Nancy Glick

Preventing Foodborne Illness Is Worth the Investment

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Nancy GlickBy Nancy Glick, Director of Food and Nutrition Policy

“We’re not going back” is a rallying cry not usually associated with food safety policy. But if the Trump Administration heeds the call from the trade association for the processed meat industry to withdraw a needed proposed food safety rule, Americans will indeed go back to facing preventable foodborne illness outbreaks. 

The rule in question – to allow USDA’s Food Safety and Inspection Service (FSIS) to establish standards that will keep Salmonella contaminated chicken carcasses and poultry parts from entering the market – comes at a time when Salmonella infections are on the rise in the U.S.  According to data from the Centers for Disease Control and Prevention (CDC), Salmonella bacteria cause over 1 million human infections in the United States each year, putting more Americans at risk for serious illness, including fever, bloody diarrhea, and sometimes life-threatening complications. Moreover, CDC estimates that foodborne Salmonella causes 29 illnesses for each case that is detected – meaning significantly more people are getting sick than records show.  

The National Consumers League (NCL), as part of the Safe Food Coalition, praised FSIS for issuing the proposed rule in January 2025, as did many public health and medical societies. Why? One reason is because chicken is a major source of illness from Salmonella, causing an estimated 195,634 illnesses each year at a cost of $2.8 billion annually, according to Consumer Reports. In fact, CDC estimates that about one in every 25 packages of chicken at the grocery story are contaminated with Salmonella.  

The other reason is the good news. Today, advances in technology make it possible for inspectors to rapidly detect and mitigate Salmonella and other foodborne pathogens throughout the poultry supply chain. Thus, the FSIS rule is predicated on new technologies for early detection of foodborne bacteria.  

But, the Meat Institute, speaking for the $227.9 billion meat and poultry processing industry, has asked the Trump Administration to withdraw the rule as a way to reduce “burdensome” regulations. The group says the new FSIS rule, which was three years in the making, will “add cost to the production and supply of food, exacerbating food price inflation to the detriment of consumers.”  

However, NCL actually speaks for consumers, and we challenge this position. Polls show that Americans favor stronger food safety oversight. In a 2022 survey, 74 percent said it would be worth a 1 to 3 percent increase in the cost of food to pay for added safety measures.  

Moreover, Americans recognize that foodborne illness has widespread consequences, both in terms of people’s lives and costs to society. Starting with the human toll, CDC estimates that 48 million people get sick, 128,000 are hospitalized and 3,000 people die each year from foodborne diseases. In terms of the cost to the economy, a study by researchers from USDA’s Economic Research Service puts the cost to the economy at $75 billion (in 2023 dollars) annually, which includes medical care, lost productivity, and premature deaths, including those associated with secondary chronic illnesses.   

For all these reasons, Americans are not willing to give up food safety protections for the possibility of saving a few pennies when buying poultry products. Instead, consumers – along with public health officials and infectious disease specialists – are calling on the Trump Administration to finalize enforceable safety standards for poultry products as part of the new “Make America Healthy Again” initiative because the FSIS rule will result in safer food and fewer illnesses.  

The DEIA dilemma: What would Abraham Lincoln say

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By Sally Greenberg, NCL CEO

One of the dates seared into my memory from a young age is February 12 —President Abraham Lincoln’s birthday. We’ve had some truly heroic presidents, but it’s hard to compare any to the towering figure of Abraham Lincoln.

One of my favorite Lincoln quotes is this: “I am a firm believer in the people. If given the truth, they can be depended on to meet any national crisis. The great point is to bring them the real facts.”

As we enter the age of the second Donald Trump presidency, I’m reminded of Lincoln’s wisdom, wit, and kindness—qualities sorely lacking in the current occupant of the Oval Office. And unlike Lincoln, the truth too often eludes Mr. Trump.

This brings me to what the Trump administration is currently doing to try to erase diversity in America. They are waging war on DEIA (Diversity, Equity, Inclusion, and Accessibility), forcing federal agencies to wipe any reference of DEIA from their websites. In the process, they insult and demean millions of Americans and undermine the remarkable diversity that defines our beautiful democracy.

During his famous Gettysburg Address, Lincoln called upon Americans to “bind up the nation’s wounds.”  The Trump administration could have heeded that advice and worked to represent all people after the very polarizing election Instead, their attacks on diversity deepen our divides.

