Worried that President-elect Donald Trump will curtail federal efforts to take on the nation's medical debt problem, patient and consumer advocates are looking to states to help people who can't afford their medical bills or pay down their debts.
Why now: New state initiatives may not be enough to protect Americans from medical debt if the incoming Trump administration and congressional Republicans move forward with plans to scale back federal aid that has helped millions gain health insurance or reduce the cost of their plans in recent years.
The context: In the face of federal retrenchment, advocates are eyeing new initiatives in state legislatures to keep medical bills off people's credit reports, a consumer protection that can boost credit scores and make it easier to buy a car, rent an apartment, or even get a job.
What some states are doing: New York state has enacted several laws in recent years to rein in hospital debt collections and to expand financial aid for patients, often with support from both Democrats and Republicans in the legislature. "It doesn't matter the party. No one likes medical debt," Benjamin said.
Worried that President-elect Donald Trump will curtail federal efforts to take on the nation's medical debt problem, patient and consumer advocates are looking to states to help people who can't afford their medical bills or pay down their debts.
"The election simply shifts our focus," said Eva Stahl, who oversees public policy at Undue Medical Debt, a nonprofit that has worked closely with the Biden administration and state leaders on medical debt. "States are going to be the epicenter of policy change to mitigate the harms of medical debt."
Good insurance is a defense against debt
New state initiatives may not be enough to protect Americans from medical debt if the incoming Trump administration and congressional Republicans move forward with plans to scale back federal aid that has helped millions gain health insurance or reduce the cost of their plans in recent years.
Comprehensive health coverage that limits patients' out-of-pocket costs remains the best defense against medical debt.
But in the face of federal retrenchment, advocates are eyeing new initiatives in state legislatures to keep medical bills off people's credit reports, a consumer protection that can boost credit scores and make it easier to buy a car, rent an apartment, or even get a job.
Several states are looking to strengthen oversight of medical credit cards and other financial products that can leave patients paying high interest rates on top of their medical debt.
Some states are also exploring new ways to compel hospitals to bolster financial aid programs to help their patients avoid sinking into debt.
New York out ahead on the issue
"There's an enormous amount that states can do," said Elisabeth Benjamin, who leads health care initiatives at the nonprofit Community Service Society of New York. "Look at what's happened here."
New York state has enacted several laws in recent years to rein in hospital debt collections and to expand financial aid for patients, often with support from both Democrats and Republicans in the legislature. "It doesn't matter the party. No one likes medical debt," Benjamin said.
Other states that have enacted protections in recent years include Arizona, California, Colorado, Connecticut, Florida, Illinois, Minnesota, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, and Washington. Many measures picked up bipartisan support.
President Biden's administration has proved to be an ally in state efforts to control health care debt. Such debt burdens 100 million people in the United States, an NPR and KFF Health News investigation found.
Led by Biden appointee Rohit Chopra, the Consumer Financial Protection Bureau has made medical debt a priority, going after aggressive collectors and exposing problematic practices across the medical debt industry. Earlier this year, the agency proposed landmark regulations to remove medical bills from consumer credit scores.
The White House also championed legislation to boost access to government-subsidized health insurance and to cap out-of-pocket drug costs for seniors, both key bulwarks against medical debt.
Regulatory overreach?
Trump hasn't indicated whether his administration will move ahead with the CFPB credit reporting rule, which was slated to be finalized early next year. Congressional Republicans, who will control the House and Senate next year, have blasted the proposal as regulatory overreach that will compromise the value of credit reports.
If the CFPB withdraws the proposed regulation, states could enact their own rules, following the lead of Colorado, New York, and other states that have passed credit reporting bans since 2023. Advocates in Massachusetts are pushing the legislature there to take up a ban when it reconvenes in January.
"There are a lot of different levers that states have to take on medical debt," said April Kuehnhoff, a senior attorney at the National Consumer Law Center, which has helped lead national efforts to expand debt protections for patients.
Kuehnhoff said she expects more states to crack down on medical credit card providers and other companies that lend money to patients to pay off medical bills, sometimes at double-digit interest rates.
