It’s Time to Regulate Big Data: An Argument for Privacy in the Information Age

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By Margaret Peterman, NCL Summer Communications Intern

How comfortable are you with someone seeing your purchase history? What about who you voted for? Your health data? Browsing history? Location?
If any of those questions made you anxious, it may be disturbing to realize that just about anyone can access your personal information—including minimally regulated data brokers who sell your information to private corporations and government agencies.
Data brokers are organizations that collect and sell consumers’ personal information to third-party groups—major brokers include LexisNexis, Experian, Acxiom, and Oracle—for use in marketing, political campaigns, and even government investigations. These organizations gather all kinds of data, from contact and demographic information to precise geolocation data and browsing history.
As a result of mass data collection, data brokers and online platforms have unprecedented levels of control over what consumers see and purchase online. Thousands of the online ads Americans see daily are shaped by complex data profiles built from consumers’ social media pages, browsing and click history, location data, and demographics. Even consumers’ most personal and private behaviors are being shaped by data collection. In 2022, Pray.com came under fire for sharing users’ personal prayers with third-party sources and advertising agencies, ensuring that even prayer is not excluded from a consumer’s data profile.
Consumers’ data is even used to shape access to certain programs or even price health insurance policies. In 2019, the Department of Housing and Urban Development sued Facebook for violating the Fair Housing Act by determining which users could see housing-related ads based on their race, religion, and nationality. In 2013, the Federal Trade Commission sued Equifax for selling consumer credit scores and mortgage information to companies advertising potentially predatory and fraudulent loan services. Insurance and actuarial companies use consumer data to create health risk profiles—inferred from what consumers wear, when they pay their bills, and what they post on social media, not actual health data.
AI has further complicated data privacy concerns. A growing number of Americans are relying on AI for daily use, and nearly three-quarters of businesses have adopted some form of AI technology in the workplace. But AI has not been a champion of data privacy. Users’ chats are funneled into models to train chatbots further. Countless musicians, programmers, authors, and news outlets have sued AI companies for using copyrighted work without consent. Generative AI chatbots like Anthropic’s Claude, OpenAI’s ChatGPT, and X’s Grok have all published user chats including personally identifiable information (PII) like phone numbers, emails, and healthcare data.
So why should we care about data privacy? After all, in an increasingly digitized society, it’s hard to fathom a world where we have control over our own data.
Data privacy is closely tied to protecting consumers’ rights. Advertising agencies represent a significant portion of data brokers’ clients, making up nearly 40% of the market share. When consumers see ads tailored to their personal preferences, they are far more likely to buy the advertised products or services. As targeted ads grow more specific to a consumer’s data profile, consumers are slowly deprived of their right to make independent choices in the marketplace.
Data privacy is also part of the larger debate over individual privacy in a post-9/11 world. Even with guarantees against domestic surveillance outlined in the Foreign Intelligence Surveillance Act and the Electronic Communications Privacy Act, “data broker loopholes” allow federal and state government agencies to purchase bulk data from brokers and social media sites for immigration enforcement, criminal investigations, and surveillance of protestors.
In the past few years, several state governments have passed laws attempting to rein in consumer data collection. Regulations like California’s Delete Act are promising on paper, but it remains to be seen how effective these laws will be in practice. A recent Stanford study found that only 9% of eligible data brokers were in compliance with California’s data privacy legislation nearly three years after its adoption. Hundreds of brokers have failed to register with state consumer protection agencies, violating multiple state laws and making it difficult to understand the role data brokers play in consumers’ lives.
It is now clear that the U.S. needs a national privacy guarantee. For too long, government, healthcare, and advertising organizations have utilized Americans’ data to build personalized, error-prone, and invasive data profiles at the expense of consumers. Without meaningful federal oversight, data brokers run roughshod over consumers’ rights. Congress and state governments need to prioritize consumers’ privacy rights and pass legislation that protects consumers from, and makes them aware of, predatory data-collection practices.

