The Impact of H.R.1 on Healthcare Accessibility Nationwide

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By Moses Boyd, NCL Summer Health Policy Intern

Between 9.9 and 14.9 million—the number of people that could become uninsured as a result of the cuts and work requirements imposed by H.R.1, commonly known as the One Big Beautiful Bill Act.

446—the number of hospitals across the United States that could shut down or cut services due to H.R.1.

One month—the new, shortened period that Medicaid expansion enrollees can receive retroactive coverage for services received prior to the application date (two months for individuals enrolled through traditional Medicaid), which could leave patients requiring care—including pregnant individuals—with considerable out-of-pocket expenses.

H.R.1 represents one of the most substantial changes to the U.S. healthcare system since the passage of the Affordable Care Act in 2010. The law’s provisions restrict access to healthcare for many low-income Americans and communities that rely on Medicaid. H.R.1 limits primary care access, fosters greater health center consolidation, and makes coverage requirements more stringent—all of which jeopardize access to affordable healthcare. As we mark one year since the bill’s passage, it is important to reflect on its impact on American consumers.

One of H.R.1’s most profound effects on the healthcare system is its restructuring of Medicaid eligibility and enrollment. The law sets strict new work requirements on numerous Medicaid beneficiaries, making it increasingly burdensome for low-income individuals to get and retain insurance coverage. This burden is not only felt by those seeking coverage—who must demonstrate compliance with the 80-hour-per-month work requirement or request an exemption when applying for or renewing coverage—but also by state governments, which must now implement systems that comply with those standards or risk losing federal funding. As many of those affected are already working, attending school, caring for family members, or managing health conditions, these restrictions may force them to forgo coverage entirely due to the difficulty in navigating the administrative barriers to maintain it.

Work requirements are far from a novel idea in the realm of Medicaid eligibility. Prior to the passage of H.R.1, 11 states had attempted to implement the practice in their Medicaid programs by applying for Section 1115 waivers—authorizations granted by the Centers for Medicare and Medicaid Services (CMS) which allow states to test experimental changes to their Medicaid programs. Some of these states’ legislatures also introduced legislation directing their Medicaid agencies to pursue and enforce these requirements. Just two out of these 11 states, Arkansas and Georgia, were able to successfully overcome federal lawsuits, court injunctions, and administrative rollbacks that challenged these requirements; only Georgia’s remain in effect. In Arkansas, an estimated 18,000 eligible beneficiaries lost coverage under work requirements because of logistical and reporting challenges—prompting a federal district judge to halt the program.

From this, an important question arises: why are we doing this again if it did not work the first time?

Because Medicaid primarily serves low-income Americans—a population disproportionately composed of people with disabilities, single-parent households, rural residents, and racial minorities—work requirements are likely to exacerbate existing disparities in healthcare access.

When health coverage is lost, even temporarily, patients are more likely to delay care, leading to worsened health outcomes.

Alongside the danger of individuals losing personal coverage, the legislation also raises concerns about the financial stability of hospitals that serve large numbers of Medicaid patients. According to Public Citizen, hospitals at risk of closing serve approximately 6.6 million patients annually and employ over 275,000 workers. As coverage losses increase, hospitals face higher levels of uncompensated care and reduced reimbursement revenue, placing additional pressure on facilities that already operate on narrow financial margins. Communities that depend on rural hospitals and safety-net providers, such as community health centers, are especially affected because these facilities are often the only source of emergency and specialty care.

Economic concerns have already led some health systems to reduce services. For example, MedStar Washington Hospital Center recently announced the closure of a postpartum unit and the elimination of nursing positions, citing financial pressures. In places where these medical centers are a major employer, local employment and industry are also negatively affected. When health systems cut services, consumers are left with fewer options for care and must travel further to see a healthcare provider. During medical emergencies, mere minutes can mean the difference between life and death; for pregnant individuals, a miscarriage, premature delivery, or other complication could be catastrophic. Additionally, because of H.R.1’s narrowing of the retroactive coverage window, such events could leave these patients responsible for significant medical debt if they are unable to apply for coverage in time.

