Aggressive Medical Debt Collection Undermines the Promise of 340B

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By Lisa Bercu, J.D. – Senior Director of Health Policy at NCL
At a time when Americans are increasingly concerned about the cost of healthcare, a troubling contradiction is emerging within the hospital system meant to care for our most vulnerable patients. A new analysis from the National Consumers League reveals that hospitals participating in the federal 340B Drug Pricing Program— including many hospitals that treat high volumes of cancer patients — are more likely than non-340B hospitals to permit aggressive medical debt collection practices such as lawsuits, wage garnishment, liens, and credit reporting.
The upcoming House Energy and Commerce Subcommittee on Health hearing, “Lowering Health Care Costs for All Americans: An Examination of the U.S. Provider Landscape,” plans to address the broader debate over healthcare affordability.  As lawmakers examine the role hospitals play in shaping the cost of care for Americans, they should also scrutinize the aggressive medical debt-collection practices at 340B hospitals.
The 340B program was created with a clear and compassionate purpose: to allow hospitals to purchase certain drugs at steep discounts to help low-income, uninsured, or otherwise vulnerable patients have access to affordable healthcare. In theory, those savings are supposed to help hospitals expand services, improve access to care, and ease financial burdens for patients.
But new data suggest that some hospitals are instead sending those patient bills to medical debt collection. The National Consumers League’s analysis reviewed more than 2,500 hospitals nationwide and found that 75 percent of hospitals participating in the 340B program may take legal action against patients. Among hospitals not participating in the 340B program, that number is just 62 percent.
The pattern is particularly concerning among hospitals that treat the highest volumes of cancer patients, where 340B hospitals continued to be more likely than non-340B hospitals to maintain policies permitting legal action.
For families facing a cancer diagnosis, the financial burden can be overwhelming. Treatment often requires expensive diagnostics, extended drug therapies, and repeated hospital visits for treatments. Even for insured patients, deductibles, coinsurance, and non-covered services can accumulate into staggering bills.
Medical debt is now one of the most widespread forms of financial distress in the United States. Nearly half of American adults report they have experienced medical debt.  For cancer patients, the stakes are even higher: research from the American Cancer Society Cancer Action Network found that almost half of patients with cancer and cancer survivors incurred medical debt, and that those with debt were three times more likely to fall behind on recommended screenings.
Behind these statistics are real stories. Patients frequently exhaust their savings, tap retirement funds, or turn to crowdfunding to stay afloat during treatment.
This disconnect raises an important policy question: if hospitals are receiving substantial savings through the 340B program, are those savings truly reaching the patients the program was intended to protect?
Congress now has an opportunity—and a responsibility—to examine that question.
Ensuring that the 340B program works as intended does not require dismantling it. Rather, it calls for targeted reforms to ensure that patients benefit from the program and aren’t left facing medical debt as a result. Policymakers should strengthen charity care requirements for participating hospitals and prohibit aggressive debt collection practices against patients.  They should also exclude medical debt from credit decisions.
These and other reforms to improve program transparency and oversight would further protect patients navigating already difficult health journeys.
As Congress examines the role of providers in shaping healthcare costs, it must look not only at the prices hospitals charge, but also at how they treat the patients they serve. Programs designed to support vulnerable communities must deliver on their promise.
Nancy Glick

Dr. Casey Means is no Dr. C. Everett Koop

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By Nancy Glick Director of Food and Health Policy

“You’re no Jack Kennedy,” is the immortal remark made by Senator Lloyd Bentsen to VP hopeful Senator Dan Quayle during their 1988 debate. It wasn’t a compliment. Now, these words are appropriate for the proposed candidacy of Dr. Casey Means for the critically important role of Surgeon General of the United States.

I had the pleasure of working for Dr. C. Everett Koop, perhaps the most influential Surgeon General in U.S. history, after he left office and launched his anti-obesity campaign, Shape Up America!, in 1994. What I learned from this towering individual (he was 6 feet, 2 inches tall with a robust build and grey beard) about being a relentless advocate for public health underscores why Dr. Casey Means is no Dr. Koop.