Fill it Up and Scale it Back: Consumer Spending in the Post-Hormuz Economy 

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By Claire Leadman, NCL Summer Communications Intern
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On February 28th, when Iran closed the Strait of Hormuz, the average cost of gas was $2.98 a gallon. Six months later, in August, that rate increased nearly 34.5% to an average of $4.01 a gallon nationwide. Without President Trump having reached a deal that guarantees price decreases anytime soon, consumers are searching for any and all ways to alleviate the impact of rising costs.

As a college student with friends who live all over the country, I try my best every summer to plan a trip to see at least one of them. This summer, that came with an extra challenge. When I first started looking at flights, I knew off the bat that seeing my friends in Europe or on the West Coast was out of the question. After turning on my Google Flights price tracker notifications and comparing all my options, I settled on visiting a friend outside of Boston. From DCA to BOS, I was used to a round-trip ticket costing around $180. Compared to the $325 ticket I ended up purchasing, it was clear that I hadn’t adjusted my expectations to the current cost of travel.

For most Americans, gas is not an optional expense. With the stark increase in fuel prices, alongside relatively static incomes, households have been forced to adjust their habits at the pump to stick to pre-existing budgets.

According to a report by the Associated Press, members-only retailers such as Costco, Walmart’s Sam’s Club, and BJ’s Wholesale Club have seen an increase in traffic at their gas pumps, where fuel prices are typically lower than at independent gas stations. Not only has the price of gas influenced where consumers are filling their tanks, but also how they are doing so. Costco Chief Financial Officer Gary Millerchip noted a pattern of customers coming in to “top up in between what would have normally been a gap between getting the tank to empty,” reflecting the anticipation of price increases.

When looking at the Consumer Price Index (CPI) for July 2026, I was surprised to see that prices were relatively stable. Although the CPI rose .1% over the prior month, I had anticipated seeing prices of groceries, healthcare, housing, and other categories skyrocket – which was simply not the case. Instead, those categories showed far more modest changes than I anticipated. One notable exception that has been most heavily impacted by the surge in gas prices is the cost of air travel. Over the past twelve months, the CPI increased 3.4% across all items, while airline fares rose sharply, increasing 25.5% from July 2025.

Consumers who save all year for their summer vacations have been forced to adapt their plans as airfare prices surge, particularly for international travel. Since the Strait of Hormuz was closed, jet fuel prices have spiked 50%, significantly increasing airlines’ operating costs. That surge in jet fuel costs is the primary factor behind the 25.5% increase in airline ticket prices.

During the summer months, people are more eager than ever to use their PTO – whether that means relaxing on the beach, exploring a new city, or visiting family that lives far away. Despite the rising cost of travel, consumers have not stopped traveling altogether; rather, they have adapted their plans to fit the current economy. Travel remains a priority for many, but people are being forced to scale back their travel plans to stay within their budgets. NPR’s Stephen Basha spoke to a travel agent who reported a 10.5% decrease in fall bookings, along with a clear avoidance of “long-haul, far-off destinations”. Alternatively, spending on travel has pivoted towards more budget-friendly options, such as staycations and trips to nearby destinations.

As the summer ends and travel begins to slow for many consumers, the impact of the war in Iran and the subsequent increase in gas prices will continue to influence household spending well beyond travel. Although the rise in costs has been less abrupt in other categories, prices for groceries, retail goods, healthcare, and transportation continue to fluctuate and remain elevated. Consumers will be forced to meticulously plan and shift their budgets and lifestyles to account for the higher cost of living.

Uncertainty related to the trajectory and timeline of the war in Iran leaves consumers in the dark as to the future of prices. Until the Trump administration agrees to a deal with Iran that has the support to move forward, uncertainty is likely to persist, making the outlook for inflation, consumer spending, and the broader economy difficult to assess.

Nancy Glick

New Food Policy Reforms Are a Step Forward for Consumers

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By Nancy Glick, Director of Food and Nutrition Policy

In casual speech, geologic time is a way of describing an excessively long, painfully slow process of change. It is appropriate to describe how long it has taken the Food and Drug Administration (FDA) to issue a proposed rule to strengthen the agency’s oversight of food ingredients determined to be “Generally Recognized as Safe” (GRAS).