Misconceptions about DEIA abound. DEIA initiatives—like implementing accessibility measures for people with disabilities, addressing gender pay inequity, and diversifying recruitment outreach—exist to correct discriminatory organizational practices. As Erica Foldy, a professor at NYU’s Wagner Graduate School of Public Service, explains, DEIA efforts don’t discriminate; they put employers “on the path of creating more merit-based companies, more merit-based firms,” aiming to ensure that qualified people of all backgrounds have an “equal chance of being hired; you’re going to be paid the same as employees at comparable levels.”

Research from management consulting firm McKinsey & Company found that companies with more diversity financially and socially outperform those that are less diverse.

“The most successful companies understand that DEI isn’t just a ‘”nice-to-have,'” said Christie Smith, the former vice president for inclusion and diversity at Apple. “It’s a driver of innovation, talent attraction, and competitive advantage.”

I was among the many in my generation who marched on Washington for civil rights, women’s rights, reproductive rights, and LGBTQ+ rights. We wrote letters, met with members of Congress, and donated to causes that helped make America great—by making it more inclusive.

The fight didn’t start here. Long before I became head of this organization, the women who founded NCL were championing the rights of children, women, minorities, and immigrants. Florence Kelley, NCL’s first general secretary, was a founding member and signed the original charter forming the NAACP in 1909. She refused to stay in hotels that barred Black guests and was an outspoken advocate for federal anti-lynching laws—a law that wasn’t passed until 2022!  Her protégé, Frances Perkins, went on to serve as Secretary of Labor under FDR and, in one of her first acts, desegregated the cafeteria at the Department of Labor.

So championing DEIA – even if they didn’t call it that – has always been in NCL’s DNA. And so many Americans before us waged brave and bruising battles to secure these rights.  Rosa Parks refused to give up her seat to a white person on a segregated bus, and her protest sparked the Montgomery bus boycott, paving the way for the 1964 Civil Rights Act, signed by President Lyndon Johnson, which prohibited discrimination on the basis of race, religion, and national origin.

Japanese Americans, many of them U.S. citizens who were born in the U.S., were unjustly imprisoned after Japan attacked Pearl Harbor in 1941. They finally received reparations 47 years later through an act of Congress.

Jewish Americans formed the Anti-Defamation League in 1913 after Leo Frank, a Jew, was falsely accused of murder and lynched by a mob in Georgia.

Throughout the 20th century, gay and lesbian Americans were routinely harassed, arrested, fired from jobs, and discharged from the service until they’d had enough and fought back against yet another police raid. The Stonewall Riot in 1969 at a gay bar in New York City changed history – and many marches later and the formation of gay rights groups like the Human Rights Campaign secured myriad reforms and protections for the LGBTQ+ community.

President George H.W. Bush signed the Americans with Disabilities Act (ADA) in 1990, ensuring basic accessibility measures we take for granted today. So, when you see curb cuts and wheelchair-accessible restrooms, we can thank President Bush and the movement behind the ADA.

I began my career with the Anti-Defamation League in the 1980s, lobbying for hate crimes legislation when it was a novel concept.  At first it was a hard sell, but today, every state has hate crime laws. If you paint a swastika on a synagogue or burn a cross on a lawn, that’s not just vandalism—it’s a hate crime because we recognize that targeted violence against certain groups (all DEIA Americans) is an attack on our democracy.  And. I’m pretty sure we aren’t repealing those hate crime laws!

I am saddened that so many Americans have fought and gained hard-won rights and protections that are now under attack. Memo to Trump and his allies: America’s embrace of difference and diversity makes us a beacon to the rest of the world.

Finally, Lincoln once said, “The philosophy of the schoolroom in one generation will be the philosophy of government in the next.”  So, though the Trump administration may try to erase our land of difference and diversity, good luck with that.

The far-right thinks they have a right to control what we say, think, read, and do, but Americans don’t take kindly to being told what to do.

Most of us have grown up in a country that is far more diverse and embracing of differences than the generations before us. Diversity, alas, is our superpower and our future. You can try to erase it or ban it, but the genie is out of the bottle—and no executive order or website purge will put it back in. One way or the other, it is here to stay.

And hallelujah for that.

