July 2025 Alumni Spotlight

Allison Sesso, MPA ’04

You joined Undue Medical Debt at the dawn of the pandemic. What were some unique challenges of that time?
The biggest hurdle at that time was our efforts to establish a workflow directly with providers like hospitals and physicians’ groups. Historically we have sourced and erased the most burdensome medical debts from “the secondary debt market” — collection agencies and debt buyers who had already acquired debts from providers like hospitals. In 2020 we were given special dispensation from the Office of the Inspector General, Health and Human Services to work directly with providers. This critical decision unlocked a new source of debt for our growing organization. But getting busy institutions to engage with a new player in the healthcare space is no small feat and required investing in smart, hardworking people and giving them operational support.

The other challenge in the midst of the early pandemic was how to leverage our unique model to address this novel, global crisis. Hospitals were overwhelmed and medical debt was absolutely a consequence of so many needing emergency care, but we wouldn’t be able to acquire that debt immediately. That’s when we landed on the Helping COVID Heroes campaign where we identified frontline responders like nurses, home health aids, social workers and more and we raised money to acquire and erase their outstanding medical debts. I was very proud that our team could meet the moment and center those folks on the frontlines of this pandemic.

Undue Medical Debt offers aid to ease the effects of our flawed medical system. What are the major barriers that keep this system from working as it should?
Medical debt is a uniquely American injustice. It prevents millions from achieving financial stability while creating mental anguish. There are many causes behind our dysfunctional healthcare system, here are some of the leading issues:

Despite 92% of the population being insured as of 2022, medical debt remains a crisis to the tune of over $220 billion. This suggests that many health insurance programs are inadequate, which we see in the prevalence of high-deductible health plans, premium prices outmatching wage growth and “skimpy” health plans like faith ministries or even Medicare Advantage plans for seniors which don’t offer robust coverage.
Many people are not prepared with savings for the unexpected costs of medical bills; half of adults in the U.S. don’t have $500 for an emergency healthcare expense. Yet the system routinely calls for out-of-pocket costs beyond the patient’s means.

Prices for care are out of sync with people’s incomes. Many patients with burdensome medical debt delay the care they need out of fear they’ll accrue more debt. Medical debt is a debt of necessity, yet many unfortunately feel as if they’ve done something wrong. People skip care to avoid incurring more medical debt. For example, prescription drug prices have historically been poorly regulated, leaving many with chronic conditions (Diabetes and Cancer especially) on the hook for drugs they can’t afford leading to rationing insulin or skipping medicine altogether.
Historical and systemic racism is also a huge barrier to care. People of color are statistically more likely to have medical debt due to a complex array of factors including having symptoms or pain discounted by providers and social determinants of health like being more likely to live in areas that lack access to fresh food or adequate access to preventative services, etc. Black adults are 50 percent more likely and Hispanic adults are 35 percent more likely to hold medical debt compared to white adults.

What is the future of Undue Medical Debt? Medical debt in general?
Undue’s goal is to transform the healthcare system by ending medical debt altogether, to make medical debt relief unnecessary. Spearheading the organization’s growth and bold vision for a future where the causes of medical debt are undone, we have worked to expand Undue’s policy and program team to more intentionally influence systemic change. We will continue to streamline and expand our debt buying and relief capabilities, help inform both state-level and national policy on medical debt by centering the lived experience of families and we hope to leverage our data on which communities are most impacted by medical debt to inform research and help our hospital partners catch those falling through the cracks.
As far as the future of medical debt, it’s looking quite uncertain and will likely get much worse since the “One Big Beautiful Bill Act” has been passed by Congress. It includes deep cuts to Medicaid, onerous eligibility requirements and the end of subsidies for families to access discounted health insurance plans on the marketplace through the ACA. Third Way estimates that medical debt could increase nationally by $50 billion.

Can you tell us about your experience in the MPA program at the Marxe School?
What I remember most about my Marxe school experience was the incredible caliber of professors. I took classes with experienced public servants at high levels, like the head of the NYC Office of Management and Budget. But I also had dedicated tenured professors challenging me on ethical and political questions. This combination helped to shape my understanding of how real-world decisions are made that shape public policies and discourse.