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By Noam N. Levey, KFF Health News Worried that President-elect Donald Trump will curtail federal efforts to take on the nation’s medical debt problem, patient and consumer advocates are looking to states to help people who can’t afford their medical bills or pay down their debts. “The election simply shifts our focus,” said Eva Stahl, who oversees public policy at Undue Medical Debt, a nonprofit that has worked closely with the Biden administration and state leaders on medical debt. “States are going to be the epicenter of policy change to mitigate the harms of medical debt.” New state initiatives may not be enough to protect Americans from medical debt if the incoming Trump administration and congressional Republicans move forward with plans to scale back federal aid that has helped millions gain health insurance or reduce the cost of their plans in recent years. Comprehensive health coverage that limits patients’ out-of-pocket costs remains the best defense against medical debt. But in the face of federal retrenchment, advocates are eyeing new initiatives in state legislatures to keep medical bills off people’s credit reports, a consumer protection that can boost credit scores and make it easier to buy a car, rent an apartment, or even get a job. Several states are looking to strengthen oversight of medical credit cards and other financial products that can leave patients paying high interest rates on top of their medical debt. Related Articles Some states are also exploring new ways to compel hospitals to bolster financial aid programs to help their patients avoid sinking into debt. “There’s an enormous amount that states can do,” said Elisabeth Benjamin, who leads health care initiatives at the nonprofit Community Service Society of New York. “Look at what’s happened here.” New York state has enacted several laws in recent years to rein in hospital debt collections and to expand financial aid for patients, often with support from both Democrats and Republicans in the legislature. “It doesn’t matter the party. No one likes medical debt,” Benjamin said. Other states that have enacted protections in recent years include Arizona, California, Colorado, Connecticut, Florida, Illinois, Minnesota, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, and Washington. Many measures picked up bipartisan support. President Joe Biden’s administration has proved to be an ally in state efforts to control health care debt. Such debt burdens 100 million people in the United States, a KFF Health News investigation found . Led by Biden appointee Rohit Chopra, the Consumer Financial Protection Bureau has made medical debt a priority , going after aggressive collectors and exposing problematic practices across the medical debt industry. Earlier this year, the agency proposed landmark regulations to remove medical bills from consumer credit scores. The White House also championed legislation to boost access to government-subsidized health insurance and to cap out-of-pocket drug costs for seniors, both key bulwarks against medical debt. Trump hasn’t indicated whether his administration will move ahead with the CFPB credit reporting rule, which was slated to be finalized early next year. Congressional Republicans, who will control the House and Senate next year, have blasted the proposal as regulatory overreach that will compromise the value of credit reports. And Elon Musk, the billionaire whom Trump has tapped to lead his initiative to shrink government, last week called for the elimination of the watchdog agency . “Delete CFPB,” Musk posted on X. If the CFPB withdraws the proposed regulation, states could enact their own rules, following the lead of Colorado, New York, and other states that have passed credit reporting bans since 2023. Advocates in Massachusetts are pushing the legislature there to take up a ban when it reconvenes in January. “There are a lot of different levers that states have to take on medical debt,” said April Kuehnhoff, a senior attorney at the National Consumer Law Center, which has helped lead national efforts to expand debt protections for patients. Kuehnhoff said she expects more states to crack down on medical credit card providers and other companies that lend money to patients to pay off medical bills, sometimes at double-digit interest rates. Under the Biden administration, the CFPB has been investigating patient financing companies amid warnings that many people may not understand that signing up for a medical credit card such as CareCredit or enrolling in a payment plan through a financial services company can pile on more debt. If the CFPB efforts stall under Trump, states could follow the lead of California, New York, and Illinois, which have all tightened rules governing patient lending in recent years. Consumer advocates say states are also likely to continue expanding efforts to get hospitals to provide more financial assistance to reduce or eliminate bills for low- and middle-income patients, a key protection that can keep people from slipping into debt. Hospitals historically have not made this aid readily available, prompting states such as California, Colorado, and Washington to set stronger standards to ensure more patients get help with bills they can’t afford. This year, North