Congress should reject proposals to make school more expensive

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By Eden Iscil, Senior Public Policy Manager

A list of policy proposals currently under consideration by Republican majorities in Congress has become public. The 50-page document covers a range of programs and issue areas, looking for ways to pay for the new government’s “big, beautiful” swath of initiatives. Unfortunately, there are a bunch of policies thrown in that would make things worse for consumers. These three bad ideas related to education caught my eye. 

Taxing college scholarships. If you or your kid win a scholarship to help pay for college, the new Congress might want a piece of it. Under the proposal, they would take $5.4 billion each year from scholarship winners. This is especially harmful given a significant portion of scholarships are awarded to students who demonstrate financial need.

Making it harder for low-income children to eat breakfast or lunch at school. A plan to eliminate $900 million yearly in school breakfasts and lunches hinges on requiring children to “submit income verification documentation.” Time and time again, we have found that adding more bureaucracy to government programs reduces the number of people who enroll, even when they are eligible to benefit from the program. In this case, that means kids going hungry, which unsurprisingly is associated with worse academic performance. 

Forcing students to pay their loans while still in school. The answer to the $1.7 trillion student debt problem is not to force students to pay their loans “while actively studying.” Costs for college students are already sky-high; Congress doesn’t need to make them higher. 

Why are these ideas even on the table? Apparently, to give $522 billion to corporations by lowering the corporate tax rate. And, to cover the defunding of tax enforcement for the wealthy, a proposal the leaked memo estimates will allow high-earners and corporations to evade a total of $47 billion in taxes. 

Call your member of Congress and let them know they shouldn’t make students worse off just to pay for more corporate tax cuts.  

References (page number indicates page of Republicans’ memo where the proposal is located): 

Page 11, “Eliminate Exclusion of Scholarship and Fellowship Income” 

Page 34, “Require Income Verification for School Breakfast Program (SBP) and National School Lunch Program (NSLP)” 

Page 30, “End in-school interest subsidy” 

Pages 14 and 15, “Lower the Corporate Rate to 15 Percent” and “Repeal IRA’s IRS Enforcement Funding” 

Nancy Glick

A New CMS Rule Could Be a Gamechanger for Adults with Obesity

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Nancy GlickBy Nancy Glick, Director of Food and Nutrition Policy

If the story of combatting the nation’s obesity epidemic were a movie, it would be Groundhog Day.

Year in and year out, for over a decade, advocates and obesity specialists worked to get changes in federal policy. They pressed to get bills passed in Congress, drafted white papers, published research findings in medical journals, held roundtables and briefings, and sent letters and emails to policymakers over and over. But, using the Groundhog Day metaphor, the same day would start again.

Until now. Just as the protagonist in Groundhog Day changed his way of thinking and got the girl, the Centers for Medicare & Medicaid Services (CMS) changed its thinking to recognize obesity as a distinct and serious chronic disease requiring treatment. Based on this reinterpretation, CMS published a potentially game-changing proposed rule to establish the treatment of obesity as a medically necessary service under Medicare and Medicaid and allow Part D coverage of FDA-approved anti-obesity medications (AOMs), including new injectable drugs called GLP-1s (glucagon-like peptide-1 receptor agonists), as a result.

However, better obesity care is not a movie, and the proposed rule, while a major development, is not a final action. Before Medicare and Medicaid beneficiaries can get treated with new anti-obesity medicines, the agency must go through a formal rulemaking process to finalize the proposed rule, including receiving and analyzing comments from individuals and organizations concerned about obesity. This process is now underway, and the obesity community is coming out in force to urge CMS to update its Medicare and Medicaid coverage policy for AOMs based on medical evidence that obesity medications treat the disease of obesity and are not merely agents for “weight loss.”

As the organization that partnered with the National Council on Aging (NCOA) and leading obesity specialists across the country to develop and issue the first Obesity Bill of Rights for the nation, NCL submitted comments as the voice of the nation’s consumers and urged CMS to finalize the proposed rules for these reasons:

There Is a Widespread Scientific Consensus That Obesity Is a Distinct Chronic Disease – CMS’s reinterpretation of Medicare Part D policy is grounded in extensive medical evidence that obesity is not a cosmetic condition but a distinct and serious chronic disease requiring treatment. Reinforcing this recognition of obesity as a distinct disease state, major medical organizations now consider obesity a chronic disease due to its complex biological mechanisms and potential for significant health complications. This includes the American Medical Association, American Association of Clinical Endocrinologists, American College of Endocrinology, and all the leading obesity and nutrition organizations.