Americans already spend more on healthcare than residents of any other developed nation, yet millions continue to face barriers to obtaining timely care. As more people become uninsured, hospitals and other providers absorb higher levels of uncompensated care, costs that are shifted throughout the healthcare system and ultimately borne by patients, employers, and taxpayers through higher premiums and healthcare costs. At the same time, more uninsured

individuals are left to shoulder the full cost of essential medical care, driving increases in medical debt—a uniquely American problem that can damage credit, make it harder to qualify for a mortgage or other loans, and force families to delay additional healthcare and other basic necessities.

One year after its enactment, H.R.1 has become a defining test of the nation’s commitment to healthcare access. The coming years will reveal the full scope of its effects, but the warning signs are already clear. Millions of Americans face new barriers to coverage, hundreds of hospitals face mounting financial pressure, and patients who rely on Medicaid face a greater risk of losing access to care. The true cost of these changes will be seen in delayed care, rising medical debt, and diminished access to healthcare in communities across the country. Ensuring that healthcare remains accessible and affordable must remain a national priority.

Nancy Glick

The Case for Ending Unnecessary Antibiotic Use in Livestock

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By Nancy Glick Director of Food and Health Policy

Chronic diseases, like diabetes, heart disease, hypertension, and certain cancers, get a lot of attention from policymakers for obvious reasons. Collectively, these diseases affect more than 75 percent of American adults and drive approximately 90 percent of the nation’s healthcare costs.

But what about infectious diseases like Lyme disease, West Nile virus, pneumonia, tuberculosis, influenza, COVID, meningitis, measles, and foodborne infections like Salmonella and Escherichia coli (E. coli)? According to the Centers for Disease Control and Prevention (CDC), millions of infectious disease cases occur in the U.S. annually, causing over 23 million physician visits, tens of millions of ER visits, and many deaths, such as 45,000 flu-related deaths, 41,627 deaths from pneumonia, and 5,000 from foodborne illnesses in 2024 alone.

However, these statistics underestimate the hazard. It is the consensus of the public health community that the U.S. is losing ground in the fight against preventable infectious diseases. Not only have declining vaccination rates allowed previously controlled diseases like measles to return, but more than 30 new human pathogens have been identified over the past three decades, indicating that the number of bacterial threats is increasing.

Yet, what is most concerning to public health officials and the medical community is the surge of drug-resistant infections caused by pathogens that have become resistant to antimicrobial drugs, such as antibiotics, antivirals, and antifungals. Putting this serious problem into context, the CDC estimates that more than 2.8 million antimicrobial-resistant infections occur each year, resulting in more than 35,000 deaths. Beyond this human toll, the CDC estimated that the cost of treating infections caused by just six antimicrobial-resistant germs is more than $4.6 billion annually.

Addressing this problem will require collective action, starting with a step we can take now. Public health and medical organizations broadly agree that adding antibiotics to animal feed and water to prevent illness in healthy animals living in crowded conditions contributes significantly to the rise and spread of antimicrobial resistance (AMR). This is now the case in many livestock operations where the unnecessary use of low-dose antibiotics breeds antibiotic-resistant bacteria that multiply rapidly and make their way to humans during the slaughter and processing of meat products and when residues in animal manure leach into the soil and contaminate water sources used for crop irrigation.

Because the health of the public is at stake, the National Consumers League is one of the 65 organizations that filed a rulemaking petition with the Food and Drug Administration (FDA), calling on the agency to combat what scientific journals call the “silent pandemic” of antimicrobial resistance in the U.S., where AMR often progresses invisibly and goes unnoticed.

Specifically, the petition validates the medical need for antibiotics when animals are sick but urges the FDA to take several actions to ensure the safe use of antibiotics in animal agriculture, as required by Congress. Of key importance, the petition requests that the FDA:

  • Publish a determination that the current routine use of antibiotics in animal feed and water when not associated with diagnosed illness does not meet the mandated standard of presenting a “reasonable certainty of no harm.”
  • Withdraw approval of antibiotics administered in feed or water when not associated with a diagnosed illness. This would cover “disease prevention” and non-medical purposes of “maintenance of growth.”
  • Follow the model set by the Department of Health and Human Services (HHS) to control antibiotic use in human medicine by setting public-health-based reduction targets for antibiotic use by the livestock sector. The goal would be greater transparency and measurable improvements in antibiotic stewardship in animal agriculture.

Few actions are more important to the nation’s health than confronting the silent pandemic of antimicrobial resistance. That is why we must speak out now and urge the FDA to act. If left unchecked, resistant bacterial and fungal pathogens will make common infections harder to treat, raise the risk of complications from routine medical procedures, and cost more lives. The FDA should move quickly to curb unnecessary antibiotic use in livestock and protect the effectiveness of these lifesaving drugs for the people who need them most.