Like Dr. Means, Dr. Koop came to the Office of the Surgeon General with deep-seated beliefs. An evangelical Presbyterian, Dr. Koop rose to national prominence as a pioneer in pediatric surgery who spent 35 years at the Children’s Hospital in Philadelphia performing thousands of operations to correct until-then fatal birth defects in newborns; he was the first to separate cojoined twins. His faith and his life-saving work helped to shape his conviction that abortion and infanticide are wrong. In fact, Dr. Koop published the book The Right to Live; the Right to Die which caught the attention of newly elected President Ronald Reagan, leading to his appointment as US Surgeon General.

But President Reagan did not know that when Dr. Koop was confirmed that he would become “the nation’s doctor” and set aside his personal beliefs for the greater good. Dr. Koop began to study smoking as a public health crisis, became appalled by the deceptive advertising, and his first official act was to issue the 1982  Surgeon General’s Report on the Health Consequences of Smoking: Cancer, the most authoritative statement to date on the connections between smoking and cancer.

Dr. Koop then confronted the AIDS crisis at a time when the disease was new and terrifying, declaring that “if ever there was a disease made for a Surgeon General, it was AIDS.” Dr. Koop’s response was to follow the Hippocratic oath taken by all doctors, “First, Do No Harm,” by treating every sick person as someone needing the care of a dispassionate medical professional. Accordingly, in 1986 , he issued the Surgeon General’s Report on Acquired Immune Deficiency Syndrome with explicit, non-judgmental, accurate information about a disease no one had heard of just a few years earlier. He was also responsible for the largest public health mailing ever done, when he wrote and disseminated “Understanding AIDS,” a brochure sent to 107 million households in the US, in which he said, “Who you are has nothing to do with whether you are in danger of being infected with the AIDS virus. What matters is what you do.”

By taking these actions, Dr. Koop put medicine above moralizing and applied a science-based public health approach to threats such as obesity, drunk driving, lack of health insurance, and even an issue of great concern to the National Consumers League – the need for mandatory labeling on all alcoholic beverages. He is also credited with revitalizing the Commissioned Corps of the US Public Health Service during his tenure as Surgeon General, wearing the navy jacket and gold braid of the corps to be the face of public health.

In contrast to Dr. Koop, a recognized medical authority, Dr. Means is an author and wellness influencer who does not meet the requirements to be Surgeon General. Although she graduated from Stanford Medical School, Dr. Means has never practiced medicine; her medical license is inactive, and her general distrust of conventional medicine is alarming. Unlike Dr. Koop, who was a strong advocate for immunizing babies and children against highly infectious diseases like measles, Dr. Means has been noncommittal and has made numerous public statements discouraging or questioning vaccines. Moreover, while Dr. Koop promoted the importance of funding biomedical research, Dr. Means is more interested in questioning established science on hormonal birth control and championing raw milk (which has sickened many adults and as recently as last month, killed an infant in New Mexico), natural foods, exercise, and lifestyle changes to achieve strong health.

At a time when trust in major federal health agencies is declining because the purveyors of junk science have sowed doubt among the American public, we need a “nation’s doctor” who is a relentless advocate for public health and is aligned with – and not an opponent of – established medical treatment guidelines. Dr. Koop showed America what a great Surgeon General can accomplish. Unfortunately, the confirmation of Dr. Casey Means will raise the ante on questioning longstanding science and medicine without evidence and further jeopardize the health of all Americans.

Inside the 2026 International Consumer Product Safety and Health Organization (ICPHSO) Conference: Where Consumer Safety Meets Accountability

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By Sally Greenberg, NCL CEO

Did you know that there are 1 billion pencils in circulation in the United States, including those ubiquitous NUMBER 2 pencils required to take the SAT exam? Pencil manufacturers even have their own industry association dedicated to safety, environmental responsibility, affordability, and compliance with recognized standards. I didn’t know that either.

But that is the kind of thing you learn at the annual International Consumer Product Safety and Health Organization (ICPHSO) conference, which I’m attending this week in Orlando. More than 700 participants are here, representing manufacturers, government regulators, supply chain and recall specialists, inventory and IT operations teams, and numerous law firms that specialize in regulatory compliance.

This is a must-attend conference for manufacturers of consumer goods; it’s also a meeting where parents whose children have suffered injuries or even killed by dangerous products, such as tiny batteries or water-absorbing beads that expand if children swallow them.

