After helping Occupy Wall Street activists buy debt for a few years, Antico and Ashton launched RIP Medical Debt in 2014. They started raising money from donors to buy up debt on secondary markets — where hospitals sell debt for pennies on the dollar to companies that profit when they collect on that debt.

RIP buys the debts just like any other collection company would — except instead of trying to profit, they send out notices to consumers saying that their debt has been cleared. To date, RIP has purchased $6.7 billion in unpaid debt and relieved 3.6 million people of debt. The group says retiring $100 in debt costs an average of $1.

RIP bestows its blessings randomly. Sesso says it just depends on which hospitals’ debts are available for purchase. “So nobody can come to us, raise their hand, and say, ‘I’d like you to relieve my debt,'” she says.

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Sesso emphasizes that RIP’s growing business is nothing to celebrate. It means that millions of people have fallen victim to a U.S. insurance and health care system that’s simply too expensive and too complex for most people to navigate. As NPR and KHN have reported, more than half of U.S. adults say they’ve gone into debt in the past five years because of medical or dental bills, according to a KFF poll. A quarter of adults with health care debt owe more than $5,000. And about 1 in 5 with any amount of debt say they don’t expect to ever pay it off.

Read more in NPR.