Kentucky's rural Appalachian households are grappling with financial stress which is disproportionate compared to households in other rural parts of the country.

A report from the Consumer Financial Protection Bureau said medical, credit card, and student loan debt -- combined with household incomes significantly lower than the national average -- create a perfect storm for hardship.

Shawn Sebastian, senior fellow at the Consumer Financial Protection Bureau, said it creates financial challenges for a large percentage of the population.

"That's a quarter of people in rural Appalachian Kentucky who are dealing with medical debt collections," Sebastian pointed out. "And we know that when people have medical debt collections, it has a cascading effect on their household finances in general."

The report noted people who owe money on past-due medical bills have more than double the rates of delinquency on mortgages, car loans, credit cards and student loans, compared to those without medical debt.

Last year, the nation's major credit-reporting agencies said they would stop including paid medical debt on consumer credit reports. And beginning next year, most unpaid medical debt will no longer be reported, either.

Sebastian explained residents of Appalachia and elsewhere could even see their credit score get a boost in January.

"The three major credit reporting agencies agreed to remove about 70% of medical debt from people's credit reports," Sebastian emphasized. "That's primarily medical debt that has been paid, or medical debt that is $500 or less."

And while fewer Appalachians have an open student loan compared to the rest of the nation, Sebastian added student debt is crushing the household finances of many families.

"When you take a ratio of how much student debt is owed, divided by income, nationwide, that percentage is 32%," Sebastian reported. "In rural Appalachian Kentucky, that percentage is 47%. That's the student loan burden."

He added Biden's $10,000 student loan forgiveness plan, now in limbo, could help relieve Kentuckians' student debt burden.

The U.S. Supreme Court will hear arguments in lawsuits against the federal student-debt relief plan early next year. Last month, President Joe Biden extended the pause on student loan repayment, interest and collections until June of next year.

Due dates for student loan repayment remain uncertain for many Indiana students amid changes at the federal level. For those who were not granted loan forgiveness during the Biden administration, the possibility of pre-graduation loan repayment could be a financial torpedo.

Research site Education-data.org reports the average Indiana student loan balance is $33,000 as of June 2025 - lower than the national average - with slightly less than $31 billion owed statewide.

Nonprofit InvestEd works with students on the best approach to repayment. Its Chief Marketing Officer Bill Wozniak advises that early preparation is key.

"Plan as if it starts tomorrow. Plan as if it starts next month. Just be ready in case that happens," he said. "We've really been cautioning about planning ahead, if and when that day was going to come, and hopefully that advice was heeded, and maybe those funds weren't spent elsewhere."

Students often mistakenly pay double-digit interest rates, Wozniak said, which is why it's important to determine if loans are federal or private and to select the repayment plan that's the best fit. Every year, federal student loan rates change based on a formula set by Congress. Interest rates for loans between July 1, 2025, and June 30, 2026, range from 6.3% to 8.9%.

Education-data.org reports a total of nearly 906,000 student borrowers live in Indiana.

Wozniak admitted that setting aside money for savings is a challenge while in college, with housing, vehicles, credit cards and countless other living expenses to consider.

"Keep checking your email, keep up to date on the latest information," he said. "Make sure you read the things from your servicer, something that maybe you were supposed to start paying on, 2023, 2024, 2025. It might all of a sudden become a thing that you have to make a payment on."

President Donald Trump's tax and spending law contains new restrictions on the amount students can borrow and how they can repay. It also removes income-contingent repayment plans for student loans paid out after July 1, 2026.


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Americans have approximately 631 million credit card accounts, with nearly four cards per person.

The accounts can be a payday for con artists who prey on victims using a new scheme called the card decline scam. It involves flashing a "transaction decline" message during an online purchase. The buyer repeatedly enters the same or different credit card numbers under the belief the card or website is malfunctioning. The scammer collects a user's payment information each time they enter a card number.

Jennifer Adamany, communications director for the Better Business Bureau Serving Central Indiana, said the damage does not stop there.

"Later on, they will find out from their bank or their credit card company that the card was never declined but in fact, multiple charges have gone through," Adamany explained. "In some cases, these people's personal or financial information is being stolen, leading to identity theft."

The Indiana Economic Digest reports in 2023, Hoosiers lost almost $93 million to impostor fraud, 17% of which was due to identity theft. The Federal Trade Commission identified credit card fraud as the most reported type of identity theft nationally in 2024, with almost 450,000 cases submitted.

Most banks and financial institutions issue monthly transaction statements, meaning weeks can pass before the consumer realizes their identity has been stolen.

Adamany pointed out there are ways to shop safely online. The key is to take your time and take more than a quick glance before pulling out your credit card. Instead, verify the website and double-check the URL. Another tipoff, she explained, is a misspelling in the domain address.

"Sometimes it's a simple two-letter switch that to your eyes seems correct, but that slight little switch makes all the difference to direct you to a fraudulent website as opposed to the legitimate website," Adamany added.

It is important to look for the letter "s" in the address bar when you see the letters "http," which can add some security to the website, Adamany noted. Avoid clicking suspicious links and do not click on links in unsolicited emails, text messages or social media ads. She emphasized the tempting discounted items or limited-time offers can be tactics con artists use to rush shoppers into making an unsafe, impulse purchase.


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While a new ruling by a federal judge allows medical debt to remain on Americans' credit reports, Washington residents will be protected from the practice, under a new law.

Medical debt impacts nearly one third of Washingtonians, while six in 10 residents said they would not be able to pay an unexpected $500 medical bill.

Sen. Marcus Riccelli, D-Spokane, sponsored the bill, which he said could improve someone's credit score by an average of 20 points.

"I think there's just this general understanding that if you wake up and you have a bad day, you end up in the emergency room, that shouldn't impact whether or not you can get a job or get housing," Riccelli explained.

Some lawmakers pushed back against the bill, saying it will give an unclear picture of someone's financial status. The Washington Hospital Association supported the bill, which has been signed into law and will take effect July 27.

The law also bans unauthorized fees, threats of illegal actions and excessive contact by debt collectors. Riccelli argued it is a bipartisan issue, citing research showing the vast majority of Americans want their elected officials to reduce health care costs.

"It's really unfortunate that things seem to be moving in the opposite direction at the national level," Riccelli pointed out. "But in Washington, I'm looking to do what other states have done around cutting costs, providing protections for consumers and providing more transparency in pricing."

Emily Brice, co-executive director of Northwest Health Law Advocates, a nonprofit working to improve access to affordable health care in Washington, said recent moves by Congress will lead to more residents being saddled with medical debt, and the state needs to take more action.

"We are going to need innovative and creative policy solutions and, frankly, state leadership to prevent our health care safety net from being shredded," Brice urged.


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