The Brief

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.

And Elon Musk, the billionaire whom Trump has tapped to lead his initiative to shrink government, last week called for the elimination of the watchdog agency. "Delete CFPB," Musk posted on X.

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.

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Copyright 2024 KFF Health News

William Contreras hit a tying homer in the fifth and singled home the go-ahead run an inning later as the Milwaukee Brewers defeated the Los Angeles Dodgers 7-4 on Monday in Game 2 of the National League Championship Series.

Four relievers combined to retire the last 15 Dodgers batters in order as the Brewers took a 2-0 lead over the two-time defending World Series champions in this best-of-seven series, which heads to Los Angeles for Game 3 on Wednesday.

The Brewers are chasing their second pennant and first in the NL. They made their lone World Series appearance in 1982, when they were in the American League.

Los Angeles is trying to become the first NL team to win three straight World Series. The Dodgers last rallied from a 2-0 deficit to win a series in 2020, when they beat the Atlanta Braves in a seven-game NLCS before going on to win the World Series.

The Dodgers will need more punch from their lineup to have a chance at getting back to the Fall Classic. They mustered just three hits Monday and went 0 for 4 with runners in scoring position to drop to 2 for 26 in those situations this postseason.

Los Angeles couldn’t even get a boost from Yoshinobu Yamamoto, who entered 8-1 with a 2.14 ERA in 11 career playoff appearances. Yamamoto lasted just 2 2/3 innings for his shortest postseason start.

The Dodgers took the lead on three occasions in the first five innings. Milwaukee responded each time, the last coming when Contreras tied the game with a 436-foot homer to center off Kris Bubic in the fifth.

That turned the game into a battle of the bullpens, where the Brewers again had the edge.

Dustin May, JoJo Romero, Abner Uribe and Aaron Ashby combined to shut down the Dodgers after Logan Henderson’s early exit.

The score was tied 4-all when Milwaukee’s David Hamilton was hit by a pitch from Brock Stewart to lead off the sixth. Stewart attempted a pickoff throw that went off the glove of first baseman Freddie Freeman and into foul territory for an error, advancing Hamilton to second.

After Jackson Chourio grounded out, the right-handed Stewart walked the left-handed-hitting Brice Turang to face the right-handed Contreras, who had homered in his previous plate appearance.

Contreras singled to left this time to bring home Hamilton with the go-ahead run.

Turang and Jake Bauers added RBI singles in the eighth to extend Milwaukee’s lead.

Neither starter lasts long

The anticipated pitchers’ duel between Yamamoto and Henderson didn’t work out according to plan.

In three previous playoff starts following Dodgers losses, Yamamoto had gone 3-0 with a 1.23 ERA. When he faced the Brewers in last year’s NLCS, he threw the first playoff complete game since Justin Verlander did it in 2017.

This time, Yamamoto couldn’t even make it out of the third inning before leaving with the Dodgers behind 3-2.

Henderson entered Monday having not allowed more than three runs in any of his 24 career starts (including the postseason). That streak ended when he allowed four runs over four innings.

Because Henderson committed two errors — matching his previous career total — only two of the runs were earned.

Milwaukee trailed 2-1 in the third when Bauers capped a 12-pitch plate appearance by taking a 3-2 offering in the dirt to load the bases with a walk. Christian Yelich followed by lining a single up the middle that brought home two runs and knocked Yamamoto out of the game.

Los Angeles bailed out Yamamoto by scoring twice in the fifth.

After Kyle Tucker hit a leadoff double, Tommy Edman sacrificed him to third. Henderson fielded the bunt and made a wild throw to first, enabling Tucker to score and moving Edman to second.

Edman advanced to third when Mookie Betts grounded out, and scored on Freeman’s sacrifice fly.

Henderson also had made a wild throw to first on a pickoff attempt in the third inning that allowed Edman to score from third.

Up next

Robert Gasser (5-5, 3.87 ERA) is expected to start for Milwaukee in Game 3. Gasser allowed one run over five innings when the Brewers won 3-1 at San Diego to clinch their NL Division Series.

The Dodgers hadn’t announced their Game 3 starting pitcher.

Actor and disability rights advocate RJ Mitte, who brought a lifetime of experience with cerebral palsy to fictional family struggles in an essential role on “Breaking Bad,” died Monday at age 34, authorities and his representatives said.

Cameron County Justice of the Peace Cyndi Hinojosa told The Associated Press she declared Mitte dead at about 1:30 p.m. at what she believed was his home in Brownsville, Texas. She said she was unable to provide a cause, but an autopsy will be performed.

Mitte played Walter White Jr., the son of Bryan Cranston’s chemistry teacher-turned-meth dealer Walter White on nearly every episode of the five seasons of the AMC show, which recently ranked as the best of the 21st century in a New York Times poll.

Diagnosed at age 3, Mitte told the AP in 2014 that his disability and the surrounding struggles with physical therapy, family problems and exorbitant medical bills — all key subjects on the show — made him better at his job.“You develop a different mentality and you develop a different look at how the world sees you and how you see the world,” he said. “You’re able to use that. And I think it’s an asset instead of something that would hinder.”

Mitte was born and raised in Jackson, Mississippi.

He landed small guest roles on sitcoms after moving to Los Angeles to act in 2006. Like his character, he was in his mid-teens when he began his work on “Breaking Bad,” starting in 2007. The show ran from 2008 to 2013.

“Mitte brought authenticity to the role and built a platform on disability awareness and inclusion,” the actor’s representatives said in a statement announcing his death. The statement said he used “his platform to challenge stereotypes and promote greater representation.”