A Wake-Up Call About What’s Hiding in America’s Favorite Snacks

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By Sally Greenberg, NCL CEO

A new Consumer Reports investigation released this week left me shocked—and frankly, disgusted. 

Consumer Reports, working with the food transparency app Yuka, tested more than 120 samples of 40 popular processed foods and found troubling levels of additives and contaminants in many of the products Americans consume every day. Even more disturbing, many of these foods are heavily marketed to and consumed by children. 

The findings should concern every parent, consumer, and policymaker. Consumer Reports found that about 25 percent of the products tested contained additive levels high enough that a single serving exceeded what some public health authorities consider a safe daily limit. When contaminants were factored in, that figure rose to more than one-third of the products tested. Eleven products exceeded safety benchmarks for adults, while 14 exceeded recommended limits for children. 

One finding stood out in particular. A single serving of Hostess Donette’s Powdered Mini Donuts contained nearly 19 times the amount of glycidyl esters—a probable carcinogen—that experts consider safe to consume in a day. Other popular products, including Flamin’ Hot Cheetos, Gushers, Fruit Roll-Ups, Takis Fuego, and grape Kool-Aid, contain elevated levels of additives or contaminants linked to neurobehavioral effects, DNA damage, and other potential health risks. 

As the staff at the National Consumers League knows, I occasionally indulge in junk food. After reading this report, those favorites have lost their appeal. 

But this issue is much bigger than my snack choices. 

Consumers should not have to rely on independent investigations to discover what may be lurking in foods sold on grocery store shelves. Food manufacturers have a responsibility to monitor their products, test contaminants, and ensure that the foods they market—especially to children—meet the highest possible safety standards. 

That is why I want to thank Consumer Reports for conducting this investigation and bringing these findings to light. This is what consumer protection looks like. Independent testing, rigorous research, and a willingness to ask hard questions are essential to protecting the public and holding corporations accountable. 

The report also raises broader questions about the adequacy of our nation’s food safety system. As Consumer Reports notes, the United States often permits additives at levels that exceed those allowed in other countries, and some substances lack meaningful regulatory limits altogether. Consumers deserve stronger oversight and greater transparency from both industry and regulators. 

Food companies should not wait for negative headlines to act. I urge food manufacturers to proactively identify and address these problems before products reach store shelves. Regulators must also strengthen oversight and set clearer, enforceable safety standards. Consumers deserve prompt, transparent explanations and concrete plans for improvement when issues are found. 

The National Consumers League will be watching closely to see how the companies named in this report respond. Americans place their trust in the brands they purchase for themselves and their families. That trust must be earned—and protected. 

Consumer Reports has done consumers a tremendous service. Now I call on food manufacturers to rigorously ensure product safety and transparency and urge regulators to enact stricter oversight and clear standards. It’s time for them to protect consumers as diligently as this investigation has. 

Nancy Glick

The Significance of May 22, 2025: The End of the GLP-1 Free-for-All

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By Nancy Glick Director of Food and Health Policy

May 22, 2025 – the date set by the Food and Drug Administration for the end of sales of mass-marketed compounded GLP-1 weight-loss drugs – is a barometer of how far we have come in regulating untested, unapproved GLP-1 products and how far we still need to go.

Going back to the beginning, in 2022, studies showed that the FDA-approved GLP-1 drugs, semaglutide and tirzepatide, achieved significant weight loss. This news prompted high demand, which led to a national shortage of these drugs. Thus, to fill the supply gap, the FDA allowed compounding pharmacies to sell non-identical versions of GLP-1 drugs under specific FDA regulations until the shortage ended.

At the time, the FDA could not foresee that opening the market to compounders would create a gold rush situation for telehealth platforms and other sellers. Profits soared, and a largely unregulated market emerged where sellers hyped compounded GLP-1s as cheaper options with the same safety and efficacy as the branded drugs without disclosing the risks. Over time, this exploitative market expanded to include so-called GLP-1 products, such as gummies and patches, that do not contain GLP-1 ingredients. The market also includes online pharmacies selling counterfeit injectable GLP-1s and bad actors selling illegal research-grade raw GLP-1 ingredients online to consumers with dosing instructions.