Daniel Greene, who leads auto and product safety work at the National Consumers League, and I have spent the last few days with many of these companies, learning how they ensure the safety of their products. There are many tools and resources available to help manufacturers comply with the law. We also met with a firm that specializes in designing accessibility into consumer products, so they are usable by people with a wide range of disabilities.

I’ve learned some interesting things at this conference about the importance of consumer advocacy:

  1. The Consumer Product Safety Improvement Act of 2008, enacted at the urging of consumer advocates after a child died from ingesting a toy containing lethal levels of lead, now requires far more rigorous safety testing before products enter the marketplace. One arts and crafts manufacturer told me the law has increased compliance demands but ultimately leads to much safer products.
  2. There are highly sophisticated services available to help companies manage product recalls, comply with complex regulations, interpret voluntary standards, and do outreach to consumers.
  3. I learned that the legal business for compliance with safety regulations is booming.
  4. Despite progress, children and adults continue to suffer preventable injuries from hazardous products, including bath seats, bed rails, window blinds, tip-over furniture, poorly made bike and motorcycle helmets, and table saws.
  5. Not surprisingly, the table saw industry was not present. With one notable exception, saw manufacturers continue to resist adopting safety technology that has been available since 2001. I had an infuriating conversation about table saw safety with someone who worked for a major retailer. She spouted all the usual verbiage about the expense of fixing table saws that inflict 10 amputations a day, overlooking the fact that over the past 25 years, hundreds of thousands of innocent consumers and workers have suffered mangled hands and lost fingers that could have been saved had the industry done the right thing from the start.

That said, many good things come out of this conference. We were joined by consumer groups, including Consumer Reports, Consumer Federation of America, SafeKids, and Nancy Cowles, founder of Kids In Danger (KID). We are vastly outnumbered by the companies here, but we play an essential role in advocating for consumer safety. Many people and families who have experienced terrible injuries with products come to the conference in force, sharing powerful stories and urging industries to fix their products.

Thanks to the ICPHSO leaders, including Mark Schoem and David Kossoff, the organization’s director and president, and their teams, for putting together a critically important event for consumer safety and ensuring that the consumer voice remains part of the conversation.

From left to right: Sally Greenberg; Daniel Greene; Sean McCurry, Accessibility Specialist at TransPerfect

Sally Greenberg & Don Mays, former colleague at Consumer Reports

Sally Greenberg & Bob Eckert, former Mattel CEO

“I Was Losing Pieces of My Childhood:” a Former Child Farmworker Urges Action to End Child Labor in a Speech to Be Remembered

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By Reid Maki, NCL Director of Child Labor Advocacy & Coordinator of the Child Labor Coalition

The recent 6th Global Conference on the Elimination of Child Labour included high-ranking officials from over 100 governments, the ILO, trade groups, and employer groups. I heard many speeches from child labor experts with decades of experience, but former NCL intern Jacqueline Aguilar, only 23 and a recent college graduate, gave by far the most compelling and poignant remarks. In 2023, Jacky interned for me at the Child Labor Coalition, a program of the National Consumers League.  She came to us through a remarkable program for former Migrant Head Start students led by the National Migrant and Seasonal Head Start Association, a member of the Child Labor Coalition.

Jacky spoke on a panel with a half-dozen government officials and a trade unionist. She recalled her experiences in the United States as a child laborer in agriculture. Members of the Child Labor Coalition are concerned that, in any given year, there may be as many as 300,000 minors working in agriculture. They work legally at tasks most adults cannot do because of gaps in child labor law that apply to agriculture. These exemptions allow children to work unlimited hours in the fields (if they aren’t missing school) beginning at the age of 12.

Jacky spoke from the heart about the impact child labor has had on her life and those of her peers from migrant families. Her remarks reminded us of why we were at the conference and impressed the attendees that we must act urgently to protect the 138 million children trapped in child labor.

Jacky started: “When people hear ‘child labor,’ they imagine something far away. A different country. A different life. But I am standing here to tell you it happened. In our communities. In our fields.”

“My parents worked in the fields every single day to provide for us,” recalled Jacky.  “I remember waiting by the door as a little girl for my dad to come home. When he put his hand on my cheek, I would feel how rough it was: cracked, dry, hardened by the earth. I used to wonder why his hands felt like that. Now I know. Those hands were not meant to be that way. They were shaped by survival.”