His later credits included the ABC Family series “Switched at Birth” and the superhero satire series “Guardians of Justice.”

He was also a producer of several independent films.

As an advocate, he served as an ambassador for United Cerebral Palsy and Shriners Children’s. He was also president of his own Mitte Foundation supporting philanthropic and community initiatives around disabilities.

The drumbeat of monster hurricanes in the Pacific has broken a record for nasty long-lasting storms east of the international date line, turbocharged by nature’s supersized El Niño, scientists said.

“Since September 20th, when Odalys formed, it’s been berserk,” said Colorado State University researcher Phil Klotzbach, who forecasts and studies storm activity. “This year just everything that forms is just lasting a long time and getting really powerful.”

One of the key measurements meteorologists use to judge hurricane seasons is called accumulated cyclone energy, or ACE, which includes a storm’s wind speed and longevity. On Sunday, a section of the Pacific east of the date line, which brews storms headed for Hawaii, Mexico and the U.S. West Coast, passed the old mark set in 2018. The area is still going strong with Hurricane Simon and appears on the verge of spawning another one that will really ramp up in strength, Klotzbach said.

On Tuesday, the Pacific will tie a record for most days with a hurricane spinning and is likely to break it soon after that, Klotzbach said.

“It feels like almost everything that can spin up does spin up,” said University of Arizona atmospheric scientist Kim Wood.

El Niño and warm water are boosting Pacific hurricanes

Several meteorological factors have come together to supercharge the Pacific, chief among them the El Niño, Klotzbach and other hurricane researchers said. An El Niño weakens and shifts the high altitude vertical winds that otherwise can dampen or even decapitate storms. In the Pacific, that wind shear runs east to west, generally with the direction storms travel, so it’s like riding a bicycle with a tail wind, Klotzbach said.

Meanwhile, the weather pattern has dampened hurricanes in the Atlantic, where the ACE is less than 18% of what’s normal for this time of year. El Niño makes the wind shear in the Atlantic like riding into a headwind, he said.

Another factor is warm water, which serves as hurricane fuel. By definition El Niño is a warming of the equatorial Pacific that changes weather worldwide. In the Pacific storm basin, it’s several degrees Fahrenheit warmer than normal, said Kristen Corbosiero, a professor of storm atmospheric sciences at the University at Albany in New York.

Usually in the Pacific, the extra warm storm-friendly water doesn’t run as deep as it does in the Atlantic. So when one storm goes over a patch of water, it brings up cold water and makes it hard for a subsequent storm in the same area to stay alive, Wood said. But not this year.

Hurricane Rachel, whose remnants swamped Las Vegas over the weekend, didn’t suffer as it went over, churned up by Category 5 Hurricane Polo, Wood said. She said the waters are warm from both El Niño and climate change from the burning of coal, oil and gas.

Another factor in recent storms was a counterclockwise atmosphere spin over Central America — called a gyre — that spits out seeds of stormy weather that can form into hurricanes. It spit out both the Atlantic’s Isaias and the Pacific’s Simon at about the same time, Corbosiero and Klotzbach said.

Five major hurricanes in a row

The last five Pacific hurricanes — long-lasting Nolo, Odalys, Polo, Rachel and Simon — have all reached major status with winds of at least 111 mph (178.6 kph). Nolo, Odalys and Simon hit Category 4, while Polo set the record for time spent at Category 5 at two-and-a-half days.

When Klotzbach made those calculations on the record-breaking activity of the eastern and central Pacific, he looked at all storms east of the date line.

That’s a slightly different approach from the National Oceanic and Atmospheric Administration, which breaks that broad area into two regions. Neither NOAA-defined region is quite at record levels for ACE yet; put together they are.

Part of that is because often when one of those subregions is more active, the other isn’t quite as crazy, but in 2026 they both are hyperactive, Wood said.≠

“This is the first year that both sides have been this active together,” Wood said. “Usually it’s kind of focused more on one or the other, so that speaks to just the wide extent across this region of where there’s been that lower shear, those warmer waters, and that higher moisture.”

Off the Mexican coast is a disturbance that the National Hurricane Center gives a 90% chance of becoming Tropical Storm Trudy, which then could power up to something big, Klotzbach and Corbosiero said.

“It seems like that area is just one after another. So I would not be surprised to have another storm,” Corbosiero said. “This year, because of the El Niño, we do have very favorable conditions. So as long as there’s some sort of the seeds either from the gyre or from remnant ends of cold fronts, it seems like this is going to continue for a bit.”

California students enrolled in public colleges and universities are now eligible to apply for CalFresh, the state’s food benefits program, Gov. Gavin Newsom announced Friday.

Students enrolled in a degree program at a California Community College, California State University or the University of California may be eligible for up to $300 a month to spend on food at grocery stores and farmers markets.

“We can’t expect students to learn if they’re hungry, and in California, there is no reason for them to be, whether they’re in kindergarten, high school, or college,” Newsom said in a Friday statement. “You shouldn’t have to jump through hoops to get the food benefits you’re entitled to, and now you don’t have to.”

Those who are enrolled in an associate or bachelor’s degree program, at least half time, can apply here. Newsom said that the state expects more than 200,000 additional students to enroll in CalFresh after program expansion.

“This is what government is supposed to do: help the people we serve. It is my hope that these changes will continue to make it easier for students to access CalFresh, the largest anti-hunger program in the country,” California Department of Social Services Director Jennifer Troia said in a Friday statement.