This was the situation in February 2025, when the National Consumers League issued a national alert to relay the warning from the FDA that compounded GLP-1s are “risky for patients” because these drugs are not required to be tested, and are not reviewed and approved by the FDA. Then, on March 12, the FDA announced the end of the national shortage of semaglutide and tirzepatide, setting May 22 as the last day that mass-produced compounded GLP-1s drugs could be sold.

In advance of the deadline, NCL launched a national initiative, The Weight Truth, to help consumers learn about the differences between FDA-approved and compounded GLP-1s and identify fake and counterfeit products. The Weight Truth initiative is also the call-to-action for NCL to combat false and misleading advertising claims about GLP-1 drugs and press lawmakers to enforce existing laws that protect consumers from disinformation, take counterfeits off the market, and regulate compounding practices more aggressively.

Thus, on May 22, 2025, NCL and the patient safety community watched and waited. But what occurred was not the end of mass-marketed compounded GLP-1s. While some telehealth companies exited the market, most sellers evolved into promoting “personalized” compounded GLP-1s as microdoses or as GLP-1s in combination with other drugs, such as cyanocobalamin (Vitamin B-12). By February 2026, the hype about personalized compounded GLP-1s had reached a level where NCL felt the need to issue a second consumer alert in advance of the 2026 Super Bowl, where telehealth companies aired glitzy ads. The alert explained that these altered forms had not been tested in large clinical trials and may pose additional safety risks.

Then, the earth started to move, so to speak. The volume of misleading advertising claims, the audacious marketing of some telehealth companies, the story of a Kentucky woman who developed acute liver failure after receiving compounded tirzepatide combined with B12 and needed an emergency liver transplant, and the outcry from 38 state attorneys general to stop the illegal sale of research-grade GLP-1 ingredients all combined to get the attention of policymakers. Thus, lawmakers at the federal and state levels are taking increasingly meaningful steps to stop fraudulent advertising and crack down on illegal mass compounding.

What does change look like? In the year since the FDA declared the GLP-1 shortage resolved, there have been these developments:

  • In September 2025, the FDA announced its intent to regulate compounded GLP-s more aggressively. Then, the FDA launched a crackdown on misleading advertising claims, sending warning letters to over 55 online sellers of compounded GLP-1 drugs, telling sellers that it is a breach of FDA regulations to tout the benefits of the weight-loss drugs without any mention of side effects.
  • In December 2025, Congressman Rudy Yakym (R-IN-02) and Congressman André Carson (D-IN-07) introduced the “Safeguarding Americans from Fraudulent and Experimental (SAFE) Drugs Act of 2025” to protect patients from untested, unapproved, and potentially dangerous mass-compounded drugs. By February 2026, Senators Jim Banks (R-IN) and Martin Heinrich (D-NM) had introduced the bill in the Senate with the goal of closing regulatory loopholes and strengthening FDA oversight.
  • In March 2026, Indiana Governor Mike Braun signed a bill into law establishing new state oversight requirements for drug compounding and med spas. This step sets the stage for other states to add guardrails that will protect patients and reinforce the boundaries of lawful compounding.
  • In April 2026, FDA clarified its policies on GLP-1 compounding, stating that compounders should not assume that practices tolerated during shortage conditions are now acceptable. Soon afterward, the FDA issued a proposed rule to exclude three GLP-1 drugs – semaglutide, tirzepatide and liraglutide – from the 503B bulks list. In doing so, the FDA signaled that compounding is intended for limited purposes and not the permanent sale of mass-produced alternatives to FDA-approved medicines.

The National Consumers League celebrates these developments as a good start in improving the regulation of compounded GLP-1 drugs. A year after May 22, 2025, policymakers recognize that insufficient regulatory safeguards allowed an exploitative GLP-1 marketplace to flourish, putting the safety of consumers at increased risk. Now it is up to all of us – advocates, medical societies, public health leaders, and concerned citizens – to demand that policymakers keep moving forward to enforce existing laws and pass new ones that will keep consumers safe, combat fraud in the marketplace, and put patient safety first when implementing changes in compounding practices at the state level.

Remembering Barney Frank, a Giant for Consumers and Equality

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By NCL CEO, Sally Greenberg

I was living in Boston in 1987 when a thunderclap of a headline hit the front page of the Boston Globe: Barney Frank was about to be outed over a relationship with a man he had hired as a “massage therapist,” and he decided to get ahead of the story himself.

