Medical debt is the leading cause of bankruptcy in the United States. It disproportionately affects more women than men and more members of the African American and Hispanic American communities. Over the last decade, I’ve seen a change in my patients. It used to be that my patients who didn’t have anywhere else to go would come in, and we would treat them. If they needed to be admitted, they would be willing to be hospitalized. Now, I have patients who say, “I’m not going to accept your recommendation for further care because I can’t incur that degree of debt.” The idea here is that with a small state appropriation, we can give the resources to an entity like RIP Medical Debt (a 501 charity focused on the elimination of personal medical debt) that can partner with willing health systems to purchase distressed debt and then forgive it. That’s a win-win for everybody. It’s a win for patients because the program is targeted toward those whose household income is up to 400% of the federal poverty level or whose medical debt exceeds 5% of their annual income — which, conservatively, is up to 1 million Pennsylvanians. It’s a win for the health care systems because they will be able to collect some small amount of what is largely unrecoverable debt. With a $5 million investment (about 0.01% of last year’s state budget), it’s estimated more than $575 million of medical debt could be cleared for qualifying Pennsylvanians. And it is a win for the rest of us as there is cost-shifting in the system to compensate for those who are uninsured and underinsured. I am hopeful that we will be able to get this done.