Obesity Is the Nation’s Most Prevalent Chronic Disease and Is Directly Linked to Numerous Chronic Diseases –Today, obesity affects 41.9 percent of US adults – more than 100 million people – which makes obesity the most prevalent chronic disease affecting Americans, significantly eclipsing the other most prevalent chronic diseases: heart disease, diabetes, chronic kidney disease, cancer, chronic lung disease, Alzheimer’s Disease, and stroke. Even more significantly, more than 230 medical conditions are directly linked to overweight and obesity, meaning these diseases worsen as the degree of obesity increases. Thus, obesity today is responsible for an estimated 400,000 deaths a year.

The Cost of Obesity Is Too High and Everyone Is Paying the Price – Obesity, due to its role in causing or worsening chronic disease, accounted for 47.1 percent of the total direct and indirect costs of treating chronic conditions in 2016. Accordingly, some estimates put the national cost of obesity at $1.7 trillion a year –more than what Social Security paid in retirement benefits in 2022.

Compared to Other Serious Chronic Diseases, Obesity Goes Largely Undiagnosed and Untreated – The Obesity Bill of Rights was issued to transform obesity care in the US at a time when obesity remains largely undertreated with costly repercussions in high rates of obesity-related diseases and preventable deaths. Reflecting this reality, only 30 million of the more than 100 million Americans living with obesity in 2022 received a diagnosis of obesity, and only around 2 percent of those eligible for anti-obesity medications were prescribed these drugs. Although multiple factors are responsible for this pervasive gap in obesity care, the most pernicious are access barriers that keep people with obesity from getting the care they need, whether through the exclusion of obesity treatments in many insurance plans, restrictive insurance practices that delay or deny treatment, or out-of-date government policies.

New Anti-obesity Medications Are Safe and Effective and Result in Savings From Improved Health Outcomes – As noted in the CMS proposed rule, there have been major advances in understanding and treatment of the disease of obesity since the Medicare Part D program went into effect in 2006, resulting in new therapeutic agents, such as GLP-1 drugs that can help people lose up to 20 percent of their weight in 26 months. Calculating the potential savings resulting from better health outcomes when obesity is treated, studies are beginning to project the potential savings to the economy from covering obesity medications. One recent study published December 5, 2024, in JAMA Network Open estimated that a 10 percent weight loss resulting from obesity treatment saved $2,430 in reduced medical expenditures, and for a 25 percent weight loss, the reduction in health expenditures is $5,444 per person.

The comment period for the CMS proposed rule closes soon, and then it will be up to the new Trump Administration to finalize this important rulemaking. It is our hope that the new team at CMS will make this a priority. Simply put, this important change in CMS policy will make a significant difference in the lives of millions of Americans.

Guest Blog: Paying Tribute to Jimmy Carter, Pension Champion

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A version of this guest post was originally published by the Pension Rights Center.

By Karen Friedman

When Jimmy Carter was elected President in 1976, I was a young whipper snapper living in an old, disheveled group house in Washington D.C. When I think back on that time, I fondly remember that his Administration—dedicated to energy conservation, peace and human rights—inspired me and many of my friends to become social justice warriors.

It was thus fitting that yesterday a group of my activist friends (albeit a bit older and I hope wiser) joined throngs of other citizens to pay tribute to President Carter who was lying in state in the Capitol’s Rotunda.

President Carter accomplished so much as the many tributes about him reflect. But among his deserved accolades there is one that often gets overlooked: Jimmy Carter was a pension champion.

In 1978,  Jimmy Carter established the President’s Commission on Pension Policy, which was tasked with conducting a 2-year study of the nation’s pension systems and the future course of national retirement income policies. The Pension Rights Center (PRC) provided input to the Commission (through our own Citizens’ Commission on Pension Policy).

Among the most visionary of the study’s recommendations was the call for the establishment of a minimum universal pension system (on top of Social Security) that would require private employers to contribute at least 3% of payroll for all employees over the age of 25. Close to a half century later, despite the efforts of PRC and others, our nation has yet to enact an adequate and secure universal pension system akin to what President Carter recommended.  (Other Commission recommendations, e.g. to improve survivors’ benefits and protect spouses in divorce have since become law.)

