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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. 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.

BATON ROUGE, La. (AP) — Louisiana's Republican-controlled Legislature approved a constitutional amendment on Friday that would allow them to expand the number of crimes in which juveniles between 14 and 16 years old could be tried as adults. The state's constitution currently outlines 15 violent juvenile offenses, such as rape, murder and armed robbery, which prosecutors can handle in adult courts. Any changes to that list of crimes must be approved by voters. But the constitutional amendment sponsored by Republican Sen. Heather Cloud — which require voter approval in March 29 elections to take effect — would allow legislators the power by a two-thirds vote to decide what juvenile crimes can be transferred to adult courts. It's part of a wider push in Louisiana, which already has the second-highest incarceration rate in the country behind Mississippi, to implement tough-on-crime policies under Republican Gov. Jeff Landry. Since taking office in January, Landry has passed laws to treat 17-year-olds as adults in the criminal justice system, largely eliminate parole and allow surgical castration as punishment for certain sex crimes against children. Supporters of the measure to make it easier to expand prosecution of juveniles as adults — backed only by Republican legislators — say it will grant lawmakers more flexibility to give prosecutors the tools they need to increase public safety. Vesting authority in the constitution "has hamstringed Louisiana from being able to address changes in an ever-changing juvenile crime landscape,” Cloud said on the Senate floor on Nov. 14. Opponents, including Democrats, social workers and criminal justice reform advocates, said specific offenses routing juveniles to adult courts should remain part of the constitution to keep this power in the hands of voters. “We’re taking the people’s voice away over how children should be treated in this state,” Democratic Sen. Katrina Jackson-Andrews said. Critics also argue the changes fail to confront the root causes of juvenile crime, namely poverty and underinvestment in education. Transferring juveniles into adult court would also prevent them from accessing age-appropriate rehabilitative services, criminal justice reform advocates and social workers testified during the legislative session. “I can view this in no other way than just giving up on children,” Democratic Sen. Royce Duplessis said on the Senate floor. “We’re going to say we’re just going to treat them all as adults, and we’re not going to do our part as a society, as policymakers, to address what’s really failing — this is not going to do a single thing to deter crime." Some lawmakers said that juveniles committing violent crimes had been deprived of care from a young age and were past the point of rehabilitation, blaming their families as opposed to societal factors. “Some of these kids are already lost when they’re 2 years old,” said Republican Rep. Tony Bacala in a House committee hearing. Unless they are transferred to an adult court, young people tried in juvenile court can only be imprisoned until age 21 according to state law. The effect of the proposed constitutional change will be to open the door for Republican lawmakers to give prosecutors the power to hand down lengthy prison sentences to 14- to 16-year-olds, including for less severe crimes, said Bruce Reilly, deputy director of the Louisiana-based criminal justice reform advocacy group Voice of the Experienced. The Louisiana District Attorneys Association and the Louisiana Sheriffs' Association said they supported the measure. But New Orleans Sheriff Susan Hutson said she was concerned the measure would “almost certainly further strain our already short staff” in the jail system. Federal law still considers 17-year-olds and younger as juveniles and requires them to be kept separate from adult inmates. District Attorney Tony Clayton, who represents West Baton Rouge and two other parishes, said he would not try a juvenile as an adult for having “marijuana in his wallet,” but for violent crimes. Violent crimes are on the decline nationwide according to the latest data from FBI’s Uniform Crime Reporting. Since mid-2023, most violent crime has also been down in New Orleans, which in 2022 had the highest homicide rate among large cities nationwide. Conservative lawmakers argued this was the result of tough-on-crime penalties passed this year and Republican Gov. Jeff Landry's decision to send state troops to New Orleans. Lawmakers supporting the amendment have focused on high-profile violent crimes by juveniles, such as a deadly New Orleans carjacking case committed by teenagers — who were charged as adults — in which an elderly woman was beaten and dragged to her death. Louisiana is one of five states that classifies 17-year-olds as adults in the criminal justice system, according to the National Conference of State Legislatures. Brook is a corps member for The Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues. Follow Brook on the social platform X: @jack_brook96SEATTLE (AP) — The Seattle Seahawks rode their dominant defense to a big win over a division rival to vault into first place in the NFC West. No, it isn’t 2013. These are the 2024 Seahawks, who, after struggling mightily against the run earlier this season, held the visiting Arizona Cardinals to 49 rushing yards in Sunday's 16-6 victory . Javascript is required for you to be able to read premium content. Please enable it in your browser settings. Get the latest sports news delivered right to your inbox six days a week.

