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Beacon Media NC

As a registered nurse in rural North Carolina, Dawn Daly-Mack sees the choices people make every day when they have to weigh their health against the cost of it. She’s actually seen the issue from a rare, 360-degree perspective. 

In 2014 she managed a Federally Qualified Health Clinic managed, located in the emergency department at the local hospital. That gave her a daily view of the choices people had to make concerning their finances and health. She also learned quite a bit about how healthcare costs impact individuals when she worked as a benefits manager, before becoming a nurse.

And when she was diagnosed with cancer herself in 2025, it thrust her into a similar position as many of the people she has treated and worked with in the past. 

“It’s bad enough that you’re sick, and you have to, you know, seek medical attention to start with. And then you are met with these really huge bills that you probably can’t afford to pay,” Daly-Mack said. “Hundreds of dollars for a small x-ray, thousands of dollars for a CAT scan or an MRI. Those are things that people just can’t even imagine having to pay for. For the first time in my life, I now have medical bills.”

Daly-Mack works. She has insurance. And she went back to school to become a nurse, advancing her career, in her mid-40s. But an unexpected medical condition, beyond her control, only added yet another bill to the list for her and her family. 

“I think it is important for lawmakers to understand that not everybody that has issues with medical debt are, you know, who they assume they are, people that don’t work. That’s not what it is. Anybody, anybody at all, I don’t care how much money you make, is just a few steps away from medical debt wiping them out,” she said. “It could happen to anybody.”

In 2023, lawmakers in North Carolina voted to expand eligibility for Medicaid coverage, making healthcare available to hundreds of thousands of previously uninsured people. But the effort did nothing to address the enormous sums of debt people, like Daly-Mack, had already accrued. Medical debt in the state had ranked among the nation’s worst for some time.

North Carolina’s Medicaid program used a financing tool called the Healthcare Access and Stabilization Program (HASP) to increase Medicaid payments to the state’s hospitals, most of which are nonprofit and already required by federal law to offer financial assistance to patients. In exchange for those higher payments, hospitals agreed to relieve certain medical debts dating back to 2014 and strengthen their financial assistance policies going forward. All 99 hospitals in the state signed on.

Eligibility for the medical debt relief program was based on income and included Medicaid enrollees, individuals with incomes at or below 350% of the Federal Poverty Level, and individuals carrying medical debt that exceeded 5% of their income. 

Hospitals worked with the national nonprofit Undue Medical Debt to identify and relieve qualifying debt. The program has relieved more than $6.5 billion in medical debt for more than 2.5 million North Carolina residents.

Daly-Mack was one of them. She received a letter in the mail notifying her that her medical debt had been relieved and she thought it was fake. She shared the letter to Facebook and asked if anyone she knew had also received a letter. A couple friends told her they had. 

Daly-Mack said the program offers individuals hope at a time when budgets are stretched increasingly thin. And, she said it infuses communities with more trust toward the healthcare system.

Lingering medical debt not only takes an emotional toll on individuals, but it can negatively impact credit and reduce the availability of funds individuals use for other expenses. The prospect of medical debt, as Daly-Mack has seen as a nurse, also deters people from getting the care they need.

“Something as simple as having one less bill to worry about is going to have great implications,” she said. “If people see that this local hospital is helping them out in more ways than one, both treating their conditions, but making sure they don’t go back into medical debt, I think that just changes the whole atmosphere, right? We’re feeling good about this service in our community that’s really trying to help us.”