Going back to the Food Additives Amendment of 1958, Congress established a mandatory pre-market approval process under which manufacturers must submit safety data to the FDA before a new additive may be used in food production. At the same time, Congress recognized the need for a statutory carve-out for common, time-tested ingredients like salt, vinegar, baking soda, and flour and created the “Generally Recognized as Safe” provision for substances widely understood by qualified experts to be safe under their conditions of use. Thus, in December 1958, the FDA published the first GRAS list in the Federal Register, and soon hundreds of traditional ingredients received GRAS status.

Yet there were problems with the GRAS carve-out from the start. The 1958 statute did not lay out exactly how “general recognition” should be proven; the FDA was flooded with manufacturers’ requests for opinion letters on whether their conclusions of GRAS status were justified; and food chemical manufacturers started hiring their own experts to review proprietary safety data and declare a new chemical “GRAS.”

Then, in 1969, the FDA removed cyclamate salts from the GRAS list due to safety concerns, prompting a “comprehensive review” of presumed GRAS substances conducted over many years by an outside scientific body known as the Select Committee on GRAS Substances (SCOGS). By 1982, SCOGS submitted opinions to the FDA on the health aspects of more than 400 substances. At the same time, the FDA established rulemaking procedures for a GRAS affirmation petition process, which allowed companies to assert the GRAS status of a particular use of a substance. Under this framework, the FDA signed off on the GRAS status of numerous ingredients, including canola oil, whey, and cocoa butter substitutes.

However, because the GRAS affirmation petition process was resource-intensive, the FDA sought an alternative pathway and, in 1997, shifted to a voluntary GRAS notification system. In doing so, the FDA unintentionally created the GRAS loophole. This regulatory gap allows food companies to introduce new chemical additives into the food supply without getting approval from, or even notifying, the FDA. For consumers, this means a wide range of food products may contain undisclosed chemicals and alternative proteins that the FDA never reviewed for safety.

How serious is the problem? Reports from independent bodies and consumer and environmental organizations find that the GRAS loophole is overwhelming the food safety system. Specifically:

For decades, the National Consumers League has been advocating for closing the GRAS loophole through reforms that will increase FDA oversight, so food companies can no longer add ingredients without the FDA’s knowledge. And we are far from being alone. In May 2017, the Center for Science in the Public Interest (CSPI) and other public-interest groups filed a lawsuit challenging the FDA’s voluntary GRAS notification rule, first proposed in 1997 and finalized in 2016, as unlawful and undermining the integrity of the nation’s food system. (Sadly, the court sided with the FDA).

Then, in 2025, former FDA Commissioner Dr. David Kessler filed a citizen petition urging the FDA to revoke the GRAS status of refined carbohydrates used in industrial food processing, such as corn syrup, corn solids, glucose syrups, wheat, and corn flour. Dr. Kessler’s petition argues that processed refined carbohydrates can no longer be considered GRAS now that scientific evidence links their consumption to metabolic harm, leading to obesity, diabetes, and cardiovascular disease.

Now, 68 years after the FDA published the first GRAS list, there is potential for meaningful change. On August 10, 2026, the agency issued a proposed rule that would end the voluntary notification system for most GRAS substances by requiring companies to notify the agency and provide details on how the manufacturer deemed the additive “generally recognized as safe.” Manufacturers with GRAS substances already on the market would also need to let the FDA know how the additive is used, information that would be made public in a database of GRAS notices. According to FDA officials, these actions will modernize the GRAS framework, increase transparency, and give the FDA greater visibility into substances entering the food supply.

NCL considers the proposed rule a good start, but along with other advocacy groups, believes that improving the GRAS framework requires more than mandatory notification. For this reason, public health and consumer advocacy organizations will be pressing for guardrails to strengthen the proposed rule, such as a requirement that companies provide the underlying data supporting their independent GRAS conclusion and a premarket approval requirement, so companies cannot sell products with GRAS ingredients before completing the notification process. Other reforms include penalties or sanctions for noncompliance and the requirement that companies conduct post-market reviews of GRAS ingredients.