In May 1987, U.S. Representative Barney Frank became the first member of Congress to voluntarily disclose that he was gay, making the announcement in an interview with the Globe. Motivated by both personal integrity and a desire to manage the growing press scrutiny, his decision was met with overwhelming support from constituents in his district. This was decades before Grindr, Tinder, Match.com, etc.; men (mostly) would place ads in gay papers with an unlisted phone number or go to a gay bar. But a closeted member of Congress couldn’t go do that and not be recognized. Frank described his dilemma in the interview: he was a lonely, overweight gay member of Congress with no means for finding romance or sex.

As a gay icon, Barney was a trailblazer. To younger generations, this may sound unremarkable now, but 39 years ago it was anything but. There were many gay members of Congress then, of course, but none who were out.

I moved to Washington in 1996, and over the years, I had several memorable interactions with Barney, as everyone called him. He was a legendary curmudgeon — cranky to the core —, and I had the dubious honor, like so many others, of being scolded by him after making some innocuous comment, possibly a question, about Israel needing stronger support in Congress. He snapped back, “You’re so immature.” I couldn’t help but laugh at why he chose those words to berate me. But it was almost a badge of honor to be on the receiving end of one of Barney’s rebukes — a little like making Nixon’s enemies list or being called “low IQ” by Donald Trump.

But the Barney Frank I remember most was the extraordinarily smart and wickedly funny man. He once quipped that Senator Dianne Feinstein had “more Jewish husbands than a room full of Hadassah members.” And when a fellow House member declared that America was a Christian nation, Barney famously shot back: ‘If this is a Christian nation, why did you drag this Jew out of bed to get here to listen to all of you?‘

He was also generous with his time, and despite being a curmudgeon, he also had a heart. I remember on one memorable occasion, my son Joe, then a junior in high school, was part of a group of students with Operation Understanding returning to Washington, DC from Mississippi. At the airport, they crossed paths with Barney, who was heading to Boston. At my prompting, he spent nearly half an hour speaking with the students about his experiences working on Freedom Summer in the early 1960s. For the young people on that trip, it was a rare opportunity to hear firsthand reflections from someone directly involved in a pivotal moment in the civil rights movement. That he would take the time to engage with these students — just because — showed the heart beneath the curmudgeon.

Most importantly, Barney was an iconic champion of so many causes: gay rights, consumer protection, and economic fairness.  For consumer advocates, he was a steadfast ally, a brilliant and innovative legislator who successfully navigated the enormously complex but critically important Dodd-Frank financial reform bill to rein in corporate abuses. Barney never hesitated to call out corporate misconduct, and he did so with honesty, humor, and conviction.

I send condolences to his friends, staffers, the LGBTQ community, and especially to his sister, Ann Lewis — a pioneering feminist, close confidante of Hillary Clinton, and someone with whom I’ve had the pleasure working for many years.

Rest in peace, Barney, and know we will never forget your enormous contributions.

Are we heading into Jim Crow 2.0?

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By NCL CEO, Sally Greenberg

How is it possible that decades of civil rights advances can be wiped out in a single year?  Well, it may be happening as we speak. Because polling numbers show the White House and Republicans in danger of losing their narrow 5-seat majority in the US House of Representatives, there’s been pressure on Republican-controlled state legislatures to redistrict out Democratic seats in hopes of keeping their majority.

Many of these seats are held by African Americans: we currently have 6 African American Senators and 63 members of the House of Representatives. But that could change dramatically this year.

There’s a potential for 14 additional Republican seats from new districts in Texas, Florida, Missouri, North Carolina, Ohio, and Tennessee. This means that as many as 15 to 20 Black lawmakers’ seats are at risk, with the threat even greater after a recent Supreme Court ruling that severely weakened the Voting Rights Act.

After the Civil War, during the period known as Reconstruction, some 2,000 Black people held public office, from the local level to the U.S. Senate.

Jim Crow changed all that.  As described on PBS, the Jim Crow era was, “a formal, codified system of racial apartheid that dominated the American South for three-quarters of a century beginning in the 1890s. The laws affected almost every aspect of daily life, mandating segregation of schools, parks, libraries, drinking fountains, restrooms, buses, trains, and restaurants. “Whites Only” and “Colored” signs were constant reminders of the enforced racial order.”