“At 11 years old, I stepped into those same fields. 11,” she continued.  “While other kids were worrying about homework or sleepovers, I was waking up at 4:00 in the morning. It was still dark outside…By 5:00 a.m., I was in the lettuce rows. The fields were endless. My hands wrapped around a hoe that felt too heavy for my body. The metal burned my palms. Blisters formed and broke. My feet ached from standing for hours. The morning dew soaked through my shoes, and the cold crawled up my legs.”

“There was no one asking how old I was. No one asking if I was tired. No one asking if I was okay. We had 30 minutes for lunch. 30 minutes sitting in the dirt. No cold water. No shade. Just the understanding that we needed to move faster. I wasn’t building character. I was losing pieces of my childhood.”

Like many farmworker families, Jacky’s was touched by cancer. “My father was diagnosed with lung cancer,” she said. “He had been in agriculture since he was seventeen years old,” she recalled.  “I think about the pesticides he inhaled. The dust that settled deep into his lungs. The chemicals that were part of his everyday air. My mother’s body gave out, too. Years of lifting heavy sacks of potatoes tore her shoulder until she couldn’t lift them anymore. I watched my parents sacrifice their health for us. And when my father had to move three hours away for treatment, I stayed behind. I was still in school. But I worked the potato harvest so we could survive, and I could help support my family. “

Jacky recalled one day in particular: “One morning, it started snowing while we were in the field, and the snow collected on the dirt, on the crops, on our shoulders. My fingers went numb. My socks were soaked. I couldn’t feel my toes. I remember standing there, staring at the ground, silently begging for someone, anyone, to say, ‘Go home.” That’s enough.’ But no one said anything. And that silence… it teaches you something. It teaches you that your pain is normal. That your exhaustion is expected. That your childhood is negotiable. I didn’t lose my childhood in one moment. I lost it in early mornings. In blistered hands. In missed school events. In falling asleep over homework because my body couldn’t take anymore.”

Jacky wasn’t alone. She saw other farmworker children suffer. “I watched classmates disappear from school. Smart kids. Funny. Full of light. They didn’t transfer schools. They transferred to full-time labor. And no one called it a crisis,” she recalled.  “No child should have to choose between education and survival. No child should feel responsible for keeping their family afloat. No child should stand in freezing snow waiting for permission to stop working.”

Speaking before an audience of government officials from all over the world, Jacky implored them to do more to end child labor: “To our ministers, policymakers, and public leaders, I am asking you to see us. Strengthen protections for children. A child in a field deserves the same protection as a child anywhere else. Enforce the laws. Visit the fields. Ensure there is clean water, real breaks, and protection from harmful chemicals. Support families with living wages, healthcare, and financial stability so children are not pushed into labor out of desperation. Train schools to recognize working children not as lazy or distracted but as exhausted. And include survivors in your decisions. We know where the system fails because we experienced the failure.”

“I am proud of my parents. I am proud of where I come from. But I should not have had to grow up that fast,” said Jacky. “There are children, right now, standing in rows of crops before the sun rises. Their hands are blistering. Their backs are aching. Their childhood is slipping away quietly. And most people will never know their names. Please do not let their silence continue because child labor does not just take childhoods. It takes futures. And we cannot afford to keep losing them. This happened. I survived it. And I’m not going to whisper about it.”

In three decades of advocacy and four Global Child Labor conferences, I’ve never heard a speech more eloquent or powerful.

Jacky speaks for children in child labor everywhere—not just the 300,000 children who work in agriculture. In recent years, thousands of unaccompanied minors, have come to work in the U.S.  Many ended up working in auto parts factories, the graveyard shifts in meatpacking facilities, or late nights at fast food restaurants. Yet children working in the U.S. are a small fraction of the global reality: 138 million children are engaged in labor worldwide. Jackie Aguilar’s story gives a voice to all of them.

Jacqueline Aguilar is a recent graduate of Adams State University in Colorado, where she lives and works. Jacky interned for the Child Labor Coalition in the summer of 2023 at the National Consumers League.

