MacKenzie Scott continues to make medical debt relief a priority in her mysterious giving.

This week, Undue Medical Debt, formerly RIP Medical Debt, announced it had received a rare third gift -- $50 million -- from the billionaire philanthropist, signaling her satisfaction with the group's efforts to purchase medical debt in bulk from hospitals and debt collectors. Scott has donated a total of $130 million to the organization since 2020.

Medical debt is increasing despite most of the U.S. population having some form of medical insurance. Nearly 100 million people are unable to pay their medical bills, according to Third Way, a left-leaning national think tank.

Overall, Americans owe about $220 billion in medical debt, with historically disadvantaged groups shouldering the bulk of the burden. Lower-income people, people with disabilities, middle-aged adults, Black people, the uninsured, and people living in rural areas are among the groups most likely to be affected by medical debt, according to the Kaiser Family Foundation.

Undue Medical Debt buys debt at a discounted price, estimating that it erases about $100 in debt for each $1 donated. The group also collaborates with policymakers to encourage the adoption of measures to curb what people owe for medical care. Scott first gave Undue Medical Debt a $50 million donation in 2020, followed by a $30 million donation in 2022.

With that money, the group has relieved nearly $15 billion in debt for more than 9 million people, CEO Allison Sesso said. That's a significant leap from the $1 billion in debt relieved from 2014 to 2019, she noted.

"I'm frankly astounded by this most recent gift from MacKenzie Scott and feel proud to be a steward of these funds as we continue the essential work of dismantling the yoke of medical debt that's burdening far too many families in this country," said Sesso.

The continued funding has allowed Sesso "to not have to worry about my next dollar," she said, and "think more strategically about the narrative around medical debt -- she has helped us push that conversation."

Undue Medical Debt was started in 2014 by two former debt collection executives, Jerry Ashton and Craig Antico, who were inspired by the Occupy Wall Street movement's advocacy for debt relief. Growth initially was slow. But with Scott's gifts, the nonprofit has been able to staff up, produce more research, and develop relationships with policymakers who have pushed for changes to hospital billing practices to relieve debt and prevent people from accumulating it in the first place, Sesso said.

Undue Medical Debt's public policy arm has worked with lawmakers in North Carolina, which in July became the first state to offer additional Medicaid payments to hospitals that agree to adopt debt relief measures, she said. The policy change followed the publication of a 2023 report from Duke University, which found that one in five families in the state had been forced into collections proceedings because of medical debt.

Since 2020, the organization's staff has grown from three to about 40, Sesso said. Those hires included an anthropologist who collects stories from people set back by medical debt to inform the group's research and advocacy work. Scott's gifts also have helped improve Undue Medical Debt's technology to identify people eligible for debt relief and to find hospitals from which it can purchase medical debt, among other things, Sesso said.

"This coming year, because of this MacKenzie Scott grant, we'll be able to add more people, making sure that we can support that growth on an ongoing basis," Sesso said.

Few organizations have received more than one gift from Scott. Other multi-grant recipients include Blue Meridian, an intermediary group that has directed billions of dollars to nonprofits around the world, and GiveDirectly, which provides no-strings-attached cash payments to low-income people globally. GiveDirectly has received $125 million from Scott since 2020. Blue Meridian has not disclosed amounts for the four gifts it's received since 2019.

Scott's contributions to those two organizations were for specific causes like GiveDirectly's U.S. poverty relief fund, said Christina Im, a senior research analyst at the Center for Effective Philanthropy. In the case of Undue Medical Debt, the timing of Scott's first gifts in 2020 and 2022 seemed to correspond with COVID-relief efforts, she said.

Scott, the former wife of Amazon founder Jeff Bezos, is worth an estimated $32 billion but provides few details about her grantmaking decisions. Without further information, it's hard to know what prompted this third donation to Undue Medical Debt, but Scott has said in public statements that she wants to help those who are most in need and bear the brunt of societal ills, said Elisha Smith Arrillaga, the Center for Effective Philanthropy's vice president for research.

"I have not seen a lot of other folks funding in this area," Smith Arrillaga added.

Scott's latest gift to Undue Medical Debt comes amid national debates about medical insurance and the cost of medical treatments. The murder of UnitedHealthcare CEO Brian Thompson on December 4 in Midtown Manhattan has heightened these conversations, with some lionizing the man who allegedly committed the crime.

"That's no way to get change, full stop," Sesso said in reference to Thompson's murder. "But I think the anger around insurance companies and having access to care is very clear."

The U.S. has one of the most expensive health care systems in the world. And the amount of medical debt carried by individuals seems to be increasing, noted Adam Searing, a public interest attorney and associate professor at Georgetown University, where he focuses on Medicaid and other health coverage programs.

Searing previously served for 17 years as director of the Health Access Coalition at the nonprofit North Carolina Justice Center, advocating for the uninsured and underinsured. During that time, he heard from people losing their homes due to liens from hospitals. Sometimes those liens could be delayed, but it still meant that the debtors couldn't pass those homes along to their children or grandchildren, he said.

"Those stories stuck with me," he said. "It really has an impact on families."

Relieving debt allows people to get their lives back on track and become financially secure after a major illness or series of expensive bills, Searing said. For philanthropists, it's also a cause that is largely nonpartisan. Scott shining a spotlight on the issue is undoubtedly "a good thing," he said. "I think it will have a big effect."

_____

Stephanie Beasley is a senior writer at the Chronicle of Philanthropy. This article was provided to The Associated Press by the Chronicle of Philanthropy as part of a partnership to cover philanthropy and nonprofits supported by the Lilly Endowment Inc. The Chronicle is solely responsible for the content. For all of AP's philanthropy coverage, visit https://apnews.com/hub/philanthropy.