The conversation that President Carter began those many years ago is needed more than ever today. We must continue to work together to create a pension system that, in conjunction with Social Security, provides adequate and secure retirement income to our nation’s working families.

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About the National Consumers League (NCL)

The National Consumers League, founded in 1899, is America’s pioneer consumer organization.  Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad.  For more information, visit nclnet.org.

New NCL analysis of medical debt policies highlights need for reform

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By Sam Sears, Health Policy Associate, National Consumers League

The National Consumers League (NCL) recently published a new issue brief focused on hospital’s medical debt practices. With over 100 million Americans grappling with medical debt, and 1 in 7 of them reporting to KFF Health News that they’ve been denied care, it is prudent to evaluate these anti-consumer hospital policies.

The analysis, which was completed by Magnolia Market Access, found that 340B hospitals are significantly more aggressive with their medical debt policies – 340B hospitals are twice as likely to deny or defer chare and also significantly more likely to take legal action against a patient. Additionally, our analysis found that for-profit hospitals are significantly less aggressive in their practices against patients with medical debt than nonprofit or government hospitals, and that screening for financial assistance does not resolve medical debt issues.

Medical debt is unpredictable and can have long lasting consequences. Nearly 50% of Americans struggling with medical debt have it reported to their credit report, and over 40 million people owe nearly $88 billion that has been sent to collections. The Biden Administration has taken action to combat and address medical debt, which you can read more about here on our blog. However, there are additional actions that policymakers may take.

NCL has, and continues to fight to protect consumers from excessive troubles due to medical debt, including working with policymakers to combat anti-consumer debt collection policies hospitals continue to practice. The findings from the analysis conducted in this issue brief further highlight the need for 340B Drug Pricing Program reform, to ensure the savings that hospitals receive are reinvested in ways that continue to benefit consumers and patients.

Hospital Medical Debt

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About the National Consumers League (NCL)

The National Consumers League, founded in 1899, is America’s pioneer consumer organization.  Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad.  For more information, visit nclnet.org.

Nancy Glick

Science Should Drive Obesity Care

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Nancy GlickBy Nancy Glick, Director of Food and Nutrition Policy

Today, over 100 million Americans, or 40.3 percent of adults, are living with obesity. This makes obesity the nation’s most widespread chronic condition, impacting many more people than diabetes, heart disease, stroke, certain cancers, chronic lung disease, and chronic kidney disease.

Yet, the sad fact is obesity still gets short shrift from health professionals and policymakers, even though it worsens the outcomes of more than 230 chronic diseases, is responsible for an estimated 400,000 premature deaths annually, and costs society an estimated $1.72 trillion a year.  As a consequence, only 10 percent of people with obesity get help from medical professionals, meaning the disease remains largely undiagnosed and undertreated.  This is occurring even though leading medical societies, including the American Medical Association (AMA), agree that obesity is a serious disease requiring comprehensive care.

It doesn’t have to be this way, which is why the National Consumers League worked with the National Council on Aging and leading obesity experts to issue the first Obesity Bill of Rights for the nation, which establishes eight essential rights so people with obesity will be screened, diagnosed, counseled, and treated according to medical guidelines. The goal is to put an end to the prejudice, incorrect beliefs about obesity, misinformation about treatment options, and outdated government policies that keep Americans from getting the same standard of care as those with other chronic diseases.

It will take time for the Obesity Bill of Rights to be incorporated into clinical practice, but specific rights already have significance. This is the case with new “blockbuster” injectable medicines called GLP-1 (glucagon-like peptide-1 receptor) agonists that work by mimicking a hormone produced in the small intestine to reduce appetite and slow digestion. Considered a game-changer in chronic obesity treatment, GLP-1s can help people lose up to 20 percent of their weight in 26 months. Thus, The Right to Coverage for Treatment reinforces calls from obesity specialists and medical societies for an end to exclusionary coverage policies by insurers and government agencies, so GLP-1 medications are a treatment option for adults at higher risk for living with weight-related diseases.