Complementing these reforms, organizations like NCL are also working to pass the Food Chemical Reassessment Act of 2025 (H.R. 4306), proposed federal legislation introduced by Representatives Jan Schakowsky (D-IL) and Rosa DeLauro (D-CT) that will require the FDA to systematically reevaluate the safety of chemicals added to food and packaging every three years, targeting aging approvals and the “Generally Recognized as Safe” loophole.

After decades of debate, there is broad consensus that the GRAS loophole must be closed for good. Now it is up to those speaking on behalf of consumers to ensure that the FDA’s final rule not only ends the loophole, but adds the regulatory guardrails needed to enhance the safety of the food supply.

 

 

 

AI and Medicine: Promising Future or Dangerous Mistake?

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By Ben Rozner, NCL Summer Communications Intern
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Artificial intelligence has encroached upon every aspect of people’s daily lives; health and wellness is no exception. While it can provide numerous benefits, including the ability to access straightforward medical advice without an appointment quickly, AI is far too prone to mistakes to be fully trusted with your health. Here are five things you should keep in mind when using AI to self-diagnose:
  1. AI is often wrong or deliberately misleading: AI accounts on TikTok that pose as doctors have been gaining millions of views recently, posing a “huge danger to public safety,” according to numerous experts. AI-generated physicians have peddled disproven myths about numerous activities causing cancer and, in some cases, fabricated medical products. Alex Ruani, health misinformation researcher at UCL, called these false claims an “industrialized exploitation of trust,” putting profits and engagement above people’s safety and health.
  2. AI may ignore emergency symptoms: While doctors are trained to ask specific questions that help patients recognize symptoms they might not otherwise mention, AI chatbots focus only on the prompt they are given.
  3. AI does not know your medical history. It does not know what medications you take, what surgeries you have had, or how your body works. AI can be used as a starting point, but it should not be the source of your official diagnoses. Generally, AI can provide surface-level education that a doctor can later clarify and work with.
  4. AI chatbots are not required to protect your personal information: Doctors must strictly follow HIPAA regarding patient confidentiality; AI chatbots such as ChatGPT do not have such restrictions. For example, a newer version of ChatGPT specifically designed to help people navigate health-related questions collects users’ personal information to make more accurate diagnoses and recommendations. While this may mitigate some of the other issues AI faces when giving medical advice, it also puts users at greater risk. Users often upload their entire medical history to these chatbots, meaning that a single cyberattack could expose their most sensitive information to bad actors online.
  5. Your doctor knows best: As mentioned above. At the same time, an AI chatbot can provide helpful answers to basic questions; you should always check with a real healthcare provider before making major medical decisions. Doctors spend years learning how to diagnose and treat patients on a case-by-case basis. AI chatbots cannot give you the same personalized care and attention you need in a medical emergency.
The influence of AI on medicine does not stop at online inquiries. Artificial intelligence is already in your doctor’s office, and it often proves more burdensome than helpful. Doctors have found that AI-drafted patient charts are also riddled with mistakes, forcing them to revise each document manually. According to Sarah Preum, a corresponding author of a recent study on this issue, “AI can sound like a doctor but not think like one.” Importantly, the study found that an AI trained to adapt to individual physicians’ communication styles is more accurate and requires less editing. These AI models could save doctors precious time, but must be under constant scrutiny to ensure that they are safe and unbiased.
AI can provide numerous benefits to the medical sector. A study from Johns Hopkins found that algorithms designed to spot nearly imperceptible variations in medical images may revolutionize cancer screening. Predictive models could warn doctors before a medical emergency happens. AI has already helped researchers identify and create new drugs, vastly reducing the time it takes to develop new vaccines. And while chatbots are not reliable for self-diagnosis, they can serve as virtual assistants, providing helpful instructions to patients navigating a range of medical issues. There are undoubtedly more benefits still to be discovered, yet whether they outweigh the risks will likely remain heavily debated.
​There is no single right way to use AI regarding health and wellness. Whether it is doctors using AI chatbots to streamline the communications process or patients asking important questions they may be too embarrassed to ask their physician, AI can and does help everyone involved. Yet we must not ignore its pitfalls, as the risk AI poses to patient safety and privacy is immense. A single data leak or repeated instances of algorithm bias could put lives at risk in a field that already carries a great deal of peril. If medical professionals fully adopt AI systems, they must be consistently monitored to ensure maximum security for both patients and physicians.
Nancy Glick

