Pictures of large medical bills are sometimes shared on social media to show how patients can be blindsided by unexpected costs for care, but as the new year begins, consumers will be offered federal protections to avoid health-care sticker shock.

On Saturday, the No Surprises Act takes effect. Supporters said it will block out-of-network providers from sending large bills to patients who did not choose who cared for them in an emergency situation.

Patricia Kelmar, health care campaigns director for the Public Interest Research Group (PIRG), said getting statements in the mail can be very hard for the many Americans who don't have much in the savings accounts to cover the expenses.

"And when you think about the average out-of-network bill for anesthesia is $1,200, these costs can create a real burden on consumers and can lead to medical debt," Kelmar explained.

She noted under the law, your bill cannot be sent to collections while you have a complaint under review. Groups such as the American Medical Association have sued the federal government, saying while they back the law, they oppose the arbitration process drawn by regulators. And the North Dakota Health Information Management Association worries it could force smaller providers out of business.

The statewide group said consumer protections are needed, but argued the process caters to larger providers who have more patient volume.

Kelmar contends the law is trying to establish reasonable fees based on average contracted rates in a community.

"We're seeing higher-than-average, higher-than-market prices from many specialties that use surprise billing as a way to increase their profits," Kelmar contended.

She added more emergency rooms are being staffed by private-equity firms using contracted specialists.

Groups such as PIRG pointed out while the law will make a difference, they have suggested changes of their own. Kelmar noted the measure addresses air-ambulance service from-out-of-pocket providers, but leaves out ground transport.

"Your ground transportation, the ambulance that we think of when we call 911, those bills from an out-of-network ambulance could still be your financial responsibility," Kelmar cautioned.

According to federal estimates, the law will impact roughly 10 million surprise medical bills each year. Nearly 30 states have similar protections in place, but policy experts say they're often limited in scope. North Dakota is among the states without these protections.

People gathered outside Rocky Mountain Power headquarters in Salt Lake City on Tuesday, calling out the company for what they describe as "a strategy to keep Utah locked into high-cost, polluting fossil fuels."

The utility just released a new Integrated Resource Plan, which outlines how it will meet the state's energy demands.

Jonathan Whitesides, spokesperson for Rocky Mountain Power, acknowledged previous plans included more renewable resources but said the company tries to plan 20 years into the future and changes are almost inevitable. Electric rates could soon increase by more than 15% for residential customers if the Utah Public Service Commission approves a rate-hike request later this month.

"The commission has to determine, were we prudent in what we spent on behalf of the customers?" Whitesides explained. "Even though it is a 15.5%, the commission will determine whether that is reasonable and prudent."

Whitesides pointed out the rate increase would help cover costs associated with maintenance as well as energy projects, like the Rock Creek Wind Project in Wyoming. The company's latest plan also extends, rather than shortens, the life of coal operations in the state.

Stan Holmes, volunteer for the group Utah Needs Clean Energy, was at Tuesday's Salt Lake City event. He thinks costs will be passed onto Utahns if Rocky Mountain Power moves forward with its latest plan.

"It's not just the environmental community and the business community that's saying, 'What's going on here?' It's folks that have been tracking Rocky Mountain Power for a long time, saying, 'something smells wrong here,'" Holmes emphasized. "We're hoping the commissioners do now what they did 10 years ago, when they stopped Rocky Mountain Power from slapping a monthly surcharge on its rooftop solar customers."

Holmes called the utility's latest plan "terrible," but added he and others feel optimistic their message will be heard.

"When you take a look from an economic standpoint at what the future holds for Utah if we shift to clean renewables -- like geothermal, for example, which is given short shrift in this 20-year plan -- we wouldn't have any argument," Holmes contended.

President Donald Trump's administration has targeted the Consumer Financial Protection Bureau, so advocates for people in rural communities are pressing California lawmakers to step in.

Trump's new bureau director has moved to close the agency, claiming it had been weaponized against certain industries and individuals. The Republican-controlled House Financial Services Committee just voted to roll back a bureau rule on high bank overdraft fees.

Christine Chen Zinner, senior consumer policy counsel at the nonprofit Americans for Financial Reform, explained the rule's importance.

"This is a rule that would bring overdraft fees from $35 down to $5," Chen Zinner pointed out. "That would now save families $5 billion a year, or $225 per household per year that pays these overdraft fees."

Rural communities are often considered "banking deserts" with limited options for people to do their banking, making them more vulnerable to unfair business practices, which had been regulated by the bureau.

Zinner called on Rep. Adam Gray, R-Calif., Rep Jim Costa, D-Calif., and Rep. David Valadao, R-Calif., all from districts in the Central Valley, to oppose efforts to weaken banking rules.

"They can either represent their constituents who need these protections, especially as they live in these rural banking deserts or they could side with big banks," Zinner contended. "This is really an opportunity to show who they answer to."

A recent report from the HEAL Food Alliance found since 2011, the bureau has returned $21 billion to people who had been scammed and handled nearly 850,000 consumer complaints from the Golden State alone.

Navina Khanna, executive director of the HEAL Food Alliance, said people who are the most in need would feel the brunt of the cuts.

"Weakening or eliminating the CFPB is going to harm rural communities and working families the most," Khanna argued. "We're trying to make sure that our policymakers defend us by defending the CFPB."

The bureau has also worked to keep medical debt off people's credit reports and handled a deluge of fraud complaints after natural disasters like the Los Angeles wildfires.

Nevada legislators and conservation groups this week stood up for policies they say will help lower energy bills, protect the outdoors and grow the state's economy.

Kristee Watson, executive director of the Nevada Conservation League, said NCL is working to hold utility monopolies such as NV Energy and Southwest Gas accountable. A recent survey found that almost 90% of respondents agree that both utility companies must do more to keep bills affordable.

Watson said Nevada families are crunching numbers to cover expenses.

"It is our job to show up and tell our legislators that we're going to advocate for ourselves and the rest of everyday Nevadans," she said. "Times are tough, the fight is hard, I am frustrated, I am exhausted, I know all of us are. But this is also a worthwhile fight."

Watson said they're advocating for legislation to create ratepayer protections to ensure utilities spend customer dollars wisely and responsibly. Meanwhile, companies such as NV Energy and Southwest Gas have contended they're forced to raise rates to ensure all Nevadans receive quality service. NV Energy says it uses grants and other payment options to reduce consumer costs. Earlier this year, the company asked the state's Public Utility Commission to increase its base-rate charges.

Assemblyman Howard Watts, D-Las Vegas, called conservation and clean energy "quality of life issues." He said now is the time to address issues such as excessive heat, drought and wildfires by unlocking the potential of renewables. That's why he's sponsoring Assembly Bill 458, also known as the Solar-Power Affordable Housing bill, which he said "will expand the use of rooftop solar power in affordable-housing communities. These are residents who are dealing with these issues every day, but unfortunately they've been locked out from the benefits that solar energy can provide."

AB 458 awaits action in the Committee on Growth and Infrastructure.

Assemblyman Steve Yeager, D-Las Vegas, sponsored the bill that led to the creation of the Nevada Outdoor Education and Recreation Grant Program. He said the initiative provides outdoor experiences for Nevada students, and that continued support is vital.

"This grant is about equity and sustainability," he said. "It is about making sure that future generations inherit not just the beauty of Nevada's outdoors but the ability to enjoy it safely and responsibly."