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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The Environmental Protection Agency this week banned a toxic chemical commonly used in dry cleaning and other consumer products.

Trichloroethylene and perchloroethylene have been used for decades and are known to affect the liver, brain, kidney and immune and nervous systems. Research shows dry-cleaning and laundry workers are at increased risk of dying from cancer.

Jennifer Orme-Zavaleta, former principal deputy assistant administrator for science at the EPA Office of Research and Development, said businesses will be required to use alternatives and employees will be safer at work, adding the changes also affect surrounding communities.

"If you happen to live near a dry-cleaning facility, you know there would be the potential for the ground to be contaminated and for these chemicals to get into the water supply," Orme-Zavaleta pointed out.

California has been ahead of the curve. In 2007, the state banned installations of new perchloroethylene dry-cleaning machines, required existing ones be shut down by 2010, and required a complete ban of use of the chemical by 2023.

Orme-Zavaleta noted many environmental statutes are aimed at cleaning up hazardous chemicals. While recent legislation has enabled the EPA to more effectively reduce exposures or prevent them from happening in the first place, she stressed the effort takes time and resources.

"The agency's been playing a lot of catch up," Orme-Zavaleta acknowledged. "They need to keep going, but they also need to be looking to the future, especially looking at some of the new chemicals coming into commerce."

According to the advocacy group Heal the Planet, the dry-cleaning industry uses hundreds of millions of gallons of solvents such as perchloroethylene every year, the chemical's airborne particles are difficult to detect in the air and can linger for weeks.


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Kentucky residents are being notified about their lead water pipes that could be posing a health danger. According to an EPA report, around 40,000 service lines in the Commonwealth contain lead, and earlier this year the agency announced a new rule requiring drinking water utilities in all states to identify and replace lead pipes within ten years.

Dr. Leah Werner, family physician and assistant professor at Oregon Health and Science University, said the federal change increases water sampling and transparency about lead between communities and local governments, and added that there are actions residents can take, too.

"People can also test their own water, and really the best way to do that is to look at your either your city government website, and beyond that, the government is mandated to help you with testing kits, but Home Depot and places like that also sell lead testing kits," she explained.

The mailed notices from utilities will confirm whether or not a home relies on lead water lines, or if the piping materials is unknown, and if any pipes need to be replaced.

Werner added that if a family is concerned that they and their children may be exposed to lead, it's important to visit a primary-care physician as soon as possible, who can also be a guide through the process of testing and treatment for lead exposure.

"Lead crosses the placenta, so that is really dooming a fetus before even being born, to the same sort of cognitive impairments and behavioral issues that children who are exposed to lead suffer," Werner continued.

According to the CDC, exposure to lead can reduce IQ in children and be a primary driver to learning disabilities and Attention Deficit/Hyperactivity Disorder, permanently damage the brain and nervous system, and cause speech and hearing problems.


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If your holiday shopping list is far from complete, consumer advocates in Nebraska hope you don't ignore warning signs of scams in the rush to buy gifts.

In a digital world, there are always new things to pay attention to.

Over the past few years, shoppers have been warned about avoiding gift card scams, or not falling prey to phony texts about a shipment delay.

Jina Ragland - associate state director of advocacy and outreach for AARP Nebraska - said the emergence of cryptocurrency in the online trading world presents another challenge, including during the holiday shopping crunch.

"Scammers and fraudsters are using the same types of scams that they've used in the past," said Ragland, "but they're now soliciting people to pay them through the cryptocurrency ATMs, using things such as bitcoins and that."

AARP says if you're directed to send someone money by converting cash to cryptocurrency at a convenience store kiosk, it's a scam.

As for other tips, experts note scammers can tamper with gift cards on store racks and steal the funds when the card is activated.

They say it's best to ask for a gift card sold behind the counter. They also advise regularly updating software on your electronic devices for additional fraud protection.

Ragland said if you get a call from someone initiating a scam about a purchase you never made, asking for a call-back number will quickly get their attention.

"Typically, you will find if you do ask for a call-back number, they're going to hang up on you immediately," said Ragland, "because they've not gotten what they need and they want it, and they know you're on to them. "

Overall, Ragland said a key thing to remember is, if you see an online ad for something that appears too good to be true in terms of price, it's usually a fishy deal.

Shoppers are also encouraged to take advantage of tracking information and other shipping supplier services, and to schedule deliveries for when you or someone you trust is present to receive them.