Cook County Tops $1B in Medical Debt Relief

Cook County, Illinois, home to Chicago, has abolished more than $1 billion in medical debt, the most erased by any county in the country, according to Becker's Hospital Review. The county launched the program in 2022 with Undue Medical Debt, a nonprofit that purchases unpaid medical bills from providers and debt sellers, then forgives them.

The model works because distressed medical debt trades for a fraction of its face value. Undue Medical Debt buys it for pennies on the dollar, so a relatively small public outlay can wipe out a large volume of balances. Residents do not apply; they receive a letter telling them their debt is gone. The approach has spread as cities, counties, and states use federal pandemic relief dollars and local budgets to fund similar buyouts.

The relief is real but reactive. It clears existing debt without changing the billing, pricing, and coverage gaps that generate it, meaning new medical debt keeps accumulating even as old balances disappear.