She left her deteriorating marriage. Then the medical bills came.

Debbie Smith of Alamance County is one of roughly 3 million North Carolinians who suffer the burden of medical debt. She spoke with Cardinal & Pine about her story, the realities of debt, and what she hopes will be done about it.

One day last October, an ambulance pulled up outside Debbie Smith’s home. 

The paramedics helped Smith into the ambulance and transported her to Alamance Regional Medical Center.

But Smith wasn’t sick. Instead, the then-69-year-old was leaving what she described as an abusive marriage. After more than 20 years of marriage, Smith said, things had deteriorated and her husband had begun to threaten her. While he never physically hurt her, the threats of violence were severe enough that Smith said her psychiatrist recommended she leave her home, in part because her husband kept guns there. 

Her psychiatrist even called the police to check on her, Smith said. 

When law enforcement first visited Smith, they spoke with both her and her husband. Smith didn’t leave that day, she said, but officers returned the next day, alongside Adult Protective Services, who asked if she wanted to leave. Smith said she did, and they called the ambulance.

Cardinal & Pine confirmed law enforcement visited Smith’s home on at least two separate occasions via police records, and that she was taken from her house. 

Smith spent the next five days in the hospital, where she had to sleep in a cot in a hallway outside the ER.

“They said they were too full. They couldn’t get any rooms in the hospital, and couldn’t get any rooms in the emergency room. They were just too crowded,” Smith said. 

But she was at least safe. 

After her time in the hospital, she stayed in a motel for five nights. Three nights were paid for by a local church, one by her sister, and another by her son. Smith now lives in a group home in Alamance County, but her hospital stay left her with a $600 medical bill — one she’s struggled to repay. 

Smith’s debt and the impact it’s had

Smith says she receives $1,108 per month from Social Security. Of that, $1,018 goes to pay for her room at her group home, which provides three meals a day. Another $95 goes towards a storage unit she has for personal items. That leaves nothing left over from her income to pay for necessities, let alone cover her medical bills. 

“I’m paying that $30 at a time, or had been. They couldn’t take less than $30. I tried to get less than that,” she said about the hospital. 

Smith said she’s had to completely deplete her savings in order to make payments on the debt and to afford her prescription medications.

“I’m broke. I’ve gone through all my savings that I had,” she explained. “I had something that I cashed in, and I’ve spent all of it paying off these debts, and I don’t have anything left to cash in or go through. I’m just completely broke.” 

Smith stopped paying the hospital bill over the summer, because she could no longer afford to, and the debt — which currently sits at about $400 — was handed over to Wakefield, a medical debt collection agency. The calls from collectors are constant.

“Now they call 18 times a month it seems like. They call a whole lot.”

Smith says her minimal income and debt has made it impossible for her to get basic necessities.

“It makes it really hard for me to buy anything I need,” she said. “Be it paper towels or anything,  clothing, anything that I might need.” 

Medical debt forgiveness in NC 

On July 1, Gov. Roy Cooper called on hospitals in the state to forgive $4 billion worth of medical debt for around 2 million lower income North Carolinians in exchange for increased funding provided by the federal government through the state’s Medicaid expansion program. 

“This is big, sweeping change that will benefit our health care system and the health and well-being of millions of North Carolinians,” North Carolina Secretary of Health and Human Services Kody Kinsley said at the time.

Currently, hospitals are identifying those who are eligible for forgiveness. And on January 1st, each hospital must allow those who are homeless or enrolled in Medicaid, the Women, Infants, and Children (WIC) program, and the Supplemental Nutrition Assistance Program (SNAP) to receive free or reduced-cost care.

By July 1, 2025, hospitals will forgive debt for those who are enrolled in Medicaid, SNAP, and WIC. After that date, the hospitals who signed onto Cooper’s program will have to follow new rules guiding debt collection practices, including new standards for when debt is turned over to creditors. For example, hospitals will not be able to garnish a person’s state income taxes or turn over patients’ debt to collectors until after 120 days have passed since their first bill was sent out.

Vice President Kamala Harris collaborated with Cooper on the development of the plan and its rollout, and has vowed to cancel additional medical debt if she’s elected president. 

Smith supports the forgiveness program and believes more is needed to help people struggling with debt.

“I just think it’s a wonderful thing they’re doing for people who can’t do it themselves. At some point you’ve got to have some help,” she said.

Forgiving debt could be literally life saving, Smith added.

“I really think that it will save some lives. Because I think some people get so desperate that they just don’t care whether they live or not. I really do,” she said. “And I think I’ve felt that way at times, that I was just so depressed about it. I’m not a suicidal person so I don’t think that way, but I can see how some people would.”