In the next few weeks, tens of thousands of people in Cook County, Ill., will open their mailboxes to find a letter from the county government explaining that their medical debt has been paid off. Officials in New Orleans and Toledo, Ohio, are finalizing contracts so that tens of thousands of residents can receive a similar letter. In Pittsburgh on Dec. 19, the City Council approved a budget that would include $1 million for medical debt relief. More local governments are likely to follow as county executives and city councils embrace a new strategy to address the high cost of health care. They are partnering with RIP Medical Debt, a nonprofit that aims to abolish medical debt by buying it from hospitals, health systems and collections agencies at a steep discount. About 18 percent of Americans have medical debt that has been turned over to a third party for collection. Cook County plans to spend $12 million on medical debt relief and expects to erase debt for the first batch of beneficiaries by early January. In Lucas County, Ohio, and its largest city, Toledo, up to $240 million in medical debt could be paid off at a cost of $1.6 million. New Orleans is looking to spend $1.3 million to clear $130 million in medical debt. The $1 million in Pittsburgh's budget could wipe out $115 million in debt, officials said. These initiatives are all being funded by President Biden's trillion-dollar American Rescue Plan, which infused local governments with cash to spend on infrastructure, public services and economic relief programs.