Under the Biden administration, the CFPB has been investigating patient financing companies amid warnings that many people may not understand that signing up for a medical credit card such as CareCredit or enrolling in a payment plan through a financial services company can pile on more debt.
If the CFPB efforts stall under Trump, states could follow the lead of California, New York, and Illinois, which have all tightened rules governing patient lending in recent years.
A focus on financial aid
Consumer advocates say states are also likely to continue expanding efforts to get hospitals to provide more financial assistance to reduce or eliminate bills for low- and middle-income patients, a key protection that can keep people from slipping into debt.
Hospitals historically have not made this aid readily available, prompting states such as California, Colorado, and Washington to set stronger standards to ensure more patients get help with bills they can't afford. This year, North Carolina also won approval from the Biden administration to withhold federal funding from hospitals in the state unless they agreed to expand financial assistance.
In Georgia, where state government is entirely in Republican control, officials have been discussing new measures to get hospitals to provide more assistance to patients.
"When we talk about hospitals putting profits over patients, we get lots of nodding in the legislature from Democrats and Republicans," said Liz Coyle, executive director of Georgia Watch, a consumer advocacy nonprofit.
Many advocates caution, however, that state efforts to bolster patient protections will be critically undermined if the Trump administration cuts federal funding for health insurance programs such as Medicaid and the insurance marketplaces established through the Affordable Care Act.
Trump and congressional Republicans have signaled their intent to roll back federal subsidies passed under Biden that make health plans purchased on ACA marketplaces more affordable. That could hike annual premiums by hundreds or even thousands of dollars for many enrollees, according to estimates by the Center on Budget and Policy Priorities, a think tank.
And during Trump's first term, he backed efforts in Republican-led states to restrict enrollment in their Medicaid safety net programs through rules that would require people to work in order to receive benefits. GOP state leaders in Idaho, Louisiana, and other states have expressed a desire to renew such efforts.
"That's all a recipe for more medical debt," said Stahl, of Undue Medical Debt.
Jessica Altman, who heads the Covered California insurance marketplace, warned that federal cuts will imperil initiatives in her state that have limited copays and deductibles and curtailed debt for many state residents.
"States like California that have invested in critical affordable programs for our residents will face tough decisions," she said.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF .
A block of Equinix data centers sit across the street from a Prime data center on Great Oaks Blvd. in South San Jose on Aug. 31, 2026.
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Topline:
Gov. Gavin Newsom signed seven data center bills into law on Monday, signaling a tide change toward regulation of the industry.
Why it matters: Three of the new laws shift electric infrastructure costs away from residential customers and toward data center operators, three more mandate disclosures of water usage and other resources, and the last one makes data centers ineligible for environmental review exemptions.
The backstory: Newsom’s signature on the new laws represents a significant departure from his actions on data centers last year, when he vetoed a water disclosure bill over concerns that regulation could stifle AI growth and signed into law only a single stripped-down environmental study bill.
Facing growing public backlash and a pivot from his own past vetoes, Gov. Gavin Newsom signed a sweeping package of seven bills on Monday that aim to force the data center industry to pay its own way in California.
Three of the new laws shift electric infrastructure costs away from residential customers and toward data center operators, three more mandate disclosures of water usage and other resources, and the last one makes data centers ineligible for environmental review exemptions.
Newsom, in a written statement, contrasted the new regulations with President Donald Trump’s hands-off approach to data centers and artificial intelligence.
“We know that we don’t have to sell out Californians or sacrifice our well-being to innovate and succeed,” the statement read. “California has proven that time and time again. With these laws, we are ensuring that Californians remain in the driver’s seat — and that those profiting from data centers aren’t doing so at our expense.”
Trump has aggressively pushed to accelerate data center development nationwide, arguing that they represent a significant economic opportunity for states that embrace them. He said last week at the All-In Summit, an invite-only conference for business leaders, that the industry is the “oil of the next 20, 25 years.”
Newsom’s signature on the new laws represents a significant departure from his actions on data centers last year, when he vetoed a water disclosure bill over concerns that regulation could stifle AI growth and signed into law only a single stripped-down environmental study bill.
Environmental advocates and the lawmakers behind this year’s bills previously told CalMatters that intensifying public backlash to data center construction propelled the legislation this year, despite a flood of lobbying funds from Big Tech and other business interests that aimed to soften the proposals.