Following the ratification in 1870 of the 15th Amendment, which barred states from depriving citizens of the right to vote based on race, many states in the south launched measures to keep African-Americans from voting, such as literacy tests, primaries with all-white candidates, poll taxes, felony disenfranchisement laws, fraud, grandfather clauses, and other types of intimidation.

It looks like the practice of suppressing Black representation is on track to be repeated.  The wave of redrawn districts could bring the largest single-session drop in Black representation since 1877.

Why is this a concern for the National Consumers League? Because as our founders understood, racial discrimination is deeply tied to the violation of labor and consumer rights, and our mission is to promote both. Florence Kelley, NCL’s towering first General Secretary, was a signatory to the original charter of the NAACP in 1909, and her colleagues – Jane Addams, Florence Kelley, Clara Beyer, and many others – deplored Jim Crow discrimination.

In 1926, Kelley wrote to a colleague, “I write to call your attention to the shameful treatment by hotels of colored members of the Conference at Cleveland. The Statler Hotel was especially brutal. …I think there should be a written pledge from every hotel that there will be no race discrimination. Certainly, I should not dream of staying in any hotel which refused my fellow members either bed or board.” She also noted that her colleagues at the NAACP reported that Statler hotels wouldn’t allow Black people as guests or employees.

States also passed black codes limiting the jobs African Americans could hold, and their ability to leave a job once hired, and they restricted the kind of property Black people could own. African Americans faced social, commercial, and legal discrimination. Theatres, hotels, and restaurants segregated them in inferior accommodations or refused to admit them at all. Shops served them last. The Black Codes and Jim Crow Laws

Keeping Black Americans from representation in Congress was critical to Jim Crow. That changed with the historic voting rights laws and the court cases that upheld the law.

But here we are again – a Congress that is supportive of redistricting out Black representation and a Supreme Court that acts as an “amen chorus” for these discriminatory policies.

The potential loss of many Black members of Congress means silencing the voice of millions of African American constituents. We should not return to the bad old days of Jim Crow, but without fair representation, we lose the voices of so many who have stood  for labor and consumer rights of their African American constituents in Congress.

So is this Jim Crow 2.0? That’s what many – including me – fear. Historic turnout could change that.  This year’s elections will hopefully prove me wrong.

Strengthening the Consumer Voice Across the Atlantic

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By Sally Greenberg, NCL CEO

This week, I had the pleasure of attending the Transatlantic Consumer Dialogue (TACD) meeting in Brussels. TACD provides a formal mechanism for U.S. and EU consumer representatives to contribute to transatlantic policy discussions, negotiations, and agreements, while also advancing the consumer perspective in international forums. The organization plays a critical role in ensuring that policy dialogue between the United States and Europe promotes consumer welfare and reflects the real-world impact of decisions on people’s daily lives.

The meeting offered a unique opportunity to spend time with consumer advocates from both Europe and the United States—comparing notes on shared challenges and learning from one another’s experiences. We also met with European officials to discuss their priorities for the coming year. Notably, the Trump Administration declined to send representatives, marking a departure from past administrations that have participated in these important conversations.

As always, a key issue on the agenda was how to counter ongoing efforts by big tech companies and other industry groups to weaken consumer protections. In that context, I am continually inspired by my colleagues, whose creativity and determination have led to meaningful wins for consumers. Their work often sparks new ideas for legislation and regulation to create a more level playing field.

For example, in the United Kingdom, regulators have introduced new rules banning “drip pricing”—fees added late in the purchasing process that obscure the true cost of goods and services. In the United States, we commonly refer to these as “junk fees.” I was also reminded of the stronger airline passenger protections in the European Union—protections we still lack here at home, despite efforts to advance similar measures through proposals like the FAIR Fees Act.

Across both sides of the Atlantic, consumers face a familiar set of challenges: digital services that collect and sell personal data, rising costs for essentials like food and housing, product safety concerns, and business practices that trap consumers in automatically renewing contracts with no easy exit. Hidden fees continue to proliferate—from rideshare “booking fees” to salon “convenience charges” to daily resort fees added to hotel bills at checkout. Airfare prices remain strikingly high, and live event ticketing is increasingly dominated by excessive fees and systems that favor companies like Ticketmaster and secondary sellers at consumers’ expense. Our responsibility is to call attention to these practices and advocate for laws and regulations that rein them in.