The major challenge has been the Medicare program, which excludes coverage for weight loss drugs due to past safety concerns that no longer exist today. But this could change. On November 26, 2024 the Centers for Medicare and Medicaid Services (CMS) published a proposed rule to allow seniors on Medicare and adults with Medicaid to have coverage for GLP-1s, thereby removing one of the biggest obstacles impeding access to quality obesity care in the country. If CMS’s proposal is finalized, the right to coverage for obesity treatment will become a reality for 7.4 million Americans – a good start in ensuring that people with obesity receive individualized quality care.

However, there is a lot of misinformation about GLP-1 medications, so The Right to Accurate, Clear, Trusted, and Accessible Information is also important, especially because disinformation is raising concerns among health professionals and the public. To date, the Food and Drug Administration (FDA) has approved four GLP-1 drugs based on evidence from large-scale clinical trials that these medicines are safe and achieve substantial weight loss. Yet, critics of these drugs assert these compounds cause severe side effects in all users, claim GLP-1 medications cause depression and suicidal thoughts, and allege the European Union (EU) is investigating this matter.

Responding to these allegations, experts in obesity treatment have assembled the facts from scientific journal articles and government reports. In furtherance of the right of the public to have this information, here is a summary of these findings:

  • Regarding the potential side effects of GLP-1s, several studies dispute the assertion that GLP-1 drugs cause severe adverse effects in all people. The consensus is that because these drugs slow stomach emptying, they can cause gastrointestinal problems that are usually mild to moderate and often go away within one to two months.
  • As to GLP-1s causing suicidal ideation, a recent commentary in JAMA Open Network concludes that large-scale studies do not show any increased risk of suicidal ideation while a 2024 study by researchers at Case Western Reserve University School of Medicine found that people taking a GLP-1 drug had a lower risk of suicidal thoughts compared to those taking a non-GLP-1 compound.  Similarly, the FDA published a detailed report in January 2024 also finding no association. FDA reached this conclusion after analyzing information on adverse events from the FDA Adverse Event Reporting System (FAERS), reviewing a meta-analysis of GLP-1 clinical trials data, and analyzing post-marketing data in the FDA’s Sentinel System.
  • Concerning the investigation by the EU’s European Medicines Agency, EMA’s Pharmacovigilance Risk Assessment Committee conducted a review of health records and issued a finding that no causal association exists between GLP-1s and suicidal thoughts or self-injurious actions.

The Rand Corporation coined the term “truth decay” to call attention to the blurring of the line between opinion and fact. It is important that “truth decay” not become a new obstacle to Americans receiving quality obesity care.

Congress Must Protect Consumers from PBM Abuse

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By Sally Greenberg, Chief Executive Officer

The post-election lame duck session of Congress could be one of the most influential for consumers – if our elected officials are willing to act. As Americans struggle with high prescription drug costs, insurance middlemen pharmacy benefit managers (PBMs) siphon dollars from the drug pricing system into their own pockets. Two bills sitting in Congress aim to change this by increasing transparency, ensuring PBM rebates are passed directly to consumers, and disconnecting PBM profits from the price of medicines.

S. 3973: The Pharmacy Benefit Manager Transparency and Accountability Act, would require PBMs to pass on rebates from drug manufacturers directly to consumers, ensuring they benefit from cost savings at the point of sale. It also delinks PBM profits from drug prices, eliminating the incentive to drive up costs.

S. 3430: The Prescription Drug Price Relief and Consumer Protection Act establishes stronger regulations on PBMs, ensuring transparency in drug pricing and rebate negotiations, and making sure PBMs act in the best interests of consumers.

These bills will create a much fairer system, ensuring that savings reach consumers and medications are made more affordable. Congress must advance these bills this year to protect consumers from PBM exploitation now and lay the groundwork for additional healthcare reforms next session.

Although this session – and year – is coming to a close, meaningful healthcare reforms that directly benefit consumers can start now.

Medical debt, a growing crisis for Americans, and the Biden Administration’s bold moves to tackle it

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By Sam Sears, Health Policy Associate, National Consumers League

Consumers, unfortunately, accrue debt quite often throughout their lives – be it a mortgage, a car loan, credit cards, or even student loans. However, there is one type of debt that consumers have no way of knowing when it will be incurred – medical debt.

At the National Consumers League (NCL), we have been fighting to protect consumers from the unfair burdens of medical debt, both as it relates to access to care and exposing the inadequacy of the 340B Drug Pricing program. However, medical debt as a whole has a moment in the spotlight this October as the Biden Administration tackles the issue.