Carolina also won approval from the Biden administration to withhold federal funding from hospitals in the state unless they agreed to expand financial assistance. In Georgia, where state government is entirely in Republican control, officials have been discussing new measures to get hospitals to provide more assistance to patients. “When we talk about hospitals putting profits over patients, we get lots of nodding in the legislature from Democrats and Republicans,” said Liz Coyle, executive director of Georgia Watch, a consumer advocacy nonprofit. Many advocates caution, however, that state efforts to bolster patient protections will be critically undermined if the Trump administration cuts federal funding for health insurance programs such as Medicaid and the insurance marketplaces established through the Affordable Care Act. Trump and congressional Republicans have signaled their intent to roll back federal subsidies passed under Biden that make health plans purchased on ACA marketplaces more affordable. That could hike annual premiums by hundreds or even thousands of dollars for many enrollees, according to estimates by the Center on Budget and Policy Priorities, a think tank. And during Trump’s first term, he backed efforts in Republican-led states to restrict enrollment in their Medicaid safety net programs through rules that would require people to work in order to receive benefits. GOP state leaders in Idaho, Louisiana, and other states have expressed a desire to renew such efforts. “That’s all a recipe for more medical debt,” said Stahl, of Undue Medical Debt. Jessica Altman, who heads the Covered California insurance marketplace, warned that federal cuts will imperil initiatives in her state that have limited copays and deductibles and curtailed debt for many state residents. “States like California that have invested in critical affordable programs for our residents will face tough decisions,” she said. ©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

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Where to Watch Carolina Hurricanes vs. New York Islanders on TV or Streaming Live – December 7House Democrats Jim McGovern of Massachusetts and Rosa DeLauro of Connecticut say their Republican colleagues in Congress caved to the demands of Elon Musk , sinking a bipartisan government funding bill that would have regulated U.S. investments in China. > Philadelphia news 24/7: Watch NBC10 free wherever you are Congress passed a separate stopgap funding bill over the weekend, averting a government shutdown. In a series of posts on X, McGovern said more could have been accomplished. The scrapped provision "would have made it easier to keep cutting-edge AI and quantum computing tech — as well as jobs — in America," he wrote. "But Elon had a problem." Tesla , run by Musk, is the only foreign automaker to operate a factory in China without a local joint venture. Tesla also built a battery plant down the street from its Shanghai car factory this year, and aims to develop and sell self-driving vehicle technology in China. "His bottom line depends on staying in China's good graces," McGovern wrote about Musk. "He wants to build an AI data center there too — which could endanger U.S. security. He's been bending over backwards to ingratiate himself with Chinese leaders." SpaceX, Musk's aerospace and defense contractor, has reportedly withheld its Starlink satellite internet service over Taiwan at the request of Chinese and Russian leaders. Taiwan is a self-ruling democracy that Beijing claims as its territory. Taiwan's status is one of the biggest flashpoints in U.S.-China relations. DeLauro, the top Democrat on the House Appropriations Committee, wrote in a letter to Congress on Friday that Musk needs "Chinese government approvals for his company's projects in the country." It's concerning, that Musk "has ingratiated himself with Chinese Communist Party leadership," she wrote. In the letter, DeLauro referred to the Tesla and SpaceX CEO as "President" Musk, alluding to the fact that the world's richest person began railing against the prior funding bill on Wednesday, before President-elect Donald Trump came out with a statement of his own. Trump had wanted the GOP to sink the bill, and issue a new one that would raise the debt ceiling so he could avoid that fight during the start of his second term in office. The stopgap funding bill, which President Joe Biden signed on Saturday, did not include the two-year suspension of the U.S. debt limit that Trump was seeking. Musk responded to DeLauro's concerns by calling her an "awful creature" in a post on X. After acquiring Twitter in 2022, Musk rebranded it X and used it to help propel Trump back into the White House, becoming a close adviser and major backer to the incoming president along the way. Musk contributed $277 million to the Trump campaign and other Republican causes during the 2024 cycle, according to Federal Election Commission filings. Since the election in November, Musk has become a nearly constant presence at Trump's side, including in meetings with foreign leaders . Trump appointed Musk to co-lead a group that's not yet formed, but will be tasked with finding ways to cut regulations, personnel and budgets. WATCH: Musk's influence on government

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