Progress at Risk as Global Leaders Confront the Ongoing Child Labor Crisis

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By Reid Maki, NCL Director of Child Labor Advocacy & Coordinator of the Child Labor Coalition

In Marrakech, Morocco, on Wednesday morning, the 6th Global Conference on the Elimination of Child Labour opened at the Palais des Congrès to a palpable air of excitement.

About 1,300 government leaders, employer groups, union leaders, and advocates against child labor attended the conference, organized by the government of Morocco with logistical assistance from the International Labour Organization (ILO). It is the first such international child labor conference since the one held in Durban, South Africa, in May of 2022.

As the Director of Child Labor Advocacy for the National Consumers League and the coordinator of the Child

Labor Coalition, this is my fourth quadrennial global child labor conference. Wednesday’s opening plenary began with a status check, highlighting the remarkable progress in reducing child labor, with estimates dropping from 246 million to 138

million last year. That’s phenomenal progress, but uncertainty hung in the air about what the future holds. The Trump administration’s cancellation of US AID poverty-reduction programs and $550 million in cuts to child labor and labor grants administered by the U.S. Department of Labor International Affairs Bureau in early 2025 has been an ongoing concern for child labor advocates, who fear a reversal of progress toward eliminating child labor.

Despite progress, advocates stressed the unfinished work: the global target to eliminate child labor by 2025 was missed, and 138 million children remain affected. As one speaker put it, ‘the number is simply not acceptable.’

Both the morning and afternoon plenaries featured ministers from several governments, ILO officials, and the International Trade Union Confederation discussing progress and future directions. Participants highlighted that reductions in child labor occurred across all continents where it was prevalent. The largest decrease was a 43% drop in Asia. Globally, the number of children in hazardous child labor fell from 79 million in 2020 to 54 million in 2024. However, speakers also noted a troubling rise in the proportion of child laborers who are between five and eleven years old.

Speakers urged identifying gaps in current efforts and emphasized the need to expand effective remediation—underscoring a united call to action.

Nobel Peace Prize Laureate Kailash Satyarthi addressed participants via video, urging the world to take “tools and guns out of children’s hands” and replace them with “pens and books.” He warned that recent years have seen a troubling decline in “moral accountability” and called for a “resurgence of compassion,” which he described as the transformative force needed to meet global child labor reduction goals. He also urged the ILO to mobilize heads of state committed to ending child labor into a special task force, aimed at building a stronger and more coherent “framework of action.”

“We must be bold,” said Satyarthi.

The conference continues until Friday afternoon, with officials and advocates sharing the strategies they have found most successful.

 

Voices, Urgency, and Hope at the National Health Council Annual Meeting

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By Sally Greenberg, NCL CEO

Have you heard of Alpha-1 Disorder? I hadn’t either until I had a conversation with the Alpha-1 Disorder team that’s gathered in Ft. Lauderdale for the National Health Council Annual Meeting. I love coming to this gathering because of the energy and drive behind the diverse patient groups and companies working to develop treatments and cures. Lisa Bercu, our Senior Health Policy Director, and I are here talking with and learning from colleagues across the health care spectrum.

Back to Alpha 1 or Alpha-1 Antitrypsin Deficiency (AATD) it’s a genetic condition that can cause damage to the lungs and/or the liver and is often misdiagnosed as COPD. There is no cure for Alpha-1, but symptoms can be managed with treatment. The Foundation is here and exists to advocate for research, more effective treatments and cures, and benefits for patients with Alpha 1.

Tracy Garner from Easter Seals is describing what lies ahead for Medicaid patients whose benefits will be slashed, as called for in HR 1, the so-called “Big Beautiful Bill” that Congress passed in 2025. One in four people in the US identifies as having a disability. One-third of those receive Medicaid benefits. That will have a huge impact on these patients.

Tracy and her team are working with states and their over seventy affiliates to hold meetings with the Centers for Medicare & Medicaid Services and state Medicaid administrators.

Ashlie White’s with the American Orthotic and Prosthetic Association. Her patient base is made up of amputees, and her challenge is ensuring that they get the Medicaid coverage they need, as many of them are on the program. The slashing of Medicaid could be devastating to these patients.