Playing Russian Roulette with Food Safety Can Be Very Costly

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By Nancy Glick, Director of Food and Nutrition Policy

The numbers are staggering. The nation is facing the largest cyclospora outbreak in U.S. history, with nearly 23,000 reported (over 10,400 laboratory-confirmed) cases since May 1, 2026, tied to contaminated shredded iceberg lettuce imported from central Mexico. Now traced to 47 states, the outbreak is hitting the Midwest and South hardest, with Michigan, Ohio, and Missouri reporting the largest number of infections.

However, the magnitude of the problem is far greater than the cases reported to date. While the illness caused by the cyclospora parasite is not generally life-threatening, the Centers for Disease Control and Prevention (CDC) classifies cyclosporiasis as a nationally notifiable disease requiring ongoing monitoring. This is because the symptoms of cyclosporiasis – including explosive bowel movements, frequent diarrhea, and vomiting – can last for weeks or months without treatment with antibiotics. And, in young children, older adults, and immunocompromised individuals, cyclosporiasis can be deadly. As of August 2026, there have been over 500 hospitalizations and two reported deaths linked to underlying conditions and severe dehydration.

Yet the most troubling aspect of this outbreak is that the federal food safety system we rely on is falling short. The system was designed to be comprehensive, giving shared responsibility for the safety of our food supply to the Food and Drug Administration (FDA), the U.S. Department of Agriculture (USDA), and CDC. It also involves healthcare providers, hospitals, and laboratories reporting probable cases of foodborne pathogens such as cyclospora to local and state health departments, which in turn voluntarily share the data with the CDC to track, prevent, and stop public health threats.

But in March 2025, the federal government’s investment in the food safety infrastructure started to change. First, USDA terminated two long-standing advisory panels – the National Advisory Committee on Microbiological Criteria for Foods (NACMCF) and National Advisory Committee on Meat and Poultry Inspection (NACMPI) – indicating to consumers that food safety will not be a priority at USDA in the foreseeable future. The agency’s Food Safety and Inspection Service (FSIS) also withdrew a strict rule that would have kept poultry products containing high levels or dangerous strains of Salmonella from being sold.

While USDA was stripping away food safety protections affecting meat and poultry processing, the “Department of Government Efficiency” (DOGE) zeroed in on the CDC, laying off roughly 18 percent of the workforce including eight of the 11 members of the CDC laboratory team specializing in cyclospora outbreaks. This was made worse by the dismantling of the Agency for International Development (USAID) and the loss of experts and labs dealing with diseases like cyclosporiasis in facilities that USAID shared with the State Department and CDC. These reductions, according to health experts, have left the agency under-resourced to handle large-scale monitoring and traceback efforts.

The other injustice also occurred in 2025 when CDC scaled back its Foodborne Diseases Active Surveillance Network (FoodNet), which was created in 1995 to track the top eight pathogens most responsible for the estimated 48 million cases of foodborne illness in the US every year: Campylobacter, Cyclospora, E-coli, Listeria, Salmonella, Shigella, Vibrio, and Yersinia.  Designed as a collaborative effort among CDC, state health departments, USDA, and FDA, FoodNet was considered the backbone of America’s foodborne illness surveillance system for 30 years because it gathered data from clinical laboratories at 10 sentinel sites, estimated the burden of foodborne infections, and guided prevention efforts.

