Nearly one in three Americans carry some form of medical debt, and consumer groups are warning patients about the risk of medical bankruptcy posed by some hospital billing practices.

Adam Fox, deputy director of the Colorado Consumer Health Initiative, said hospitals are a significant driver of health care costs, in part because consumers have no way of knowing what the price of care will be, or if the cost is reasonable.

"Because of the lack of transparency in health care billing, and hospital billing in particular, this puts consumers at risk of medical debt and unexpectedly high bills," Fox explained.

The costs of care at hospitals are dramatically different across the country. A recent analysis found the highest and lowest prices for standard outpatient services varied by nearly 300%.

In 2019, Colorado passed legislation protecting some consumers from surprise billing, and Congress expanded protections nationwide with the No Surprises Act in 2020.

Many hospitals ask patients to pay for care using medical credit cards, which do not count as medical debt and can show up on your credit report.

Jim Manley, board member of Consumers for Quality Care, said if charges are not paid off in full, patients often see their hospital bill balloon after introductory interest rate periods end.

"The interest charge on medical credit cards often start at 0%, and go on for a period of time," Manley noted. "But when interest rates do kick in, it can often be higher than 25%."

The Internal Revenue Service requires nonprofit hospitals to have financial assistance programs, but only 42% told patients they qualify, and 45% routinely send bills to patients who quality for charity care.

Fox pointed out Colorado has had laws on the books since 2012 requiring hospitals to screen uninsured patients for financial need, and insured people can also be eligible for assistance.

"But they have to ask to be screened, and I think that's where a lot of patients get into a challenge," Fox emphasized. "They may not necessarily realize or know to ask about financial assistance."


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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."

By Nina B. Elkadi for Sentient.
Broadcast version by Nadia Ramlagan for West Virginia News Service reporting for the Sentient-Public News Service Collaboration

Egg prices have never been this high. To address this, newly appointed United States Department of Agriculture Secretary Brooke Rollins recently outlined a five-pronged plan to address high egg prices for American consumers: including potentially importing eggs. Importing eggs is not the norm in the United States, especially considering this country is the second-largest egg exporter in the world. We produce over 100 billion eggs per year, millions of which go to Canada and Mexico.

The U.S. plans to import 420 million eggs from Turkey - barely a drop in the 100 billion-eggs-annually bucket. Even if the U.S. imported one billion eggs, that would only lower prices by a small percentage, Associate Dean of the School of Public Policy at UC Riverside Bruce Babcock tells Sentient. If the U.S. wanted to lower prices by, say, 10 percent, it would need to import close to 2 billion eggs, he says. And by the time that happens, more chickens will likely have been culled - meaning the "lower" price may still be much higher for consumers than pre-avian flu levels.

In order to keep up with avian flu, which is still spreading, the U.S. would need to import billions, not millions of eggs. Other countries also might not want their own domestic egg supplies to diminish, which could in turn raise their prices.

"Whether or not we can actually import that many eggs to have that kind of price effect is probably not possible, because other countries don't have that many surplus eggs, and if they did try to export that many eggs to the United States, their egg prices would rise dramatically," Babbock says. "It's not clear that it's feasible, but is it theoretically possible? Yes."

Importing Eggs: a Fragile Plan

Eggs are incredibly fragile and need to be refrigerated, making them an expensive commodity to trade, explains James Mitchell, Assistant Professor and Extension Livestock Economist at the University of Arkansas. "Think about how careful you have to be transporting eggs from the grocery store to your house," Mitchell tells Sentient.

As avian influenza continues to spread, each day resulting in the death of thousands of chickens (killed by culling), the U.S. government is scrambling to get a hold of how to keep costs low for consumers. Thus far, they have not been successful, and importing eggs seems like one of the least economically viable options considering the scale of the problem.

Factory Farms Have Boosted Cheap Egg Supply, But at a Cost to Public Health

Over 99 percent of farmed animals are raised in concentrated animal feeding operations (CAFOs), where they often do not have room to move around or see daylight. According to a new report by Food & Water Watch, the system is incredibly consolidated: 75 percent of egg-laying hens in the U.S. are raised on fewer than 350 factory farms, and the vast majority - 99 percent - of commercial laying hens impacted by bird flu lived on factory farms.

The efficiency of factory farms and increasing consolidation in agriculture has historically enabled eggs to be an extremely cheap commodity at the grocery store. Feed costs are low, and factory farms are highly efficient, churning out millions of eggs per month. But the true cost of these operations can be seen in their externalities: a lack of animal welfare, pollution and compromised worker safety.

"With regards to animal welfare, we're probably the worst country in the world with our battery cages," Babcock says. "Any country that crams those laying hens into little battery cages...It's just inhumane, in my opinion, but that's my opinion, because I care about animal welfare."

CAFOs are notorious breeding grounds for highly pathogenic diseases. Animals often defecate on top of one another and ventilation is scarce.

"When disease hits a production facility, and they have to destroy all the chickens that are laying hens, there's so many in one location that it disrupts the supply of eggs nationally to a much greater extent than if you had smaller production units spread out across the countryside," Babcock says. "Consolidation increases the risk to our food security. It doesn't decrease the risk."

When one chicken tests positive for avian influenza, the entire flock needs to be killed, though new secretary of Health and Human Services Robert F. Kennedy Jr. is interested in trying out "therapeutic drugs" on flocks to avoid culling.

Uncertainty About the Trump Administration's Avian Flu Plan

Advocates from across the aisle are calling for the federal government to intervene. Rollins responded with her plan to put $1 billion toward avian flu research. But with sweeping federal government cuts from the Department of Agriculture to the Food and Drug Administration, including within the avian flu research team, it is unclear how much will actually get done.

"The actions of the Trump administration to unilaterally disable key roles of government runs completely counter to the proper role of government in providing food security and food safety," Babcock says. "It's almost as if the Trump administration...[is] trying to actually disable the government functions in those areas, and one of them is in food safety."

Additionally, relying on imported eggs also relies on the notion that avian flu will not spread to, or highly affect, the countries the U.S. imports from. So far, avian flu has been detected in 108 countries.

"We don't have a crystal ball, so we don't know how this could look like for those other countries in a month, two months, two months, six months, a year from now," Mitchell says.

Both Mitchell and Babcock agree that the solution rests in collective action to restructure the industry. Mitchell says more research on vaccines and biosecurity are needed, and that the problem extends far beyond factory farms to migratory flocks, too, ushering a need for more cross-departmental collaboration.

"The public good is the ability for producers to produce in a disease-free environment," Babcock says. "Private industry does not provide public goods at the right level."


Nina B. Elkadi wrote this article for Sentient.


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