As I’m sure consumers have noticed, the cost of everything has gone up– groceries, rent, and even healthcare. Many families are forced to make tough decisions between putting food on the table or paying their medical bills. For some, it means putting off medical care to avoid the cost of the visit.

Medical debt now plagues more than 100 million Americans across the nation. As KFF Health News found, 1 in 7 people with debt shared that they’ve been denied access to a hospital, doctor, or other healthcare provider, and two-thirds have put off care they or a family member needs because of the cost. Shockingly, nearly 50% of those Americans have medical debt reported on their credit report, and over 40 million people owe around $88 billion, which has been sent to collections. This makes medical debt the single largest source of debt in collections, outpacing auto loans and credit cards.

The harsh reality is medical debt doesn’t just linger on a credit report; it devastates lives and can have lasting consequences. NCL has previously covered how medical debt collection practices can leave consumers in a “never-ending spiral of debt.” Hospitals across the nation are suing patients over their medical debt, and patients may not know that they must go to court or have the resources to hire a lawyer to protect themselves. As a result, creditors may seek default judgements in which a court authorizes them to garnish a patient’s wages as part of a payment plan, or place a lien on their home, cars, or other property.

Over the past few weeks, the issue of medical debt has been highlighted in the national conversation. A new proposed rule from the Department of Defense would introduce a sliding-scale discount program for civilians who receive care at a military medical treatment facility (MFT). Health and Human Services Secretary Xavier Becerra also announced that the Center for Medicare and Medicaid Services (CMS) will be adding questions about medical debt to the Medicare Current Beneficiary Survey (MCBS), an annual survey of Medicaid beneficiaries used to understand their health needs. These new questions will allow CMS to further understand the impact of medical debt on the day-to-day lives of seniors and people with disabilities.

Recently, the White House held a pivotal event hosted by the Consumer Financial Protection Bureau (CFPB), where individuals directly impacted by medical debt shared their heartbreaking stories. In tandem, the White House released a fact sheet unveiling the Administration’s new actions to address and reduce medical debt for consumers. Following these actions, the CFPB has taken several steps to protect consumers experiencing medical debt.

In his remarks, CFPB Director Rohit Chopra stated that the agency “has been laser-focused on dealing with the growing burdens of medical debt.” NCL commends CFPB and Director Chopra for their ongoing efforts to address the impact of medical debt on patients. Back in June, CFPB issued a proposed rule that would ban unpaid medical bills from being included on credit reports, and prevent the repossession of medical devices. The public comment period for this proposed rule closed on August 12. During the White House event, Director Chopra stated that CFPB is “working to finalize our credit reporting rule now.” But, with nearly 75,000 comments, NCL anticipates that it may take the agency some time to issue a final rule.

Given the complexities of medical bills, the CFPB has also been urging and requiring transparency from hospitals and debt collectors. New guidance was issued to crack down on deceptive medical billing practices, including the illegal collection of medical bills that are false, inflated, or not actually owed. CFPB has received several complaints from patients and consumers over medical debt collections, particularly for bills that the patient does not owe, were already paid by the consumer, insurance, or a government program (such as Medicare or Medicaid), or for debts that are covered by insurance, hospital assistance programs or other programs. More than ever, hospitals and healthcare providers are subcontracting medical billing and collection activities to third parties, who have legal obligations under the Fair Debt Collection Practices Act. CFPB has issued guidance to further clarify these legal obligations as they relate to medical debt and collection practices.

And let’s not forget the shameful practices of some nonprofit hospitals. As tax-exempt institutions, nonprofit hospitals are legally required to provide financial assistance to offset healthcare costs for low-income patients and consumers —yet many fall woefully short. In early October, CFPB published a comprehensive blog post drawing attention to billing and debt issues arising from nonprofit hospitals, many of which provide inadequate financial assistance. Often referred to as ‘charity care,’ federal regulations do not provide further guidance on the eligibility of patients or spending standards for hospitals. Thus, financial assistance policies are left to the hospitals themselves. While some states have intervened in an increasingly bipartisan manner, there are still too few regulations governing what financial assistance should look like or how it should be administered. NCL supports and recognizes the critical role hospitals, particularly nonprofit hospitals, play in their communities. However, the lack of transparency, as well as the predatory practices of some, need to change. NCL applauds CFPB for the spotlight they’ve put on these practices as a driver in the medical debt crisis.