Cheryl Wicks’ group, Mosaic, provides support to 5,000 people with disabilities, mental and behavioral needs, and autism. I asked her what she thought legally about Sheltered Workshops for people with disabilities, where they get to go to work but get paid subminimum wage. NCL has never thought those Sheltered Workshops were a good thing, as they take advantage of people with disabilities, having them work for dirt cheap wages on the theory that at least they are getting out of the house or home. She agreed and used a term I had never heard – Community Integrated Employment, which means people with developmental and intellectual disabilities have jobs like everyone else that pay the legal minimum wage and work out much better. They are at grocery stores or pharmacies, stocking shelves or doing other similar work. Walgreens is particularly outstanding as an employer of people in her community. Hear, hear!

I cannot possibly capture the impact and dedication I feel among these patient advocates and the companies that develop the drugs and cures to treat the conditions described above, and so many more.

Guest Blog: Lives on the Line: Dialysis Patients Fight for Innovative Medicine

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By Katie Riley, Vice President of Communications, Alliance for Aging Research

For many older Americans with kidney failure, life isn’t just about surviving the next dialysis session, it is about protecting their hearts, keeping their transplant hope alive, and preserving dignity and independence.

When kidneys stop working and patients rely on dialysis, phosphorus levels build up. That small-but-dangerous imbalance massively raises the risk of cardiovascular events and can threaten someone’s eligibility for a transplant.

Enter a lifesaving tool: oral Phosphate Lowering Therapies (PLTs). These medications help keep phosphorus under control and are especially important for older adults, including those on fixed incomes or using nursing-home care. But a federal policy change at the start of 2025 cut off easy access. Under the new rule, oral-only PLTs were moved into the ESRD payment bundle meaning many patients outside dialysis centers or in nursing homes have to jump through hoops to get access to them.

That policy shift is more than inconvenient…it’s harmful. Reports reveal that aging dialysis patients in nursing homes are being denied coverage altogether, resulting in higher phosphorus levels, greater risk of heart problems, and shrinking transplant chances.

Patients across the country have been impacted by the bundle and are sharing their concerns with policymakers and the public. Here are a few of their stories:

CKD care is not always straightforward, and encompassing every patient into a single fixed-payment bundle system takes away the key patient and provider relationship, where decisions are made to save lives, not time.

Ensuring that older adults can get the treatments they need to manage chronic conditions like kidney failure demands action.

The solution to this problem is simple. Medicare must reverse the decision to include oral-only Phosphate Lowering Therapies into the ESRD Bundle and restore coverage access to Medicare Part D. This change would immediately expand treatment options, reduce avoidable harm, and help keep thousands of older Americans eligible for transplant.

But the call for action is not just coming from advocates or clinicians, it is coming directly from patients. Their experiences are clear, consistent, and urgent. They are telling us what is at stake: their health, their independence, and their chance at a better life. Policymakers must listen.

Seniors and kidney patients deserve policies shaped by the realities they live every day not by technical payment decisions that ignore those realities. We urge the administration to return to a patient-centered Medicare approach that respects individual needs and ensures that older adults can age with health, dignity, and hope.

Guest Blog: A Life in the Shadows of North Carolina Fields

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By Yesenia Cuello

A former child farmworker and the daughter of immigrants reflects on her life and the current moment.

I was 14 the first time I worked in a tobacco field alongside my family.

We entered a field we couldn’t see the end of. We slit holes in black trash bags to wear over our clothes, keeping us dry from the dew. The spray from the tractors across the road made our noses itch and our eyes water. We ignored what we were told was “vitamins for the plants” being sprayed.

The tobacco stood taller than most of us, making it impossible to see between the rows as the sun caused the air to wave and the humidity to climb, heavy and suffocating.

When we finally stopped sweating, and the air felt cool against the back of our necks, even as our vision blurred, we assumed the worst had passed. We didn’t know then that our daily labor exposed us to the nicotine equivalent of a pack of cigarettes, chronic heat illness, and pesticide drift with lifelong health impacts.

We stayed together and took care of each other as we worked. The only thing we knew was that we needed the money.

Leading the nonprofit organization NC FIELD (North Carolina Focus on Increasing Education, Leadership & Dignity) was the first time I learned that what I experienced as a teenager was about food and labor justice. As part of NC FIELD’s leadership, I helped bring national attention to child labor, including advocating for the first federal minimum age for workers permitted to apply pesticides. We learned our words matter.

