afford.

[00:33:43] If it’s $700 a month and that’s gonna create a real financial burden on you and your family, then do not sign up for it despite all of the pressure that you might feel from the debt collector, if it’s an individual, individual entity or if it’s the hospital themselves. So that’s what I would advise.

[00:34:00] Unfortunately, as much as I hate having to tell people. be their own advocates. This system is set up that it expects you to be an advocate for yourself, and so you have to advocate for yourself and make sure that you don’t sign up for things that you can’t afford.

[00:34:19] George Weiner: Uh, what a mess. It just, what a mess. In my mind, I’m just saying like, Well, what if I just waited, like I had my $45,000 debt and I just waited out of like, I’m gonna buy this back on a penny on the dollar in a year. I’m gonna come back to you as an independent broker, and I’m just go buy back.

[00:34:36] Allison Sesso: Yeah, but you aren’t, you can’t do that.

[00:34:38] Right. You know, you’re not gonna have the negotiated power that I can collectively, and you can’t come to r i p and. Well look, I got this one debt. It’s 45,000. I’m in

[00:34:46] George Weiner: Texas. Hear me out. I mean, you can, I will donate this much over here for the help my angle get better fund, right? Exactly. Doesn’t, doesn’t work.

[00:35:01] No,

[00:35:01] Allison Sesso: it doesn’t. It doesn’t work that way, unfortunately. But I do. But I will say this, when we work with hospitals and increasingly so, Our vision is for when we work with hospitals that they take a look at their financial assistance policies and try, because you’re right hospitals, especially non-profit hospitals.

[00:35:20] Mm-hmm. are supposed to give out charity care. They’re supposed to focus on low income individual. Remember that

[00:35:25] George Weiner: C3 classification in the old taxis?

[00:35:27] Allison Sesso: Yes, exactly. But the thing is that, Hospitals don’t really get that classification taken away. Like that’s not, that’s not a thing that really happens that frequently.

[00:35:38] Yeah, I, and I, and I don’t, I don’t mean to imply at all that hospitals don’t take that seriously. I think they take it very seriously there. They’re nonprofit status, and again, not all hospitals are alike. There are some bad actors and there are some that are genuinely struggling right now. Hospitals are not really in a great financial place.

[00:35:56] Compared to some of the patients, they’re probably better off. It depends, you know, on the situation. But hospitals are supposed to provide charity care, bottom line, and so they are not necessarily as generous as our program. So there’s people in between, like some of them could be 200% of poverty or there’s discounts provided at 300% of poverty, not the full, you know, getting it all relieved like r I p.

[00:36:21] So we do hope though, that by doing an analysis of their bad debt file people, that means people that did not get charity care, whose debt we are buying, that we’re able to give them information that helps them reflect on their own charity care policies and approaches, like letting people actually know about the charity care, making sure the application process is not to burdensome.

[00:36:45] We encourage hospitals to do what’s called presumptive eligibility, meaning that they just take a look on their own by buying data from, from TransUnion like we do, or any other, you know, Equifax, whatever. Buying the data, looking at people’s incomes and making assumptions about whether or not they deserve or, you know, can get.

[00:37:02] Charity care based on their income, and then they just give it without, just like we do. We just give it away. We let people know that they’ve gotten this free kick, this debt relief without them having to fill out any paperwork or anything like that. .

[00:37:17] George Weiner: So that’s so interesting. I didn’t realize You’re not looking at pii, personally identifiable information to the degree where you see maybe a name and an address.

[00:37:24] You’re getting like top line stats on somebody Or could you do like, do the search for, you know, George, we in Texas who’s got 45 K in debt and you’re like, Ah, I found

[00:37:34] Allison Sesso: you, you’re there. No. Well, when we get a, when we get a file, so we are HIPAA compliant, right? So we, we have a DAA with the hospital and, and we, you know, we do keep , uh, we’re very vigilant about our, our cyber security and all of that other stuff.

[00:37:47] But, and we, we have to be able to have the information of the individual or else we wouldn’t be able to let them know about the fact that we’ve relieved their debt. Right. Right. You do know it. Right. So we do have that information, but, When we analyze a file from a hospital, we’re doing it in the aggregate.

[00:38:03] We’re not focusing on the individual at all, that we’re completely ignoring the individual’s name and all of that stuff. All we’re focusing on is those elements that qualify them, and so we take the entire part that qualifies, and that’s what we hold onto, and then we send out the letters after we’ve bought that debt, et cetera, etc.

[00:38:24] George Weiner: Gotcha. I love, still, in my mind I’m thinking like, but there’s technically a way I could go through and be like, if my name comes up, let’s just say I’d be, uh, encouraged to make a donation. You’d never do it, but would it open up a second? Don’t get my debt for me.

[00:38:42] Allison Sesso: Let you know. We’d never, ever let you, We would not, we don’t give away the names of the individuals that we.

[00:38:49] if people want to tell their stories, they are encouraged to do so, and we let them do that and they can put their stories on their web, on our website, and they can talk to our anthropologist, but we would never tell a donor you helped X, Y, Z. Ever.

[00:39:01] George Weiner: Oh, that’s fair. I was saying in reverse like the, the person who’s like in distress, like, could I go search a database to be like, Oh, I’m in this distressed category of people, but you can’t open up it up because of hipaa.

