‘Touch and go’: Raleigh family struggles despite NC medical debt relief

Randall Edge, says he felt a burden lift after he received help through North Carolina’s medical debt relief program.

But it hasn’t been enough. Edge, 54, is still barely staying afloat. And this year, he received another bill he’s not likely to be able to pay back soon.

In 2022, the Raleigh resident went in for a colonoscopy recommended by his primary care doctor. He says he believed the procedure would be fully covered.

Instead, several months later, he got a bill in the mail for about $1,800. The anesthesia used during the colonoscopy wasn’t covered under his high-deductible insurance plan, he said.

Edge said he tried to pay what he could but quickly fell behind.

“Unfortunately, other things happened — between family, groceries, bills, car payments, car insurance, maintenance on the vehicle. You name it. There’s just tons of bills,” he said.

Edge has worked about a decade at a heating, ventilation and air conditioning company, earning about $50,000 a year. He supports a family of four that includes a stepson and a granddaughter, who he said both receive insurance through Medicaid. The program covers some people who have low incomes or disabilities, are pregnant or qualify for other reasons.

The federal poverty level in 2025 for a family of four is about $31,200. Edge’s household income is roughly 160% of that, disqualifying him and his wife from many forms of federal and state aid.

But despite earning above the threshold for many forms of assistance, he said he still struggles.

“It’s touch and go every month,” he said.

Because of his income, the roughly $1,800 in debt Edge took on after his 2022 colonoscopy was eventually erased through the state’s medical debt relief program, according to Undue Medical Debt, the nonprofit partnering with North Carolina on the initiative, who connected The News & Observer with Edge.

But now Edge faces a second bill unlikely to qualify for relief.

Announced last year, the program has provided help to many struggling North Carolinian families.

But Edge’s story underscores the limits of North Carolina’s medical debt relief effort and the challenges many families face: While the program wipes away billions in old debt, it doesn’t stop new debt from accumulating for many.

The program uses Medicaid funds to reimburse hospitals that agree to forgive old debt and strengthen their charity-care policies. Every one of the state’s 99 acute-care hospitals opted in. So far, the program has erased $6.5 billion in hospital debt for about 2.5 million North Carolinians.

The relief applies to two main groups: Medicaid patients, whose hospital debt dating back to 2014 is forgiven, and lower-income patients with incomes at or below 350% of the federal poverty level — about $100,000 a year for a family of four — or whose hospital debt exceeds 5% of their income. For the non-Medicaid group, the program forgives hospital debt more than two years old, but not newer bills.

A second bill with no relief in sight from NC

Earlier this year, when his doctor again recommended a colonoscopy, Edge said he explained what had happened three years earlier and asked to make sure the anesthesia would be covered this time. After his doctor’s office assured him it would be, he went ahead with the procedure.

A few weeks later, another bill arrived — this time for just over $1,000 — after his insurer again denied the anesthesia coverage, he said. The charge pushed him back into familiar territory: another balance he couldn’t easily pay.

Undue Medical Debt told The N&O that the bill is likely too recent to qualify for relief under the state’s program, which only applies to older hospital debt.

“I think I make decent money, but it’s not enough decent money to take care of a family household that has such issues as ours,” Edge said.

His wife, he said, does not work so she can stay home caring for their family and drive their autistic stepson to doctors and therapists each week. She is uninsured because adding her to his plan offered through his work would raise his weekly premium from about $50 to roughly $200 — about $10,000 a year, he said.

His high-deductible insurance plan from Blue Cross Blue Shield of North Carolina doesn’t cover much of anything — except some preventive care — until he pays about $5,000 out of pocket, he said.

Families with plans with high out-of-pocket expenses remain especially vulnerable to piling up medical debt.

And even higher-income households aren’t immune. A KFF Health News analysis found that 45% of adults with annual household incomes above $90,000 reported having medical debt in the past five years.

Those uninsured are also at risk. And following several major changes in the health care landscape, projections show many across the nation are expected to lose coverage.

The nonpartisan Congressional Budget Office estimates that, compared with coverage levels before President Donald Trump’s One Big Beautiful Bill took effect, the law will leave 10 million more people uninsured by 2034 — including 7.5 million fewer with Medicaid coverage and 2.1 million fewer with marketplace plans created via the Affordable Care Act.

When those effects are combined with the possible expiration of the Affordable Care Act’s enhanced premium tax credits, the number of uninsured people is projected to increase by more than 14 million nationwide by 2034, according to KFF.

The One Big Beautiful Bill will also eventually end the mechanism North Carolina uses to require debt forgiveness and charity-care protections of hospitals participating in its medical debt program, said Jonathan Kappler, deputy secretary for external affairs at the state Department of Health and Human Services. That means the program would end and debt accumulated once it’s gone would not be erased unless hospitals choose to do so on their own or keep the stronger charity-care standards.

Compounding those pressures, premiums are set to rise even without accounting for the loss of enhanced subsidies. In North Carolina, the Department of Insurance has approved 2026 marketplace premium increases ranging from 12.66% to 36.40%, depending on the insurer. Nearly 1 million North Carolinians rely on the federal Health Insurance Marketplace for coverage.

Medical bills mount

When he received the medical bill in 2022 that was later erased, Edge was coming off a stretch of heavy medical expenses. In 2021, he hit his deductible after being diagnosed with skin cancer. He said he spent about $5,000 toward that deductible and was only able to manage it with help from one of his stepsons, who lent him $3,000.

That year, he also went to the emergency room several times, each visit costing about $200 upfront and followed by more bills in the mail, he said. Because he had met his deductible, insurance covered part of those costs.

Edge is now cancer-free but still goes for annual checkups to monitor for recurrence.

Beyond the medical debt, Edge said he’s often close to maxing out his credit cards, which hover around 75% of their limits. Between all his cards, he said he owes about $14,000.

And his finances are only getting tighter.

Edge has been with the HVAC company for a decade. But this year, the company stopped allowing overtime — which he said helped him stay afloat — and two months ago laid off seven employees.

He’s now doing a side job in construction on weekends to compensate for the loss.

“I hate to say this, but I live week to week,” he said. “Right now, if an emergency were to come up, I don’t have any money to pay for any emergency services or doctor bills or anything like that.”

How are health care costs affecting you? We want to hear from you.

Are you facing higher insurance premiums, denied coverage or medical debt? Have you delayed or avoided treatment because of costs? The News & Observer is reporting on health care access and affordability in North Carolina and wants to hear from people across the state.If you’re willing to share, please email lperezu@newsobserver.com with a brief description of your experience and the best way to reach you.