Nissan and Honda to attempt a merger that would create the world's No. 3 automaker TOKYO (AP) — Japanese automakers Nissan and Honda have announced plans to work toward a merger that would catapult them to a top position in an industry in the midst of tectonic shifts as it transitions away from its reliance on fossil fuels. The two companies said they signed an agreement on integrating their businesses on Monday. Smaller Nissan alliance member Mitsubishi Motors agreed to join the talks. News of a possible merger surfaced earlier this month. Japanese automakers face a strong challenge from their Chinese rivals and Tesla as they make inroads into markets at home and abroad. What a merger between Nissan and Honda means for the automakers and the industry BANGKOK (AP) — Japanese automakers Honda and Nissan will attempt to merge and create the world’s third-largest automaker by sales as the industry undergoes dramatic changes in its transition away from fossil fuels. The two companies said they had signed a memorandum of understanding on Monday and that smaller Nissan alliance member Mitsubishi Motors also had agreed to join the talks on integrating their businesses. Honda will initially lead the new management, retaining the principles and brands of each company. Following is a quick look at what a combined Honda and Nissan would mean for the companies, and for the auto industry. Nordstrom to be acquired by Nordstrom family and a Mexican retail group in $6.25 billion deal Century-old department store Nordstrom has agreed to be acquired and taken private by Nordstrom family members and a Mexican retail group in a $6.25 billion deal. Nordstrom shareholders will receive $24.25 in cash for each share of Nordstrom common stock, representing a 42% premium on the company’s stock as of March 18. Nordstrom’s board of directors unanimously approved the the proposed transaction, while Erik and Pete Nordstrom — part of the Nordstrom family taking over the company — recused themselves from voting. Following the close of the transaction, the Nordstrom Family will have a majority ownership stake in the company. An analyst looks ahead to how the US economy might fare under Trump WASHINGTON (AP) — President-elect Donald Trump won a return to the White House in part by promising big changes in economic policy — more tax cuts, huge tariffs on imports, mass deportations of immigrants working in the United States illegally. In some ways, his victory marked a repudiation of President Joe Biden’s economic stewardship and a protest against inflation. It came despite low unemployment and steady growth under the Biden administration. What lies ahead for the economy under Trump? Paul Ashworth of Capital Economics spoke recently to The Associated Press. The interview has been edited for length and clarity. American consumers feeling less confident in December, Conference Board says American consumers are feeling less confident in December, a business research group says. The Conference Board said Monday that its consumer confidence index fell back in December to 104.7 from 112.8 in November. Consumers had been feeling increasingly confident in recent months. The consumer confidence index measures both Americans’ assessment of current economic conditions and their outlook for the next six months. The measure of Americans’ short-term expectations for income, business and the job market tumbled more than a dozen points to 81.1. The Conference Board says a reading under 80 can signal a potential recession in the near future. Stock market today: Wall Street rises at the start of a holiday-shortened week Stocks closed higher on Wall Street at the start of a holiday-shortened week. The S&P 500 rose 0.7% Monday. Several big technology companies helped support the gains, including chip companies Nvidia and Broadcom. The Dow Jones Industrial Average added 0.2%, and the Nasdaq composite rose 1%. Honda's U.S.-listed shares rose sharply after the company said it was in talks about a combination with Nissan in a deal that could also include Mitsubishi Motors. Eli Lilly rose after announcing that regulators approved Zepbound as the first prescription medicine for adults with sleep apnea. Treasury yields rose in the bond market. The internet is rife with fake reviews. Will AI make it worse? Researchers and watchdog groups say the emergence of generative artificial intelligence tools that allow people to efficiently produce detailed and novel online reviews has put merchants, service providers and consumers in uncharted territory. Phony reviews have long plagued many popular consumer websites, such as Amazon and Yelp. But AI-infused text generation tools enable fraudsters to produce reviews faster and in greater volume, according to tech industry experts. The deceptive practice is illegal in the U.S. and becomes a bigger problem for consumers during the holiday shopping season, when many people rely on reviews to buy gifts. A tech company and watchdog group that uses software to detect fake reviews says AI-generated reviews have multiplied. Romanian lawmakers narrowly approve new pro-European coalition during period of political turmoil BUCHAREST, Romania (AP) — Romanian lawmakers have voted narrowly in favor of a new pro-European coalition government led by incumbent Prime Minister Marcel Ciolacu. The move on Monday could usher in an end to a protracted political crisis in the European Union country following the annulment of a presidential election. Parliament approved the new administration in a 240-143 vote in the 466-seat legislature. The new coalition is made up of the leftist Social Democratic Party, the center-right National Liberal Party, the small ethnic Hungarian UDMR party and national minorities. President Klaus Iohannis swore in the new government on Monday night. Government regulators close investigation into Ford Focus recalls Government safety regulators are closing an investigation into two previous recalls of the Ford Focus after determining that Ford Motor Co. has satisfied its concerns. Ford recalled around 1.5 million Ford Focus sedans from the 2012-2018 model years in 2018 because they could lose power. The issue was a malfunctioning canister purge valve and software that didn’t adequately detect when it was stuck open. Ford fixed the software in two separate recalls, but after cars continued to stall, the government opened an inquiry last year. Earlier this fall, Ford offered to replace the canister purge valve on all of the vehicles, satisfying regulators' concerns. AI will eavesdrop on world's wildest places to track and help protect endangered wildlife PUERTO JIMÉNEZ, Costa Rica (AP) — A biologist hid 350 audio monitors across Costa Rica’s tropical rainforests to spy on endangered spider monkeys in order to help protect them. But she had to go back to collect the data and feed those sounds into artificial intelligence systems that can recognize monkey calls. Now tech giant Microsoft's philanthropic arm is hoping to supercharge AI-assisted wildlife research with new solar-powered devices that can capture sounds, images and other wilderness data for a year or more without human intervention. Researchers say more AI wildlife surveillance is urgently needed to monitor the health of species at risk of extinction.

LAFAYETTE, La. (AP) — Michael Gray Jr. had 19 points and Byron Ireland made two free throws with 6 seconds left to rally Nicholls to a 76-75 victory over Louisiana on Saturday night. Gray shot 6 for 11, including 5 for 10 from beyond the arc for the Colonels (4-4). Jamal West added 15 points and nine rebounds. Jaylen Searles hit three 3-pointers and scored 15. Ireland also finished with 15 points. Javascript is required for you to be able to read premium content. Please enable it in your browser settings. Get updates and player profiles ahead of Friday's high school games, plus a recap Saturday with stories, photos, video Frequency: Seasonal Twice a week

Biden’s decision to commute sentences for death row inmates sparks social media frenzyF-35C stealth fighter makes combat debut with US Marine Corps air strikes