[00:39:11] Yeah.

[00:39:12] Allison Sesso: Well, you need to find out if we already relieved your debt. If it’s already gone, we, we would’ve notified you.

[00:39:20] George Weiner: Oh, thank you for humoring me. I’m such a, such a rabbit hole runner. That’s even a thing. All right, we’re gonna move to rapid fire. okay. With your permission, Please keep your responses as short as you feel like they, eh, feel like.

[00:39:34] Okay. What is one tech tool or website that you or your organization has started using in the last year?

[00:39:40] Allison Sesso: Max Q D, which is a qualitative data analysis visualization tool. Cool.

[00:39:49] George Weiner: What are some tech issues you’re currently battling with?

[00:39:53] Allison Sesso: Well, we are making sure that our cyber security is so to compliant, so we’re really focused on that and we’re super excited about that.

[00:40:01] And we also are trying to send people emails in addition to hard copy letters, and so we’re working to incorporate that into our model. ,

[00:40:10] George Weiner: what is coming in the next year that has you the most excited?

[00:40:15] Allison Sesso: The ability to enhance how we analyze our data, specifically with a focus on.

[00:40:24] George Weiner: Talk about a mistake that you made in or maybe earlier in your career that shapes the way you do things today.

[00:40:33] Allison Sesso: Creating space for everyone who’s a stakeholder, be it on the board, on your team, uh, donor to make their voice heard and to be part of decision making. By not doing that, I think you really undermine everyone’s buyin to what you’re doing and the direction you’re headed.

[00:40:52] And that was a mistake I made in my career that I have overcorrected for, probably .

[00:40:59] George Weiner: Do you believe nonprofits can successfully go out of business?

[00:41:04] Allison Sesso: I sure hope so. I really do. I think that nonprofits are generally not set up to solve problems, but resolve them in your. And I hope that nonprofits can have a greater voice in getting systemic change so that they can help solve problems at a larger scale.

[00:41:24] George Weiner: If I were to put you in the hot tub time machine, back to the beginning of your work at r I p Medical debt, what advice would you give your dryer self yourself

[00:41:34] Allison Sesso: to focus on the progress over the. So that I could feel more excited about the work that I’m doing going forward and less

[00:41:43] George Weiner: stressed. Uh, if I were to give you a magic wand to wave across the industry you work in, what would it do?

[00:41:52] And you can’t say, just clean up every single bit of debt

[00:41:57] Allison Sesso: across the industry. Uh, I would, I, I would say, and when I say the industry, I’m talking about the nonprofit industry at large, I would say improve the marketing of the industry. I think that we. A, a skewed view as if we are the secondary industry that’s sort of just doing what everyone calls God’s work, which I hate.

[00:42:16] I think that we are doing an essential, fundamental, fundamental function for society and that it takes real skill that not everybody has, and not everyone can from a business can just jump in and do, and take over and do well. And I think that I would do a better job of marketing who we are and how important we are as an, as an industry in terms of non.

[00:42:38] George Weiner: What is something you think you should stop doing?

[00:42:43] Allison Sesso: Uh, sometimes I think we put our heads down too much and do the day to day work, you know, going in and outta of meetings, taking, checking off our to-do list and I think we need to stop doing that as much and put our, pick our heads up and look at the big picture and appreciate what we’ve accomplished.

[00:42:59] George Weiner: How did you get your start in the social impact sector?

[00:43:04] Allison Sesso: I don’t have a good answer for that. I feel like it’s a calling for me. As lame and cheesy as that sounds, I’ve always, uh, felt like I needed to work in a mission driven, uh, capacity. And so here I am. ,

[00:43:19] George Weiner: what advice would you give college grads looking to enter the sector?

[00:43:24] make sure that you have a strong ethical and moral compass and that you have people to talk to to ensure you stay with that because money and donors even can really influence you in a way that’s not

[00:43:37] George Weiner: always. What advice did your parents give you that you either followed or did not? Heed

[00:43:47] Allison Sesso: Finding balance in my life, both in terms of work happiness and personal happiness.

[00:43:56] To be

[00:43:56] George Weiner: clear, you heated that advice. I

[00:44:00] Allison Sesso: did. Yes. I’m very happy in both my work life and my, My question

[00:44:03] audio1239347413: could

[00:44:03] George Weiner: have gone the other way there. Life, right? could have been a real dark turn. Yeah. Uh, that’s wonderful. Uh, how do people find you? How do people help you?

[00:44:14] Allison Sesso: Well, first donate to us please. Uh, r i p medical debt.org.

[00:44:19] I can’t do this work without that. You can also follow us on Twitter, on Instagram. Just add our ip medical debt. but I really encourage you to, uh, to take a look at our website, check us out and, and talk about the issue of medical debt, uh, how it impacts you. I think one of the biggest problems with this issue is that people feel like they’ve personally failed when the reality is the system is broken.

[00:44:41] And you have to remember that. And unless we talk about it in our personal stories, this issue’s gonna be with us and it’s gonna be killing us slowly, literal.

[00:44:51] George Weiner: I’m grateful for the work that you are doing. Thank you. Thank you for, uh, just, uh, continuing to, to make this a national issue and an Avenue, Avenue to finally put dollars to work, I think, in a high leverage way.

[00:45:03] Thank you. Thank you.