“When you’re looking down the barrel of public outcry that says we don’t want [data centers] at all, and you’ve got localities that are saying they’re going to ban them, then you know the atmosphere has changed,” Assemblymember Diane Papan, a San Mateo Democrat who authored two of the bills which were signed into law on Monday, previously told CalMatters.
Other state legislatures as well as Congress are also advancing new measures to regulate the industry. In May, a Gallup poll found seven in 10 Americans oppose data center construction in their communities, while a July Public Policy Institute of California poll found similar opposition statewide. Hundreds of cities nationwide — including Monterey Park and Bay Area cities like Pittsburg — have either passed data center bans or walked back approvals following public outcry.
Arnab Pal, the executive director of Deploy Action, a nonprofit that promotes clean energy, told CalMatters the new laws are a good step toward preventing data centers from harming consumers through utility rate increases or environmental damage. Still, Pal said, more can be done to ensure such projects actually benefit everyday people through advancements to the electrical grid and the acceleration of clean energy infrastructure.
“I don't think these bills are the end of this fight; I think we're gonna have to do a lot of implementation on the back end and, as other states roll out their policies next year, I think California is going to look back and be like, ‘maybe we should have done more,’” Pal said. “I'm interested to see what we do next year on this.”
Business interests that oppose the measures, like the Data Center Coalition — which counts companies like Google, Microsoft and OpenAI among its members — warn that further regulation could push the data center industry out of California. According to the latest figures from the Data Center Coalition, the industry contributed 665,500 jobs, more than $159 billion in economic activity, and $14.1 billion in federal, state, and local taxes in California in 2024.
Khara Boender, the director of government affairs west for the Data Center Coalition, told CalMatters that “the data center industry shares the goal of ensuring growth of this critical infrastructure is responsible and well managed,” but more work needs to be done “to promote responsible data center growth while maintaining California as a key, competitive market in the global economy.”
Newsom signed the following bills:
Senate Bill 1168, SB 886 and Assembly Bill 2383, which shift electric infrastructure costs away from residential customers and toward data center operators
AB 2469, AB 1577 and AB 2619, which mandate disclosures or estimates of water usage and other resources
SB 887, which makes data centers ineligible for blanket environmental review exemptions, and offers fast-tracked approval for facilities that meet state standards for water and energy conservation
Why it matters: The bills take effect Jan. 1, 2028, and will create a five-tiered system determining how many bachelor’s degrees each district can offer. Districts will be placed into tiers based on the percentage of students who complete a degree or certificate or transfer to a four-year university. Districts with higher graduation and transfer rates will be allowed to create more bachelor’s degrees — up to the maximum of 12.
What's next: The legislation does make at least one significant change supported by the community colleges: It only prohibits degrees that duplicate CSU programs offered in the same local service area as the community college proposing the degree.
Senate Bill 960 and Assembly Bill 2694, which were sent to Newsom as a two-bill package, will let community college districts create between two and 12 new bachelor’s degrees to fill local workforce needs.
The bills take effect Jan. 1, 2028, and will create a five-tiered system determining how many bachelor’s degrees each district can offer. Districts will be placed into tiers based on the percentage of students who complete a degree or certificate or transfer to a four-year university. Districts with higher graduation and transfer rates will be allowed to create more bachelor’s degrees — up to the maximum of 12.
The tiered system, which was among several last-minute amendments to the legislation, has drawn backlash from community college presidents and chancellors, who say the system will pit colleges against one another.
However, the legislation does make at least one significant change supported by the community colleges: It only prohibits degrees that duplicate CSU programs offered in the same local service area as the community college proposing the degree. In the past, duplication wasn’t tied to location, and community colleges sometimes faced duplication objections from CSU campuses located in different regions of the state.
The legislation also allows for certain circumstances when community colleges can create bachelor’s degrees even if a nearby CSU campus has a similar program. That will be permitted if the CSU program has had a transfer acceptance rate of less than 75% for three consecutive years.
EdSource is an independent nonprofit organization that provides analysis on key education issues facing California and the nation. LAist republishes articles from EdSource with permission.