CFPB has also taken steps to remove all medical collections under $500. This last step went into effect on April 11, 2023, and with this change, it’s estimated that roughly half of those with medical debt on their reports will have it removed from their credit history. If you find a medical collection under $500, a paid medical collection, a collection less than a year old, or errors on your report, you can dispute that information with the credit reporting company.  One of the first steps you can take is to check your credit reports for any outstanding medical bills.

NCL stands in strong support of the efforts of the CFPB and the Biden Administration as they work to safeguard consumers and bring transparency to the healthcare and credit reporting systems. NCL shares CFPB’s concerns regarding how consumers accrue these inaccurate, undue bills in the first place. The Biden-Harris Administration continues to prioritize consumers’ access to healthcare and a commitment to protecting vulnerable populations from the unfair consequences that arise from an illness or medical emergency. NCL applauds Director Chopra, the Biden-Harris Administration, and federal agencies for their leadership in addressing the burden of medical debt.

We look forward to the CFPB’s final ruling on medical debt and credit reporting, which could be a game-changer for millions of Americans.

To learn more about your rights, and actions you can take, if you have medical debt on your credit report or need to dispute a medical bill, visit CFPB.

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About the National Consumers League (NCL)

The National Consumers League, founded in 1899, is America’s pioneer consumer organization.  Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad.  For more information, visit nclnet.org.

As election looms, regulators can act now to help consumers save at the pharmacy counter

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By Sally Greenberg, Chief Executive Officer, National Consumers League

Now that we are a mere 15 days away from the election, all attention is unsurprisingly laser-focused on the outcome of the general election. Surprisingly, however, both candidates have made it clear that one of the leading healthcare issues on the ballot is the future of the Affordable Care Act (ACA). Ten years after its enactment, the ACA has become intertwined with the very fabric of the healthcare landscape in the US and thus requires federal agencies to regularly revisit the statutes to ensure it is fulfilling its original intent.

Now that the current administration has released proposed rulemaking on core provisions of the ACA, it has become more important than ever to add statutes to address a loophole in the essential health benefits (EHB) provision of the ACA. There is no better time for three federal agencies – the Department of Treasury, Department of Labor, and Department of Health and Human Services – to change language in the ACA that is constantly exploited by profit-seeking insurers, producing severe access and affordability barriers for patients and undermining the original intent of the ACA.

The loophole goes something like this: Essential health benefits are a central pillar of the ACA and provide affordability protections to Americans by ensuring that everyone in the individual and small group health insurance markets has access to coverage that actually covers the services they need. These essential health benefits fall into ten categories, one of which is prescription drugs.

If a patient pays out-of-pocket for their prescription (an essential health benefit), that dollar amount counts towards their out-of-pocket maximum. Once they hit the out-of-pocket cost maximum set by the ACA, insurance kicks in and covers the remainder of their out-of-pocket costs. However, insurers and pharmacy benefit managers (PBMs) are designating some specialty prescriptions to be “non-essential” – regardless of whether a patient needs them to stay alive. Once labeled “non-essential,” the patient is no longer protected by the out-of-pocket maximum set by the ACA.

What does this look like in practice? A patient may spend money on lifesaving medications that don’t count toward their out-of-pocket maximum. All year, a patient could pay out-of-pocket for prescriptions but never reach their maximum and see their insurance kick in. This saves a few bucks for insurers and PBMs but imposes massive financial burdens for patients who would otherwise be protected under the ACA. The EHB loophole forces patients to pay more out-of-pocket, a situation that circumvents the original intent of the law — which, as a reminder, is to keep drug costs affordable for consumers.

How can we close this loophole? The Department of Treasury, Department of Labor, and Department of Health and Human Services could act now. The tri-agencies can integrate language to close the EHB loophole into the Notice of Benefit and Payment Parameters (NBPP) to clarify that any service covered by a health plan is defined as an EHB.

Both of the frontrunners of the 2024 presidential election have signaled their intent to find solutions that lower prescription drug costs for Americans. While the country braces for the ripple effects of a new administration regardless of the results, regulators should close the EHB loophole to protect consumer access to treatments in line with the original intent of the ACA – affordable and accessible care for patients.

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 About the National Consumers League (NCL) 

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.