Regarding cyclospora specifically, FoodNet captured infection data across roughly 15 percent of the U.S. population – which would have been valuable in addressing the current outbreak. But, as a budget-saving move rationalized by Administration officials as eliminating duplicative CDC programs, the agency restricted federal monitoring under FoodNet to only Salmonella and E. coli. Thus, the burden for tracking cyclospora and the five other pathogens now falls largely to participating state and local health departments– themselves facing localized funding and staff constraints.

When news of FoodNet became public, NCL spoke out about the potential consequences of this action, calling the measure tantamount to playing Russian Roulette with Americans’ health. We were joined by other consumer advocates, food safety experts, public health leaders and state health departments, all of whom stressed that foodborne disease surveillance is the foundation of our food safety system and requires the expertise, resources and coordination of information and data beyond borders that are beyond the ability of states.

Now, with the cyclospora outbreak, we are witnessing the consequences of not viewing foodborne illness surveillance as a national priority. Because investigators are working with incomplete information, it took six weeks from the start of the outbreak around May 1 for CDC and the FDA to link the source of the parasite to iceberg lettuce imported by Taylor Farms de Mexico. Thus, on July 14, CDC issued a Health Alert Network alert notifying clinicians and public health practitioners about the outbreak and followed on July 17 with a food safety alert warning the public not to eat this lettuce. On the same day, Taylor Farms initiated a recall covering shipments to food service operations like Sysco, restaurant chains including Taco Bell locations, and Marketside-brand products at select Walmart stores in at least 27 states.

However, we are not yet out of the woods. CDC and FDA are currently investigating six separate cyclospora outbreaks not yet linked to an identifiable product; it is unclear which cases across the country are connected, and food safety experts caution that multiple sources are likely contributing to the cyclospora surge. It is an object lesson that food safety requires a coordinated national system staffed by specialists in foodborne pathogens, based on collaboration among local, state, and federal agencies.

Underscoring the need for corrective action, recent polls by Gallup and the International Food Information Council reveal that only half of today’s consumers have confidence in federal food regulation (53%) and the overall safety of the food supply (55%). Even more troubling, a Quinnipiac University poll conducted as cyclospora cases passed 20,000 shows that only 12 percent of consumers express a lot of confidence in the nation’s food safety system while 31 percent express some support but another 30 percent say they have no confidence at all, Also of interest, polls show that Americans favor stronger food safety oversight and, 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.

With this consensus as a starting point, NCL is one of the organizations pressing Congress to fully fund CDC’s foodborne illness surveillance and other food safety programs in the upcoming fiscal year. Recently, we joined with the Consumer Federation of America and 25 other organizations and food companies in sending a letter to the House and Senate Subcommittees on Labor, Health and Human Services, Education and Related Agencies urging Congressional appropriators to provide a 50 percent ($37 million) increase in funding to maintain FoodNet along with other critical problems needed to solve outbreaks. This would bring total funding to $111 million for FY2027, a small price to pay for Americans to have confidence in the safety of the foods we buy and eat.

If there is any good to come from the cyclospora outbreak, it is that we now know food safety cannot be taken for granted. It is a national priority that all Americans should count on.

Prevention Strategies
  • Cook poultry, eggs, and ground meats to safe internal temperatures.
  • Wash produce thoroughly.
  • Avoid raw or undercooked shellfish.
  • Keep perishables refrigerated promptly.
  • Practice safe food handling and cross-contamination prevention.
For detailed, interactive trend data, CDC’s FoodNet Fast tool provides maps, graphs, and tables for each of these pathogens.

The Medical Debt-idemic

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By Moses Boyd, NCL Summer Health Policy Intern

As a kid, I would count down the days until I was an adult. I yearned for freedoms like staying up late and being able to drive. Nothing in my imagination rivaled the maturity, respect, and independence that the milestone promised. Now, as a college student, I realize that the flagship freedoms of adulthood are, in fact, not free.

