The New York State Legislature passed two bills aimed at easing medical debt back in May, and a new report indicates they're much needed.

The first bill bans medical liens and wage garnishment; the second regulates the billing of so-called "facility fees," and requires that patients be informed about those fees up front.

In a report on hospital debt, the Community Service Society of New York found 112 nonprofit hospitals sued more than 53,000 patients across the state between 2015 and 2020.

Dr. Elisabeth Benjamin - vice president of health initiatives with the society - said she thinks facility fees help hospitals get money from people when they aren't supposed to be charged.

"We helped one woman who went in for her preventive mammogram and she was charged a $250 facility fee," said Benjamin. "Well, that's just a secret end run around the Affordable Care Act prohibition on charging copays for preventive services. You're not supposed to charge a patient a dime when they get a preventive service like a mammogram."

Hospitals had qualms about the facility fees bill. They said they shouldn't have to give notice about these fees every time a patient is seen, but could do it annually.

Currently, 13 states and Washington, D.C. have similar laws against predatory medical debt collection tactics.

While the New York bills regulate the collection of medical bills, they wouldn't prevent hospitals from suing patients. Rather, they limit how the funds can be collected.

Benjamin said all non-profit hospitals are supposed to offer certain patients financial aid on a sliding scale, but her group's research has found this isn't always the case. It supports the idea of developing a common application for hospital financial assistance.

She called the current system a disservice to patients.

"One of the things that makes it so problematic is every hospital is allowed to design and implement its own application," said Benjamin. "Higher education figured this out. This is a really big burden, and that's why they set up a common application."

She added that - in the Community Service Society's report - some hospitals weren't aware of what was being done in their name, while others knowingly continued these practices.

By establishing new rules across the board - that declare a person's home and wages as off-limits - Benjamin said she hopes patients will be more at ease the next time they need health care.

Health-care professionals say low pay and a worker shortage have led a dramatic number of nursing homes in rural Iowa to close their doors. They hope increased government funding and more focus on rural health care this year will help.

Looking at a graph that shows the number of nursing-home employees between January 2019 and January 2020, the bright red line goes almost straight down. The pandemic was a big reason for that, but Iowa Health Care Association President and CEO Brent Willet said there are other economic factors at work, and the staffing shortages have already resulted in double-digit closures.

"It is alarming," he said. "The latest figures are, we've had 17 nursing homes in Iowa close in the last 12 months. Fifteen of those 17 have been in rural parts of the state."

Willet said nursing homes can't offer competitive wages to people who are willing to take these demanding jobs, especially in rural areas where the population is declining. He said he remains optimistic, though, adding that the Iowa Legislature will reconsider those wages this year, since more than half of nursing-home funding comes from state and federal governments.

Willet said it's also becoming harder for people in rural nursing homes to get the support they need from other medical-service providers in town. He said this adds to the problems already caused by staffing shortages, simply because those services dwindle along with the population.

"Like dialysis, like their primary-care doctor," he said. "As those services become harder and harder to come by, it creates additional challenges pertaining to costs and logistics to care for people in their home community."

The national long-term care facility numbers are also alarming. The Centers for Medicare and Medicaid Services reported recently that 129 nursing homes closed in 2022 - although this year, the numbers are starting to improve.

Health-care professionals and advocates in Connecticut have said it will take sweeping reforms to bolster the state's flailing public health system.

At the labor union 1199 SEIU's Health-Care Policy Symposium, experts spoke of the system's long-time underfunding and staffing shortages. A union-related group, called Expand Services to Save Lives, wants to see part of the state's multi-billion-dollar surplus used to address the issues - including $30 million to recruit and retain public-health workers.

Rebecca Simonsen, vice president and director of the public division at 1199 SEIU, said the state needs to revitalize this system of critical services.

"State health-care services generally serve the most at-risk, highest need, complex residents," she said. "Often folks without insurance, often folks that have been turned away from the private sector. And we created these services because, as a state, we believe that every resident's life should be valued."

In 2022, the state received a $32 million grant from the Centers for Disease Control and Prevention for public-health workforce development. She added that even if the group gets everything it's seeking from this legislative agenda, it wouldn't be the entire solution.

One area of the staffing crisis to be addressed is retention of nurses, more of whom are leaving the field due to burnout and higher patient limits. The union wants to see a pipeline created for nursing students to prepare them for public-sector jobs.

Brian Williams, an organizer for 1199 SEIU and a certified addiction counselor with the Connecticut Department of Mental Health and Addiction Services, said it's time to commit to action instead of acknowledging the problem.

"We cannot continue to say, 'Hey, you know, we have a nursing crisis, we have a nursing crisis.' We have to create incentives to actually expand the pool of nurses," he said. "And this is one of the proposals that we have that we believe will have an impact."

The group also proposed a $12 million investment to add workers to the department to address what was described at the conference as an ongoing mental-health crisis.


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Iowa lawmakers are considering a bill which would dramatically reduce the use of cellphones in vehicles.

Right now, it is illegal in Iowa to send or read text messages while driving, but drivers can use a cellphone for navigation, which often takes more attention than texting. Senate Bill 60 would tighten the rules further, prohibiting drivers from operating a phone if it takes more than a single touch to activate or deactivate it.

Sen. Claire Celsi, D-West Des Moines, said she is personally motivated by the measure after attending the wake of a constituent's 12-year-old child who was killed by a distracted driver.

"It really affected me," Celsi recounted. "The dad just said, 'Please, please, please make this illegal. Please help people like us never to have to go through a loss like this.' So, that's what really spurred me to join onto the bill this year. It's a Republican bill, but I completely support it."

The Iowa Department of Public Safety said drivers who use handheld devices are four times more likely to be in a collision causing injuries than those who are not using their phones. The bill is headed to a Senate committee.

Celsi acknowledged she used to oppose hands-free cell phone measures, because she felt the costs were prohibitive, but she said technology has caught up, and prices have come down.

"You can buy something at Walmart for $20 that can help you go hands free in your car," Celsi pointed out. "I think it really demands now that we reexamine the issue and do something about distracted driving in our state."

The Insurance Institute for Highway Safety said about half of states prohibit the handheld use of cellphones when driving, and all but Montana prohibit text-messaging while driving.