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Makenna Cramer
has a special place in her heart for the animals that make this such a fascinating place to live.
Published September 21, 2026 1:47 PM
Pasadena Humane's popular "poorly drawn pets" fundraiser returns after exceeding expectations last year.
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Makenna Cramer
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LAist
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Topline:
Pasadena Humane’s popular “poorly drawn pets” fundraiser is returning for another year, and the artists are already deep into drawing as of Monday.
Why it matters: “There’s just one tiny disclaimer: we’re much better at caring for animals than drawing them,” Pasadena Humane shared on social media. “Some of our artists are genuinely talented. Others… well, let’s just say your pet may come out looking artistically interpreted.”
Why now: LAist takes you inside the artists’ studio at Pasadena Humane.
Pasadena Humane’s popular “poorly drawn pets” fundraiser is returning for another year, and the artists are already deep into drawing as of Monday.
Here’s how it works: you’ll be asked to make a donation through this Facebook post, comment on the post with a photo of your pet, and volunteers will respond in about a day with their best attempt at your four-legged friend. If you don’t have a Facebook account, you can also participate here via email.
“There’s just one tiny disclaimer: we’re much better at caring for animals than drawing them,” Pasadena Humane shared on social media. “Some of our artists are genuinely talented. Others… well, let’s just say your pet may come out looking artistically interpreted.”
Last year, officials said the fundraiser exceeded expectations, raising around $11,000 for the shelter from more than 450 submissions. Dogs and cats are most common, but people have also sent in photos of their birds, turtles, hamsters and horses in years past.
LAist takes you inside the artists’ studio at Pasadena Humane.
Both volunteers and staff signed up to draw the pets people are submitting - for good and for bad.
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The table was fully stocked with markers, colored pencils, pens and sharpies to choose from.
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Meet the people behind the 'poorly drawn pets'
Volunteers and staff filed in and out of what’s been turned into the official drawing room Monday morning. Pens, colored pencils, markers and Sharpies were scattered all over the table in between pieces of paper and small printed photos of pets.
I asked Julie Nakahara, Pasadena Humane’s director of partnerships and events, how she would describe her artistic ability as she sketched out a lounging cat.
“That of a toddler,” Nakahara replied. “All right, maybe fourth grade.”
Her strategy was to outline the pet first in pencil before thickening the lines with a Sharpie, adding pops of color through the small details in the photo.
“[The cat’s] enjoying the sunshine, and so I tried to reflect it in my drawing,” she said. “Not sure if that's a true reflection, but I did the best I can.”
Julie Nakahara, Pasadena Humane’s director of partnerships and events, sketches out submission #49.
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Robbin Huntingdale, a Pasadena resident and volunteer, had a colorful, Lisa Frank-style approach to her picture of two pups.
“I kind of felt like the more I add, the more interesting it'll be, and the less you'll notice that it doesn't look like the photo,” she said to a roar of laughter in the room.
But markers seemed to be a bold choice among the artists. As Mia Dunn, chief philanthropy officer, put it: “I'm a colored pencil girl, because they can be erased.”
Some of the portraits have been turned into tattoos in years past.
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The artists would often share their work with the room when they were done.
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Some artists focused on nailing the vibe, while others narrowed in on the details.
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Kevin McManus, PR and communications director, was trying to do justice to the two dogs he was drawing. He said he came up with a story as he sketched, describing one dog as the older brother and the other as its young punk with a look of “what did I do wrong?”
“It's a really fun way for us to raise money for the shelter,” McManus said. “Ultimately, that's what we're here for. To raise money for the pets in our care, for the programs that we do year-round.”
The fundraiser raises money to support the shelter's work and the animals in their care.
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Volunteers and staff said it's a great way to give back to Pasadena Humane.
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This LAist reporter was also invited to get in on the artistic action.
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You have until 12 p.m. Wednesday to submit your pets for the fundraiser.
Joaquin Angeles and Aurora Flores pose for a portrait outside their home in East Los Angeles on Aug. 27, 2026.
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Topline:
Boyle Heights and East L.A. residents outside the relief zones designated for the warehouse fire say the same smoky, noxious air left them sick and facing steep bills.
