As Floridians continue to grapple with rising healthcare costs and insurance premiums, Orange County announced Tuesday that it has exceeded its expectations for a medical debt relief initiative that the county first kicked off in 2024.
Since 2024, Orange County has erased $758 million in medical debt held by 515,000 county residents, according to a news release — more than the 500,000 they initially anticipated.
The debt relief is made possible through a contract with Undue Medical Debt, a nonprofit that has partnered with more than two dozen local and state governments, as well as community and student groups, to eliminate the burden of medical debt.
Through a process of buying debt from debt collectors, hospitals and healthcare providers, each investment of $1 can be leveraged to erase an estimated $100 in medical debt on average, according to Undue.
“Undue is proud to partner with Orange County on this incredibly impactful initiative to relieve the burden of medical debt from hundreds of thousands of families,” Allison Sesso, president and CEO of Undue Medical Debt, said in a statement.
Orange County invested an initial $4.5 million into the program in 2024, after initially facing skepticism from some county commissioners who worried the concept was too good to be true. The initial expectation was to clear debt for 400,000 residents, a benchmark the county exceeded earlier this year, with more than a half-billion dollars’ worth of debt erased.
So, this past August, the county invested another $2 million to clear medical debt for another 100,000 residents, including one local teacher identified by the county only as Raquel, a single mom who saw $300 of her medical debt erased.
“Having this medical debt paid off truly means the world to me,” she said in a statement shared by the county. “As a single parent living on a teacher’s salary, things can be tight financially. I didn’t have the extra money set aside for this unexpected expense, and it had been weighing heavily on me. This debt was especially stressful because I’ve spent the last three years working hard to rebuild my credit in hopes of one day buying a home.”
Where did the funding come from?
The medical debt relief program is funded entirely by a sliver of the $270 million in federal funds the county received under the American Rescue Plan Act of 2021. All of that funding must be spent by the end of this year.
The vast majority of that $270 million was invested in business assistance, health and public safety, infrastructure projects, social and community services, and revenue recovery, according to county documents.
Central Florida Jobs With Justice, however, mobilized healthcare advocates to ask the county to invest less than 2 percent of that into this novel medical debt relief program — the first of its kind in Florida. County commissioners agreed to move forward with the idea in August 2024.
The extra $2 million that the county kicked in earlier this year came from unused ARPA funds, a county spokesperson confirmed.
“This initiative is changing lives and helping residents focus on their health and build a brighter future for their families,” Orange County Mayor Jerry Demings, who’s getting ready to retire from the mayor’s office, said in a statement. “It demonstrates what we can accomplish when government, nonprofits and the private sector work together to strengthen our communities.”
Undue Medical Debt, formerly known as RIP Medical Debt, was founded by two former debt collectors who, as NPR put it, “built their careers chasing down patients who couldn’t afford their bills.”
One of the founders, John Ashton, said it was conversations with Occupy Wall Street activists in 2011 that led him to the path of using his knowledge to help those with debt — not hunt them down.
How does it work?
The process works by bringing together debt collectors, local hospitals that agree to participate (like Orlando Health) and other healthcare providers to identify debts owed by county residents.
There is no application process to have your debt relieved.
Instead, residents qualify for the debt relief program if they are a county resident and have a total household income at or below 400 percent of the federal poverty line — equal to $63,840 for an individual in 2026 figures, or $109,280 for a family of three. Residents may also qualify if their medical debt exceeds more than 5 percent of their annual income.
Then, after their debt is purchased from the collection agency and paid off using county funds, Undue mails a letter to recipients informing them their debt has been cleared.
“As healthcare costs continue to stretch budgets and force patients to make impossible decisions between putting food on the table or continuing care for a chronic condition or taking their child to the ER, we’re proud to stand with government partners that believe no one should face financial ruin simply because they got sick. We hope debt relief will allow families to reengage with the healthcare system,” said Sesso.
Not a fix
Medical debt affects an estimated 1 in 4 U.S. adults, according to a recent survey by the Urban Institute. More than half of those who carry debt owe in excess of $1,000, the survey found, and 1 in 6 owe $5,000 or more.
Medical debt, over time, can affect your credit score and your ability to pay other bills, and owed amounts tend to be higher among the uninsured, according to the Urban Institute.
At the same time, more U.S. adults are increasingly opting out of insurance due to the unaffordable options available to them. In Florida, healthcare premiums for plans on the Affordable Care Act Marketplace this next year are expected to jump about 10 percent, according to filings with the Florida Office of Insurance Regulation.
County commissioners and Undue Medical Debt representatives have acknowledged that this process isn’t a fix to a healthcare system that a quarter of Americans believe is “in crisis” and increasingly out of reach amid higher gas prices, grocery bills, and property insurance.
Recent polling found that an estimated 66 percent of Americans — or two-thirds — support the government developing a national healthcare program like Medicare for All.
The U.S. is the only major industrialized country in the world without a universal healthcare system. A recent study by researchers at Yale found that Medicare for All would actually save the U.S. money, as well as saving an estimated 114,000 lives per year.
“The U.S. spends more on health care than any other nation, yet tens of millions of Americans are uninsured or underinsured, and coverage retractions enacted in 2025 are widening these gaps,” the researchers wrote. “The misalignment between the for-profit insurance architecture and optimal patient care, together with the inefficiencies of a fragmented system, contributes to both unnecessary costs and preventable mortality.”
