Over the last decade, cities, states, churches and even comedian John Oliver have embraced a popular kind of health care charity: buying up and forgiving people’s old medical debts for pennies on the dollar. It’s been seen as a quick, cheap way to help some of the 100 million people in the U.S. stuck with medical bills they can’t pay. 

So it was a shock when a recent major research study by Stanford economist Neale Mahoney and colleagues found that forgiving old debt seemed to have little impact on people’s financial or mental health.

In this week’s episode, we talk with Mahoney and Allison Sesso, CEO of Undue Medical Debt, the country’s leading medical debt relief charity, about the lessons they believe experts and policymakers should take away from these findings. 

Here is what they learned:

1. Forgive debt sooner — before huge medical bills can devour savings, delay treatment or damage a patient’s credit score. While much of the debt forgiven in the recent study was more than five years old, Sesso says 67% of the debt her nonprofit relieves is now less than five years old — up dramatically from just 5% in 2019. Evidence from hospital financial assistance programs, which reduce or write off bills right away, suggests this shift upstream could make a difference. 

2. We need to better understand who benefits most from debt relief, and how. Sesso’s organization is constantly crunching numbers to determine how best to target assistance. For example, her team recently doubled the income eligibility limit from about $60,000 a year for a family of four to $120,000 after noticing many middle-income patients are struggling. 

3. Prioritize policy fixes that protect consumers and keep health care affordable. “People have unpayable medical bills because they don’t have [insurance] coverage or they have crappy coverage, and because the price [of care] is too high,” Mahoney says. Tackling either of those policy issues takes time, he acknowledges. “But I think our study says that those hard things are necessary.” In the meantime, he adds, smaller fixes, like recent reforms that remove most kinds of medical bills from credit reports, can help minimize debt’s damage. 

It’s clear that some lawmakers are also learning similar lessons. On May 8, Sen. Bernie Sanders introduced legislation that would wipe out America’s entire $220 billion mountain of medical debt. Going forward, it would also force hospitals to do more to make financial assistance available before collecting on bills.

Listen to the full episode above or read the transcript to learn more about other ways that policymakers might make progress on the country’s medical debt crisis.