Who qualified for Lineage assistance? Nearly 800 homes inside a designated area were eligible for assistance from Lineage during its recovery operations, according to the company. The support included free air purifiers, masks, air conditioners, temporary housing, grocery vouchers, utility assistance and cash assistance that were often delivered door-to-door by the company.
Navigating help hasn’t been easy: Residents outside the boundary have had to find alternative resources on their own. “The wind doesn’t have a boundary, why would you make a map?” Cynthia, who chose not to share her last name due to immigration concerns, recalls asking herself as she navigated long lines at city and county resource centers. City and county agencies initially offered temporary shelters, air purifiers and masks, and later added mobile health clinics, grocery gift cards and resource centers in Boyle Heights and East L.A. But residents also reported being turned away at distribution sites depending on whether they lived in Boyle Heights or unincorporated East L.A.
Read on... for more on what residents have said they feel abandoned.
Cynthia remembers the sound of her 1-year-old daughter’s cries as she tried to desperately explain to a caseworker over the phone how the Lineage warehouse fire had affected her family financially.
She had stopped working as a sidewalk vendor because of the unhealthy air, and her family was unsure how they would pay rent that month.
“I felt like, I don’t know, I was going insane,” said Cynthia, who chose not to share her last name due to immigration concerns.
When the 32-year-old mother reached out to Lineage for assistance, she was told she didn’t qualify for relief, even though her East L.A. home was less than 1.5 miles away. The company said its relief was only intended “for those closest to the warehouse.”
“We were close enough to receive the smoke and ash but not to receive aid,” she told Boyle Heights Beat.
Cynthia is among many residents who say they were left out of assistance from Lineage because of where they live. Residents outside the established boundary say they breathed the same smoke, smelled the same stench and suffered through headaches, nausea and high utility bills as their neighbors who qualified for help.
Their question has been simple: If the air has no border, why did we?
Cynthia holds her daughter while cooking next to her air purifier and air monitor.
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Who qualified for Lineage assistance?
Nearly 800 homes inside a designated area were eligible for assistance from Lineage during its recovery operations, according to the company. The support included free air purifiers, masks, air conditioners, temporary housing, grocery vouchers, utility assistance and cash assistance that were often delivered door-to-door by the company.
Earlier this month, Lineage said it had provided support to 90% of the 797 households within the designated area and spent over $3.3 million on the recovery and relief effort. Lineage CEO Greg Lehmkuhl told Boyle Heights Beat that the company had made multiple attempts to reach the remaining households.
“Our bilingual hotline remains open,” said Lehmkuhl. “We remain committed to supporting the community.”
Lineage first presented a map outlining the area closest to the warehouse as it announced a new wave of assistance at a community town hall on July 9.
The map was later expanded to include all 797 homes and a larger part of East L.A. after L.A. County Supervisor Hilda Solis pushed for more support, according to her office.
Now, the map covers households located between Union Pacific Avenue and the 5 Freeway, Los Palos Street and Herbert Avenue, all less than one mile from the Lineage warehouse.
The map with the outlined resources was presented by Lineage at an AQMD hearing on Aug. 6.
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Why the boundary matters
The expanded map still left out residents like Cynthia, who lives with her husband and baby just one block north of the 5 Freeway.
Angeles, however, said the support has been lackluster.
“We haven’t been given what we really need,” Angeles said.
Angeles said his family received an air purifier with no filters and a faulty air conditioner that turns off after just five minutes. He has not yet received the $200 Southern California Edison credit Lineage promised.
On Aug. 25, more than two months after the warehouse caught fire, his family was able to move into an Airbnb for nearly three weeks. While it allowed them a chance to finally breathe and not worry about what chemicals may be lingering in the air, the support came far too late, Angeles said.
By then, his wife and son had already racked up medical bills of more than $1,300 each for emergency room visits for shortness of breath, respiratory infections and painful skin rashes.
“We don’t have money to spare. We’re renting and living paycheck to paycheck,” Angeles said. “Aside from the illness itself, it’s a psychological blow. You feel discriminated against; you feel like they don’t care.”