Finally, I want to recognize the dedicated TACD staff—Lea Auffret, Oriana Henry, and Kirke Siimso—who bring together dozens of consumer leaders from both sides of the Atlantic. They expertly coordinate logistics, organize meetings with officials, and ensure everything runs seamlessly.

Each TACD meeting is an energizing reminder of the importance of this work—and of the collective strength of those committed to protecting consumers.

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.

Colorado can be a gamechanger in regulating GLP-1 weight loss drugs

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By Nancy Glick, Director of Food and Nutrition Policy, seen in Colorado Politics  

“As goes California, so goes the nation” is a phrase reflecting California’s reputation as a bellwether in setting regulations that often become a precedent for national policy.

Now, Colorado can play this role, setting new safety standards that will protect 1.4 million Coloradans with obesity from harm if they take a GLP-1 weight loss drug.

The opportunity at hand is SB066, proposed legislation under consideration in the Colorado state Senate that, if enacted into law, could be a gamechanger for consumers. This is because the bill would put stringent guardrails on the manufacture and sale of unapproved compounded GLP-1 drugs the Food and Drug Administration (FDA) warns could cause serious harm due to dosing errors and reactions to harmful ingredients. Underscoring the potential health consequences for patients,

as of Sept. 9, 2025, the FDA has received 1,424 reports of adverse events associated with compounded GLP-1 drugs, including reports of hundreds of hospitalizations and 23 deaths.

Understanding what brought us to this point is helpful to appreciate the significance of SB066 in solving the problem. Currently, FDA regulates compounded drugs as one-of-a-kind medications modified when a person needs a different form or dosage. This is the primary purpose for a compounded drug, which is why these drugs are not FDA-approved and why the agency exempts licensed compounding pharmacies from meeting rigorous safety standards required for other prescription medicines, such as clinical testing and labeling with risk information.

Yet these exemptions also apply when compounders mass produce modified drugs to fill a supply gap during a shortage, meaning sellers can take advantage of regulatory loopholes to make massive profits. This was the case between 2022 and early 2025 when there was a shortage of the GLP-1 drugs semaglutide and tirzepatide. Because booming consumer demand for GLP-1s was a primary reason for the shortages, it was a gold rush situation for compounders who made full use of regulatory gaps to build a large secondary market for their compounded GLP-1s by advertising the benefits without disclosing the risks.

The shortage also highlighted the problem the active pharmaceutical ingredients (API) used by compounders often come from China, where quality standards vary widely and the API may go uninspected. According to a Brookings Institution report, fewer than one-quarter of Chinese facilities marketing bulk semaglutide have been inspected by the FDA, despite significant shipments to the U.S.

Yet, consumers were not aware of these safety concerns, they believed the advertising claims, and profits soared. Thus, despite FDA announcing the end of the GLP-1 drug shortage in March 2025 and setting May 22 as the last day when compounded versions could be sold, the large-scale production of compounded GLP-1s continues unabated. Moreover, now, the market features “personalized” formulations with added vitamins or microdoses of GLP-1s that have never been evaluated as well as patches, gummies and drops that are not actual GLP-1 products.

The good news is the FDA is starting to remove questionable active ingredients from the GLP-1 market and is cracking down on telehealth companies making false and misleading advertising claims. Similarly, the U.S. Congress is considering legislation to strengthen FDA oversight, close regulatory loopholes and require reforms that will protect consumers from misinformation and inferior products.

Yet states are equal partners with FDA when it comes to compounding practices and can regulate drug compounding to tighten state controls and impose new oversight measures. For this reason, SB066 can be the change agent at the state level that will protect consumers and safeguard patient safety.

Of special importance to the National Consumers League, the bill would prohibit false and misleading advertising of compounded GLP-1s; compel labels that clearly list all ingredients, their quantities, and their country of origin; require a warning the medication is not FDA-approved; and ensure patients receive information about risks and side effects. Additionally, SB066 addresses safety concerns about the source of the API in compounded GLP-1s by setting strict standards for how the ingredients are manufactured, including the facilities where the medications are made must be registered with and inspected by the FDA.

All of these provisions are “must-haves” that will have a meaningful effect for Coloradans and the public at large.

Nancy Glick is director of Food and Nutrition Policy for the National Consumers League, a position she has held since September 2020.