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 state of Washington has launched an online system for tracking food poisoning cases.

The Washington State Health Department has opened its Foodborne Illness Notification System for filing complaints about food safety. Bill Marler, a food-safety lawyer in the state, said the system will rely on data to pinpoint potential food-safety hazards.

"If you get more and more people utilizing these services," he said, "just the sheer volume of the data will make it more useful because you get more angles to look at."

The Health Department says the system is anticipated to help with early detection of diseases, illness prevention, proactive safety measures and educational opportunities. The state has noted that one in six Americans suffers from food poisoning each year.

Marler said he believes the data collection will be helpful, but also notes that it isn't a panacea for stopping outbreaks. He said listeria is a good example: the period between consumption and onset of illness is between three and 70 days.

"I'm not sure I can remember what I ate three days ago, let alone what I ate 70 days ago," said Marler. "So, a lot of this analysis is sometimes flawed by people's memories and the incubation periods."

Marler added that listeria is also a pressing example because of the outbreak of it in deli meat. According to the Centers for Disease Control and Prevention, two people have died and 28 have been hospitalized from the current outbreak across the country, although no cases have been reported in Washington state.


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Big changes are imminent in the way homes are bought and sold, as the new forms for transactions in California come out today.

The forms are linked to the proposed legal settlement by the National Association of Realtors, which ends the long-standing practice of having a home seller's agent pay a commission to the buyer's agent. It benefited buyers who may not have saved up enough money to pay their agent.

George Lopez, a real estate agent in Indian Wells, explained buyers will now have to negotiate a separate contract to hire and pay their own agent.

"Even with these changes, a buyer can still purchase a home without having the money to pay their agent," Lopez explained. "The general public needs to understand that the real estate commissions have been, and will always be, negotiable - and that if they don't have money to pay their agent, they can still potentially negotiate it in their sale."

The lawsuit contended the old way of selling homes tended to drive up costs, as buyers' agents had more incentive to steer people to sellers willing to pay a higher commission. The changes are intended to empower homebuyers to negotiate for a better deal.

Lopez thinks most sellers will still offer to pay a real estate broker, rather than risk losing out on a big chunk of the prospective buyer pool. But it will have to be negotiated in the offer, as commissions will no longer be stated in the Multiple Listing Service. The changes also mean buyers' agents cannot just meet prospective clients "on the fly" anymore, to go check out a home for sale.

"You have to meet me at the office; we have to have a meeting," Lopez pointed out. "We have to have an agreement in place that said that you're hiring me, or I can't show you any homes."

The new forms real estate agents use to complete transactions will take effect nationwide on Aug. 17.


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A new Virginia law protects residents from utility shutoffs in extreme weather.

The law prevents utility company shutoffs when temperatures are at or below 32 degrees and at or above 92 degrees. It also prevents shutoffs during states of emergency in response to public health emergencies. Virginia was one of 34 states with a shutoff moratorium during the pandemic.

Kajsa Foskey, economic justice outreach coordinator for the Virginia Poverty Law Center, said enacting this law cleared up some misconceptions.

"Most folks already thought that utilities couldn't shut them off on a day when it was too hot or too cold outside," she said. "So, what we've really done is just created some common-sense foundational protection so that all utility customers across the state know what their rights are."

Despite having some of these shutoff guidelines as unwritten rules, utility companies pushed back, saying it didn't allow them flexibility. Foskey said she thinks the state can build on this by including elements that didn't become law. This includes requiring data collection from utilities about who is being shut off, the frequency, reasons, and the amounts owed. She said this can help craft solutions for people facing shutoffs.

Rising utility prices concern advocates since this increases shutoffs. More than 750,000 Virginia families are energy cost-burdened, meaning they spend 6% of their income on utility bills.

Foskey said another removed part of the law would have reduced financial barriers to reconnection.

"When they try to get reconnected," she said, "not only do they have to pay that past-due amount that they couldn't afford to pay, they now also have to pay reconnection fees, late fees, security deposits, things that really just make the barrier to getting reconnected very high."

She added that this can prevent people from being able to afford everyday essentials such as food or rent. However, the new law has a provision for customers who received state energy assistance in the past year. They're eligible for having their deposit capped at 25% of what they previously owed to be reconnected, but this can only be used once every three years.