A new report from the Arizona PIRG Education Fund finds that Arizonans are getting hit with what are known as facility fees, leading to higher costs for medical care.

Maribeth Guarino, health-care advocate with PIRG, said facility fees can be thought of as a flat charge, added to a patient's bill only for stepping through the door of a doctor's office to seek care. She said facility fees are arbitrary and cost anywhere between a few dollars and thousands of dollars.

"We're seeing them more because hospitals are buying up independent clinics, physician's offices and other independent provider care settings and then charging these fees as though they're hospital locations, even though nothing has changed except the logo and the letterhead," she explained.

According to Guarino, 15 states around the country, including Florida and Texas, have laws on the books relating to facility fees, but Arizona isn't one of them. She noted states could better prioritize patient protections by ensuring they're informed about the fee before receiving care. And while several federal proposals have been introduced to address the issue, none has made it to the president's desk.

Guarino said the Federal Trade Commission has issued a rule to prohibit what she terms "junk" fees, and hopes the Federal Trade Commission will apply that rule to items such as facility fees. And for patients, she recommends reviewing your bill after you have received care.

"And do your best to shop around, if you can, before you get services," she advised, "because even though there aren't always laws in place to protect patients, sometimes you'll be surprised how much information is out there if you just ask directly."

Guarino added there is no guarantee you'll get that answer, but it doesn't hurt to ask. She said patients should only pay for the services they receive, and providers need to be transparent about the fees they charge.

They may offer people a legitimate way to convert cash into cryptocurrency but crypto ATMs are also popular with scammers.

Washington had the highest rate of reported impostor scams in the country in 2023, according to the Federal Trade Commission. The Spokane City Council recently passed a resolution supporting more state regulations for the crypto ATMs, including limits on how much money can be withdrawn daily.

Det. Tim Schwering of the Spokane Police Department, said his office is receiving two or three calls a day about crypto ATM scams.

"$50,000 is very common in losses," Schwering pointed out. "You know, $100,000, $200,000 in losses, entire life savings wiped out from these types of scams."

Schwering noted most of the scams center around fake romantic relationships or bogus investment opportunities. He added most of the scammers are based in countries with no diplomatic relationships with the U.S. law enforcement. Even if he can find the money in countries like China, Russia or North Korea, he cannot get it back.

Schwering emphasized investment scams can be especially hard to recognize because scammers will allow victims to withdraw some money after making it look like their investment has grown on a fake website. Once victims feel secure they can withdraw their supposed "earnings," the con escalates. The FBI estimates Americans were robbed of close to $6 billion in 2023 through crypto-related scams.

"When you're making that kind of money, you can put money into building websites that are, they look like, legitimate investment websites," Schwering explained.

Schwering is working with the Washington State Department of Financial Institutions on legislation to limit the amount of money someone can deposit into a crypto ATM to $1,000 a day. He said it will not solve the problem but could help mitigate the potential losses.


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South Dakota is among the states with the highest percentage of residents carrying medical debt but a new federal rule announced this week could ease some of the pressure when they apply for loans.

The Consumer Financial Protection Bureau has finalized a rule stating credit agencies cannot share a person's medical debt history with a lending institution requesting credit information. The only debt details that can be relayed to determine a person's creditworthiness are mortgages, car loans, credit cards and similar activity.

Patricia Kelmar, senior director of health care campaigns for the U.S. Public Interest Research Group, said groups like hers had long pushed for this move.

"Medical debt is not really indicative of somebody's ability or desire to pay back a loan," Kelmar pointed out. "Oftentimes people are in a situation where they get a bad medical diagnosis, or they've been in a car accident. Suddenly they have a lot of medical bills."

According to the Peterson-KFF Health System Tracker, nearly 18% of South Dakota adults report having medical debt. The national average is 8%. Some credit agencies already exclude medical debt in loan situations.

Kelmar acknowledged the incoming Trump administration could seek to reverse this rule change, as some advisers have said they want to do away with the Consumer Financial Protection Bureau altogether.

Pushback is also expected from debt collection firms. Kelmar emphasized skeptics should know keeping medical debt out of the equation is good for the overall economy.

"The long arm of medical debt can really hurt people's financial future and their ability to get better," Kelmar contended.

For example, she noted a person emerging from a medical scare might need a new car to rejoin the workforce but the sudden health care debt they incurred might get in the way. The new rule will be effective 60 days after it's published in the Federal Register.


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A bill reforming the New York-New Jersey Port Authority is coming back before New York's Legislature.

The reforms it would implement date back to the Bridgegate scandal of former New Jersey Gov. Chris Christie. The bill increases oversight measures and transparency regarding capital planning. Although it passed with bipartisan support during last year's legislative session, Gov. Kathy Hochul vetoed it.

Rachael Fauss, senior policy analyst for the group Reinvent Albany, said the reforms can improve the agency.

"It would require much more public consultation, notification and hearings about the Port Authority's capital plan," Fauss explained. "Port Authority is actually the second-biggest public authority in New York State."

The legislation would add nonvoting members such as mass transit users to the Port Authority's board. It also requires members of the Port Authority to appear before the legislatures in New York and New Jersey when there is a public hearing. In her veto message, Hochul said she wants a more collaborative bill with New Jersey officials but Fauss feels signing the bill would have opened communication. So far, the bill is in committee.

New Jersey's Legislature has yet to pass a similar bill to enact the reforms. The hope is to increase public awareness about the agency's more than $9 billion budget. The Port Authority's primary opposition to the bill centered around how the changes might restrict its operations.

Fauss noted there are concerns the agency is too independent.

"Public authorities of states are often seen as being independent agencies, but that can go too far, and they can act without accountability," Fauss contended. "There is that sort of gut reaction of, 'Well, don't we want this authority to be independent?' But, obviously, we think that has gone too far because it was used for political purposes."

While it remains to be seen how the bill could shake out in the coming session, it could get bogged down in politics. Given New York enacted congestion pricing, which New Jersey has long opposed, it is uncertain whether the two states will come together about the legislation and Port Authority's reforms.