Joaquin Angeles’s wife, Aurora , shows scarring from a rash on her arm after being exposed to smoke coming from the Lineage fire at her home in East Los Angeles.
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Who created the boundary?
It remains unclear who initially identified the 797 homes.
Lineage said it did not create the map. A company spokesperson said the map originated with the Boyle Heights Unified Recovery Command, a centralized body made up of city departments established to coordinate updates during the remediation process.
The command operates under the city’s Emergency Management Department and was created at the direction of L.A. Mayor Karen Bass’ executive orders to speed up the Lineage cleanup and recovery. The Emergency Management Department did not respond to multiple inquiries about the map’s origin.
Supervisor Solis’ office told The Beat it had no say in the original map but advocated for the area to be expanded.
Navigating help hasn’t been easy
Residents outside the boundary have had to find alternative resources on their own.
“The wind doesn’t have a boundary, why would you make a map?” Cynthia recalls asking herself as she navigated long lines at city and county resource centers.
City and county agencies initially offered temporary shelters, air purifiers and masks, and later added mobile health clinics, grocery gift cards and resource centers in Boyle Heights and East L.A. But residents also reported being turned away at distribution sites depending on whether they lived in Boyle Heights or unincorporated East L.A.
A resident picks up air purifiers from a pop-up resource center in Boyle Heights on July 13, 2026.
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Many often turned to nonprofit organizations already working in the community.
In her search, Cynthia managed to secure an air purifier from InnerCity Struggle, a $500 prepaid Visa card from El Centro de Ayuda and had her July rent covered by Proyecto Pastoral. She bought a $250 air conditioner to manage the unbearable summer heat and a $300 personal air monitor to track the air quality outside her home.
Others haven’t been so lucky.
Maria Duran, a Boyle Heights resident who lives outside Lineage’s assistance boundary, said she called 311 to receive an air purifier but was told they had run out. She later learned Proyecto Pastoral had stopped accepting applications for rent and utility assistance because of a waitlist of more than 1,500 people.
“We are all being harmed. I feel frustrated. I feel down,” Duran said.
Three months after the fire, Duran is struggling to pay a utility bill that nearly tripled over the summer. She continues to deal with stubborn eye irritation that has disrupted her daily life.
Cynthia bought an air purifier following the Lineage fire.
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Nonprofits have been unable to keep up with the demand
Angela Gutierrez, a community organizing coordinator at Proyecto Pastoral, says the demand for relief reflects the scale of the disaster.
Gutierrez lives about one mile from Lineage and said she was also frustrated that she didn’t qualify for assistance from the company.
“To me, it was like we were abandoned because of our ZIP codes,” Gutierrez said. “But for Proyecto — for me — there is no ZIP code. To me, everyone is equal. The help is the same.”
Proyecto Pastoral received about 1,500 requests for assistance before closing its application in the wake of the fire. The organization helped cover rent and utility bills for residents living primarily within a 3-mile radius of Lineage, with emergency funds extending to families living as far as Monterey Park. Its fire relief funds were exhausted last week.
“It makes me sad and angry, because people were affected by the fire — and it wasn’t just in the immediate area,” Gutierrez said.
Cynthia holds her daughter’s hand in her home.
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Is more help on its way?
Lineage said it remains committed to providing resources to the roughly 80 households that have not yet received assistance.
“We’ve been working for weeks to make sure that we support everybody in this area that the county and city determined were impacted,” Lehmkuhl said.
The company did not indicate whether it planned to expand its assistance boundary.
District 14 Councilmember Ysabel Jurado is pushing for additional funding for the Lineage fire recovery. On Wednesday, the L.A. City Council approved a motion to explore creating a fund of up to $10 million to support the affected community.
For residents like Cynthia, the need is urgent. She is already behind on rent and is using a credit card to pay for basic necessities.
In unincorporated East L.A., Angeles said more should be done to help the families affected.
“It is not asking for a favor; it is simply asking for justice,” he said.
Correction, Sep. 21, 2026 4:49 pm: This story was updated at 4:48 p.m. on Sept. 21, 2026, to clarify that Proyecto Pastoral received about 1,500 requests for fire assistance. An earlier version incorrectly stated that the organization had helped cover rent and utility bills to 1,500 people