Advocating for the rights of those in our fields has become even more important over the years in North Carolina. Some who worked before us told us about breaks under shaded trees, cold lemonade, and the dignity of friendship with the farmer. Hard work was met with deep appreciation.

That’s not our story.

We were picked up by a van before sunrise. There were no scheduled breaks. We were yelled at to move faster or be fired. Water, if provided, was scarce or dirty; we were paid in envelopes of cash, and then we were transported back home. We didn’t know the farmer, and we knew not to ask their name.

We developed our own sense of belonging alongside those who embraced us. I remember a few local church ladies and teachers who showed kindness and took the time to understand us. They saw us, but to others, I was just labor — temporary, not part of their Southern heritage or the community.

Our invisibility isn’t accidental. It’s by design. The system bullies us into staying quiet, ignorant of the dangers of this work, and remain unseen in both life and death. Workers like us grew up with little access to healthcare through Medicaid, food assistance, or other safety nets. The assumption is that those resources are not for us or, by seeking that help, could endanger those we love.

During the pandemic, we were briefly called “essential.” Today, we’re labeled criminals, thieves of the American Dream. We pause before stepping outside our homes to attend church services or go to the grocery store.

And yet, the food supply still depends on the labor of thousands of migrant farmworkers in North Carolina. Eastern North Carolina drives our state’s place as one of the top 10 states in agricultural products sold, according to federal data.

I know what will happen if the immigrants who work North Carolina’s farms are taken away. If deportation forces continue to tear us from our communities, the impact will be catastrophic: crippling farms, driving up food prices, and destabilizing the food system that families across the nation depend on every single day. The consequences will ripple far beyond the fields, leaving damage that will be felt for generations.

We live with chronic stress, fear of robbery in migrant housing where it is illegal to lock doors, U.S. Immigration and Customs Enforcement (ICE) raids on farms and backcountry roads, at our children’s schools, and in our hospitals.

We go out, holding our documents in one hand and our child’s hand in the other, regardless of our legal status or citizenship.

That’s the reality of being a person of color and speaking Spanish in North Carolina today.

Who will keep farms thriving and stores supplied when thousands of us are gone? We remain essential regardless of the immigration system that facilitated our dehumanization. To deport farmworkers on a mass scale is to gamble with everyone’s food security.

This system may have been built on our silence, but our silence has not kept us safe. So, we are sharing our stories. We help make our state and the U.S. thrive. We will continue to work, hope and pray for the dignity of human existence.

Yesenia Cuello is a co-founder and the executive director of NC FIELD, a community-based organization that helps marginalized communities overcome barriers to resources. This column is syndicated by Beacon Media and is available to republish for free on all platforms under Beacon Media’s guidelines.

NCL’s Child Labor Coalition has worked in collaboration with NC FIELD for years.

Frances Perkins Is Rolling in Her Grave: Today’s Child Labor Rollbacks Are a National Shame

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By Sally Greenberg, NCL CEO

America once swore we would never go back. Never again would children be robbed of their childhoods—or their lives—in sweatshops, factories, and slaughterhouses. That promise was won through the relentless efforts of Florence Kelley and Frances Perkins, pioneering leaders of the National Consumers League.

Kelley’s crusade began in childhood, when her father, a Pennsylvania Congressman, took her into steel and glass factories where she saw children her own age toiling under dangerous conditions. That early exposure fueled her career as a factory inspector, documenting abuses, and pushing for laws to ban factory work for children under 14.

Perkins shot into the political limelight in March 1911 in the wake of the Triangle Shirtwaist fire, which tore through a high-rise industrial building in Greenwich Village, killing 146 workers, most of them young immigrant women, some only 14 years old. The doors were locked to prevent theft. Perkins was working for the National Consumers League, and was visiting a friend nearby when the fire erupted and became an eyewitness to the disaster. She dedicated her life to ensuring children never again died—or lost their childhood—in pursuit of profit.

Years later, as Secretary of Labor (1933-1945) under President Franklin D. Roosevelt, Perkins helped structure the Fair Labor Standards Act (FLSA) of 1938, which banned most child labor and enshrined worker protections built on compassion and common sense.

