Since the passage of the American Rescue Plan Act in 2021, a number of cities and counties in Ohio and around the nation have used ARPA funding to retire medical debt.

Over the summer, Akron became the latest community in Ohio to adopt a plan to retire such debts.

The city council allocated $500,000 to purchase debts through the non-profit RIP Medical Debt. RIP in turn negotiates with hospitals and debt collectors to buy old debts for pennies on the dollar and then forgives them.

Akron Ward 1 City Council Representative Nancy Holland said these debts take a toll on the community.

"Medical debt is one of the leading causes of personal bankruptcy," said Holland. "It's also a leading cause of divorce, of job disruption, of inability to qualify for most major loans like home loans, it can also cause trouble in a rental application, just to rent an apartment. "

Akron joins Lucas County, Toledo, and Cleveland in using ARPA funds to eliminate medical debts. The anticipated value of retired debts from Akron's allocation is up to $50 million.

After entering into a contract with a local government, RIP Medical Debt reviews hospital debt portfolios to determine which ones will be retired.

Residents who qualify must earn less than 400% of the federal poverty level, and their medical debts must be at least 5% of their annual income.

Allison Sesso is the president and CEO of RIP, and says medical debt can be hard to avoid.

"I think medical debt is different than other kinds of debt, because of the fact that it's inherent in the system," said Sesso. "And it's sort of a trap, you can't avoid it. You can have insurance and yet you still have medical debt. You can do all the right things and you still have medical debt. You don't control the pricing. It is not transparent as a system and so it's really hard to avoid. "

Pre-pandemic research found that 23 million Americans have medical debt, with 3 million owing more than $10,000.

While these debts are accumulated in countless ways, and at different types of healthcare organizations, Sesso said RIP will negotiate with anyone to buy qualifying medical debt belonging to those most financially burdened.

"There's often been questions about whether or not we'll work with certain kinds of hospitals, that maybe are seen as bad actors," said Sesso. "And at the end of the day, we really focus on the patient. If you have debt at a bad actor hospital, you shouldn't be punished for that."

Sesso said to date, RIP has retired $10 billion of debt for 7 million people nationally.

More than 580,000 Wisconsinites are unpaid family caregivers and they serve as the backbone of the state's long-term care system, and one organization advocating for seniors said the state could do more to acknowledge it.

Family caregivers often go without vital support, even as they provide an estimated 538 million hours of care to loved ones each year, according to AARP data.

Martin Hernandez, associate state director of advocacy for AARP Wisconsin, said while the holidays can bring added stress to their already full plates, times like these are when important discussions should happen.

"This is an opportunity to come together with family and friends and have those open and frank conversations that people should be having about caregiving," Hernandez urged. "Both in the situation they might be currently, but then also planning for the future."

It's estimated caregivers spend on average about $7,000 a year on related out-of-pocket expenses. He noted AARP Wisconsin will ask state legislators to once again consider a tax credit for family caregivers of up to $500 in the next session. A bill in Congress for a larger, federal tax credit for caregivers has sat in a U.S. House subcommittee for almost a year.

Expanding the state's family medical leave law to include up to 14 weeks of paid leave is also needed, Hernandez argued. Eight in 10 caregivers say they juggle interruptions to their work schedules, including having to change their work hours or leave early.

"Oftentimes there's different barriers, whether those are cultural or economic, where people don't necessarily want to see this as a 'transaction' that has to do with their pocketbook," Hernandez observed.

Proponents also hope the state will prioritize the needs of caregivers and the state's aging population as they develop the next state budget, which could include adopting the Medicaid expansion. Wisconsin is one of 10 states to not yet expand its Medicaid program, which would extend eligibility to about 91,000 more residents.

A new report showed how states such as Connecticut are allocating Regional Greenhouse Gas Initiative funds.

The report from the nonprofit Acadia Center found the 11 states participating in the initiative are using the funds on a variety of initiatives. Connecticut has allocated up to 80% of its funds for clean energy projects. However, some advocates said there are ways the funds can be put to better use.

Paola Moncada Tamayo, policy analyst for the center, said New Jersey serves as a model for other initiative states.

"They have a plan which they publish and that plan goes through a period of public comment," Tamayo explained. "They go through several iterations of the public comment period. They also publish a dashboard which has all the investments they do."

The report recommended states such as Connecticut consider increasing funding investments in environmental justice, including requiring at least 40% to 50% of initiative funds be invested in environmental justice and other underserved communities. The Connecticut Environmental Justice Mapping Tool showed the highest concentrations are located around larger urban areas such as New Haven, Hartford, Bridgeport and Danbury.

Advocates said the recommendations can better hold states accountable for how their funding is spent. The report found some underreporting occurring, which benefits some states' narratives of how the money is being spent. Tamayo acknowledged implementing the report's recommendations could prove challenging.

"I'll say probably in some states, there has been lack of funding and so they've been trying to fill funding holes from it," Tamayo observed. "Other states might just be that they don't have the manpower to do the level of reporting that we would want them to do."

Tamayo hopes the improvements will be implemented so states such as Connecticut can make better use of their initiative funding. While it has not been front and center, she feels it has been an important tool for helping states decarbonize.

President Joe Biden has entered a "lame-duck" period, prompting a Michigan political science expert to analyze his potential actions before President-elect Donald Trump takes office in January.

Outgoing presidents typically work on a smooth transition while the president-elect fills key positions. As Biden nears the end of his term, he has approved long-range missiles for Ukraine to strike inside Russia, marking a significant shift in U.S. policy.

Jordan Cash, assistant professor of political theory and constitutional democracy at Michigan State University, examined the possible reasons behind Biden's actions.

"He's trying to find some way to push Ukraine and Russia to a certain end point in the war," Cash explained. "Perhaps to get a final foreign policy victory to vindicate his administration at the end, or perhaps because he fears the way President-elect Trump is going to approach the Ukraine war."

Most political experts agree with Congress divided, it is unlikely much will be accomplished before the new session starts in January. However, they said it wouldn't be surprising if Biden takes other bold or controversial actions as he prepares to leave office.

Cash pointed out while lame-duck periods can have advantages, such as settling electoral disputes or confirming votes, they also come with risks. He warned an extended lame-duck phase, which is typical in the United States, can encourage an outgoing president to make partisan decisions, potentially leading to actions driven more by political motivations than the public good.

"Bill Clinton commuted several dozen sentences, including for Mark Rich, who had been convicted of tax fraud but whose wife was a major Democratic donor," Cash recounted. "President-elect Trump commuted a bunch of sentences including pardoning his former adviser Steve Bannon."

The term "lame duck" originally referred to a financial trader on the London Stock Exchange in the 18th century who defaulted on debts. It was later adapted to describe politicians with reduced influence or authority.


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