At Medical Debt Roundtable in Greenville, Governor Stein Highlights State Efforts to Bring Health Care Costs Down for Families – NC Governor (.gov)

Report on North Carolina’s Medical Debt Relief Program and Alignment with Sustainable Development Goals

Introduction: A Multi-Stakeholder Initiative to Address Healthcare Affordability

A roundtable discussion was recently convened in Greenville by Governor Josh Stein and North Carolina Department of Health and Human Services (NCDHHS) Secretary Dr. Dev Sangvai. The focus of the meeting was to assess the impact of the state’s medical debt relief initiatives on its citizens. This report details the program’s structure, achievements, and significant contributions to several United Nations Sustainable Development Goals (SDGs), including SDG 1 (No Poverty), SDG 3 (Good Health and Well-being), SDG 10 (Reduced Inequalities), and SDG 17 (Partnerships for the Goals).

Program Achievements and Contribution to SDG 1 (No Poverty) and SDG 8 (Decent Work and Economic Growth)

The state’s medical debt relief program has achieved substantial results, directly contributing to poverty reduction and economic stability for residents. By alleviating the financial burden of healthcare, the initiative supports SDG 1 (No Poverty) and SDG 8 (Decent Work and Economic Growth).

• Debt Eradication: Over $6.5 billion in medical debt has been erased in the past year.
• Beneficiary Impact: More than 2.5 million North Carolinians have had some or all of their medical debt cleared.
• Economic Empowerment: Relieving medical debt helps families regain financial stability, improves credit scores, and removes barriers to accessing housing and employment, thereby fostering economic participation and growth.

Governor Stein has further supported these goals by urging the three major credit reporting agencies—Experian, Equifax, and TransUnion—to reaffirm their commitment to excluding medical debt from credit reports, a measure that directly impacts the financial well-being and economic opportunities of citizens.

Advancing SDG 3 (Good Health and Well-being)

The program is fundamentally designed to remove financial barriers to healthcare, a critical step in achieving SDG 3 (Good Health and Well-being). By ensuring that cost is not a deterrent to seeking care, the state promotes healthier communities.

1. Removing Barriers to Care: As stated by Secretary Sangvai, the initiative ensures care is “accessible and healing, not a source of financial distress,” encouraging individuals to seek help early without fear of long-term financial consequences.
2. Preventing Future Debt: The program is forward-looking, requiring participating hospitals to adopt more generous charity care policies to prevent the accumulation of new medical debt.
3. Investing in Health Infrastructure: The state’s commitment to SDG 3 is also demonstrated by projects like the WakeMed Whole Health Campus, which will add a 150-bed mental health hospital and a 45-bed acute care hospital, expanding access to critical services.

A Model for SDG 17 (Partnerships for the Goals) and SDG 10 (Reduced Inequalities)

North Carolina’s approach exemplifies a successful multi-stakeholder partnership, a core principle of SDG 17. This collaboration effectively addresses the systemic issue of medical debt, which disproportionately affects low-income populations, thereby advancing SDG 10 (Reduced Inequalities).

Key Program Partners:

• The North Carolina Department of Health and Human Services (NCDHHS)
• All 99 eligible acute care hospitals in the state
• Undue Medical Debt, a national nonprofit organization

The program leverages the state’s Medicaid program through the Healthcare Access and Stabilization Program (HASP). In exchange for enhanced payments, hospitals agree to improve financial assistance processes. This innovative model creates a sustainable framework for reducing healthcare-related financial inequality across the state.

Conclusion and Future Outlook

The North Carolina Medical Debt Relief Program represents a significant investment in the long-term health and economic vitality of its residents. By addressing medical debt, the state is making tangible progress on key Sustainable Development Goals. Governor Stein has called upon the North Carolina General Assembly to continue this work by focusing on policies that make healthcare more affordable for all. The state’s commitment to addressing social determinants of health and removing barriers to care serves as a comprehensive strategy for building healthier and more equitable communities.

Analysis of Sustainable Development Goals (SDGs) in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 1: No Poverty

  The article addresses SDG 1 by focusing on the alleviation of medical debt, which is a significant cause of financial hardship and can push families into poverty. The article states, “By relieving this debt, North Carolina is helping families regain financial stability.” This directly connects to the goal of ending poverty in all its forms.

• SDG 3: Good Health and Well-being

  This is the most central SDG in the article. The entire initiative is about making healthcare more affordable and accessible. The article highlights that medical debt can be a barrier to seeking care (“delaying care”). Statements like, “ensuring cost is not a barrier to health,” and the construction of a new “mental health and well-being hospital” directly support the aim of ensuring healthy lives and promoting well-being for all.

• SDG 8: Decent Work and Economic Growth

  The article connects medical debt to economic opportunity by stating that it damages credit and limits “access to housing and jobs.” By erasing medical debt and calling for its removal from credit reports, the initiative helps improve individuals’ financial health, enabling them to participate more fully in the economy. Governor Stein’s comment that the work will “strengthen… our state’s economy” reinforces this link.

• SDG 10: Reduced Inequalities

  The medical debt relief program inherently addresses inequality. Medical debt disproportionately affects low-income and vulnerable populations. The program’s design, which involves hospitals adopting “more generous charity care policies,” specifically targets reducing the financial burden on those who are less able to afford healthcare, thereby reducing economic inequality.

2. What specific targets under those SDGs can be identified based on the article’s content?

• Target 1.4: By 2030, ensure that all men and women, in particular the poor and the vulnerable, have equal rights to economic resources, as well as access to basic services…

  The article’s focus on relieving medical debt for millions of North Carolinians directly supports this target. It improves access to a basic service (healthcare) by removing financial barriers and helps individuals “regain financial stability,” which is a form of economic resource.

• Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services…

  The North Carolina Medical Debt Relief Program is a direct implementation of “financial risk protection.” The article explicitly states the program’s goal is to “reduce the burden of medical bills” and ensure that care is “not a source of financial distress.” This aligns perfectly with protecting people from the financial consequences of seeking healthcare.

• Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all… irrespective of… economic or other status.

  By erasing debt that limits access to jobs and housing, the program promotes the economic inclusion of individuals who were previously held back by their medical financial burdens. The program specifically helps those with lower incomes, directly addressing inclusion based on economic status.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Total amount of medical debt erased: The article explicitly states that the program “erased more than $6.5 billion in medical debt.” This is a direct quantitative indicator of the program’s scale and impact on financial risk protection (Target 3.8).
• Number of beneficiaries: The article mentions that the debt relief has been provided for “more than 2.5 million North Carolinians.” This indicator measures the reach of the program and the number of people whose access to economic resources and financial stability has been improved (Target 1.4).
• Number of participating institutions: The article notes that “all eligible hospitals in the state joined the… Program,” specifying “99 acute care hospitals.” This indicates the level of systemic adoption and partnership in achieving the goal.
• Removal of debt from credit reports: The article implies this as an indicator by mentioning Governor Stein’s call to credit reporting agencies to “exclud[e] certain medical debts from credit reports” and the goal of “remov[ing] negative credit marks.” Progress could be measured by the number of credit reports cleared of medical debt.
• Increased healthcare infrastructure: The mention of a new “150-bed mental health and well-being hospital and a 45-bed acute care hospital” serves as an indicator of increased capacity and access to essential health services (Target 3.8).

4. SDGs, Targets, and Indicators Table

Source: governor.nc.gov