Fast forward to 2025—and we’re tearing their legacies apart. Legislative efforts in Florida, Iowa, and Ohio in 2025 attempted to loosen child labor standards in opposition to the federal Fair Labor Standards Act. The media has been reporting for years about the widespread abuses in meatpacking, roofing, and manufacturing—jobs once legally off-limits to the youngest workers who are now given the “opportunity” to risk life and limb for their employers.

In Florida, lawmakers tried to gut protections for teens: bills like HB 1225 and SB 918, would allow 16- and 17-year-olds to work unlimited hours and days without meal or rest breaks—even during school—and open the door for 13-year-olds to work in summer months. The Governor’s office drafted the legislation and talking points for sponsors, revealing a coordinated effort to exploit child workers.

In 2023, Iowa openly defied the Fair Labor Standards Act, as legislators loosened limits on hazardous work, weakening work-permit requirements for 16- and 17-year-olds, in direct conflict with FLSA rules.

In Ohio, Republicans reintroduced legislation to allow 14- and 15-year-olds to work longer hours during the school year, in direct conflict with FLSA protections.

These aren’t just local outrages; they echo a national effort to rollback child labor protections. According to the Economic Policy Institute, since 2021, at least 28 states have introduced legislation to weaken child labor laws, and 17 have passed them. From 2015 to 2022, the number of minors employed in violation of child labor laws increased by 283% and the number of minors employed in violation of hazardous occupation orders increased by 94%.

Let’s be honest: this isn’t about kids receiving work experience. It’s about cheap labor replacing the immigrant labor we are losing, or so says Governor Ron DeSantis of Florida. Allowing minors to work longer hours—sometimes overnight, in dangerous jobs—diminishes their education, endangers their safety, and undermines their future earnings. It’s a race to the bottom, sanctioned by lawmakers, cheered on by corporations driving profits, and in some cases cloaked in deception as apprenticeships or workplace training at less than minimum wage.

Back on that clear Spring day in 1911, Frances Perkins watched in horror as young girls leapt from the burning Triangle Shirtwaist factory. She vowed never again—and built laws that put children’s safety above profit. But today, lawmakers are dragging us backward, gutting protections and treating children as disposable labor to feed corporate bottom lines. This Labor Day, we say no. No rollbacks. No to profiteers. No to products being produced with child labor. And, no to a United States where children are once again sacrificed for profit.

Guest Blog: What Protections Generation Z Needs from Artificial Intelligence

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By Logan Baker, Communications Summer Intern

Artificial intelligence is not on the way; it’s already here. It’s recommending your next playlist, filtering your job applications, deciding what shows up on your feed, and even answering your Google search. As AI gets smarter, faster, and more prominent in our lives, it raises the question: What is protecting my generation, Generation Z, from AI? 

Gen Z is the first to grow up with AI incorporated into our everyday lives. It is beginning to shape how we think, how we learn, and how we see the world. While AI has created exciting possibilities, it also brings serious risks we cannot afford to ignore. 

One of my biggest concerns is how AI affects our mental health. The algorithms behind our favorite apps are designed to maximize engagement, not our well-being. AI pushes content that keeps us scrolling, even if it feeds anxiety and depression. This generation needs protection from those systems and companies need limits on how they can target young users and how often. 

Privacy is another huge issue. Every time we interact with AI, we are asked to give up our personal data. That data is not forgotten; it is stored, analyzed, and used to train more algorithms. We are all guilty of opting into data collection without truly understanding what we’re agreeing to. Gen Z, like all consumers, needs clearer privacy policies as well as the ability to opt out of privacy agreements without losing complete access. Additionally, stronger laws are needed to protect sensitive information like location and facial recognition data. 

Although misinformation has been a growing threat, AI makes it easier than ever to generate fake news and content that looks real but isn’t. This is especially dangerous in a world where 54% of U.S. adults get their news from social media. Platforms (especially social media) should be required to label AI-generated content clearly so that Gen Z has the tools to spot AI-generated content. Such protections would help people feel more comfortable navigating social media and would reduce the fear of falling for harmful AI-generated content. 

It is no secret that AI has the power to do incredible good, but with great power comes great responsibility. Me and my fellow members of Gen Z should not have to sacrifice our mental health or privacy for to power the AI revolution. To continue thriving in this brave new world, protections need to be put in place to help us co-exist with AI without companies using it to take advantage of us.