This discovery is not just a personal one. Balancing finances, building a stable career, and managing personal responsibilities is no easy task for anyone to learn. However, the newest generation to enter adulthood appears to be struggling to an unprecedented extent.

Generation Z, which currently encompasses the young adult population, has been slower to achieve financial benchmarks—such as homeownership or having children—than previous generations. This trend is driven by higher housing costs, stagnant wages, and rising education costs. Although economic inflation and political volatility are burdens affecting Americans of all ages, these challenges weigh most heavily on young adults. With limited work experience and fewer financial resources to absorb unexpected expenses, many members of Generation Z are particularly susceptible to financial instability.

Nonetheless, an often overlooked barrier also undermines Generation Z’s financial well-being—one whose impact, just like its origin, remains relatively hidden from public discussion.

Medical debt.

Nearly 38 percent of adults between the ages of 18 and 34 carry some form of medical debt. Unlike budgeting for groceries or buying a car, medical expenses cannot be adequately budgeted for in the United States. They are the result of a potent combination of unpredictability and systemic complexity. A single injury or diagnosis becomes an ultimatum, forcing young adults to choose between medical care and their livelihoods.

While it is true that Generation Z is the most uninsured generation, medical debt is an issue that extends beyond insurance status alone. Young adults can receive bills totaling thousands of dollars for relatively common procedures, even if they are insured. A Wall Street Journal reporter detailed that after insurance, his out-of-pocket cost for wisdom tooth removal surgery was $7,000—reduced from $10,000 only after negotiating directly with the provider. Although the procedure would have been three times more expensive without insurance, this anecdote nonetheless illustrates an uncomfortable truth: health insurance protects patients from catastrophic costs less effectively than many Americans assume.

Herefrom, two important questions arise:

First—what is so wrong within our healthcare system that this is such a significant problem?

Second—how do we fix it?

While the former question does not have an entirely straightforward answer, one obstacle is clear—our healthcare system is highly fragmented. Healthcare in the United States is achieved through a complex network composed of private insurers, public programs, independent providers, intermediaries, and employers. This structure creates administrative complexity, makes care harder to coordinate, and contributes to our country spending more on healthcare than any other developed nation but yielding worse health outcomes.

This cost is ultimately felt by the consumer and continues to inflate as time progresses. An inability to compare pricing for medical services, predatory insurance practices, inadequate primary care options, surprise events, and a pinch of juvenile naïveté in regard to healthcare forms the perfect recipe for a medical debt-idemic.

One way to help address the medical debt problem is through increased price transparency in the healthcare market. Unlike virtually every other expenditure—such as groceries, clothes, cars, or appliances—it is nearly impossible for consumers to compare healthcare service prices across insurance plans or providers. Consequently, consumers often do not receive the best value care simply because they are not aware that better options exist. By clarifying medical pricing data and cost estimates, information asymmetry dissipates, making healthcare a more economical pursuit through fair competition and predictability.

Namely, requiring hospitals and insurers to publish clear, upfront prices and limiting aggressive debt-collection practices puts consumers themselves in control of the healthcare market. Legislation such as the Patients Deserve Price Tags Act includes such provisions, alongside other common-sense reforms, to increase hospital price transparency so consumers can better understand the price for healthcare services they receive.

Healthcare should not require consumers to become financial experts before seeking treatment, particularly those who are just beginning to navigate adulthood. Generation Z is entering adulthood during a period of extraordinary economic uncertainty; their futures should not be jeopardized by medical debt—especially after surprise incidents. Healthcare is a basic, human need that everyone should be able to access, affordably.

I, and many of my peers, are tired. We do not want to deal with the stress of medical bills piled atop the already-towering mountain of adult life’s pressures. Adulthood is already hard; it should not be made harder by overcomplicated and artificial systemic deficiencies. Put plainly, the medical debt-idemic must end. Ensuring that healthcare is both accessible and financially sustainable must remain a national priority for the sake of both my generation and every one that follows.

The Impact of the One Big Beautiful Bill Act 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 Nutrition 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 Nutrition 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.