As federal agencies crack down on "junk fees." experts feel they can learn a thing or two from New York.

The state is one of 13 to pass facility fee reforms, which are growing as more hospital systems merge with independent physicians. The fees can vary in price and are used to help hospital systems maintain various clinics. New York passed a bill requiring hospitals to disclose them to patients in advance.

Diane Spicer, supervising attorney for the group Community Health Advocates, said consumers are getting nickeled and dimed by facility fees.

"Facility fees are usually small in comparison to some of the medical debt cases that we handle," Spicer acknowledged. "$250, $500, $200, but they all add up."

The fees are part of the growing national medical debt crisis. A KFF report found national medical debt totaled at least $220 billion in 2021. About 910,000 people in New York report having medical debt, despite more people having health insurance.

The Federal Trade Commission will hold a hearing on junk fees this month and national community health groups signed a letter calling for a ban on facility fees.

Mona Shah, senior policy and strategy director for the nonprofit Community Catalyst, believes the fees do not serve their original purpose, including fees for telehealth visits.

"I mean it's as simple as there is nothing currently that bans a hospital from saying you cannot charge an individual facility fee for a telemedicine visit," Shah pointed out.

Hospitals and medical centers have been pushing back, arguing the fees are an important source of revenue to cover operational and overhead costs. The American Hospital Association has opposed previous Congressional legislation banning facility fees because they said cuts to hospitals and health systems could severely affect patients' care.

The Texas Department of Criminal Justice is facing a class action lawsuit calling for the agency to add central air conditioning to all its prisons.

Only 30% of the prisons in Texas have central air, and advocates say the sweltering summer heat is inhumane and impacts the physical and emotional health of people who are incarcerated. Four organizations, including the Lioness Justice Impacted Women's Alliance, are plaintiffs in the lawsuit.

Marci Marie Simmons, community outreach coordinator with the Alliance, said during her 10 years at the Dr. Lane Murray Unitin Gatesville, she was concerned about her health and the health of other women.

"I remember worrying about the insides of my body, like, 'What is this heat doing to my organs?' I watched older women have a really hard time in the summer. I watched women fall out with heat-induced seizures, " she explained.

The Texas House of Representatives has passed a bill that would require all Texas prisons have air conditioning by 2029, but the prison system only has to comply if the state provides the funding.

Over the last 10 years, 13 heat-related deaths have been documented in men's prisons in Texas. According to TDCJ policy, when the heat index is above 90 degrees, additional water, ice and cups are provided to people in prison, who also can wear shorts and t-shirts. In certain cases, they can receive permission to go into one of the designated air-conditioned spaces.

Simmons said about 90,000 people behind bars across the state don't have access to cool air.

"The lawsuit is asking for the same regulations that are on jails, which is to keep the temperatures between 65 degrees and 85 degrees. Currently about 30% of beds have climate control," she continued.

The Lone Star State is one of at least 13 in the country where all facilities are not air conditioned. Texas experienced the 2nd hottest summer on record last year and climate experts predict this year will be just as bad or worse.


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The message of the importance of heart health has arrived at construction sites. On Thursday, the American Heart Association is hosting its annual event, Hard Hats with Heart, in Seattle.

Americans are at high risk for cardiovascular diseases, and construction workers have high rates of some of the contributing factors, such as nearly half not getting enough exercise.

Mark Howell, senior vice president of Skanska U.S.A. Building and chairman of Puget Sound Hard Hats with Heart, said the American Heart Association hosts "Toolbox Talks" at job sites to raise awareness about heart health.

"We've had several workers find out they're diabetic and they didn't even know it, and the only way they found out was by going into the blood pressure challenge and ended up deciding to make a doctor's appointment and discovered they had diabetes," he said. "So, just bring that awareness into the industry so people can take care of underlying issues to improve their heart health."

Hard Hats with Heart takes place at The Shop in Seattle's Georgetown neighborhood on Thursday.

Howell added the event highlights cardiovascular risks specific to the industry and ensures people on job sites understand how to be prepared in case of an emergency, such as having hands-only CPR training.

"It's an evening where we celebrate the progress we've made, the number of lives that we've impacted with the message about proper heart health, and it's also an opportunity to hear from some construction workers who have personally been impacted by cardiovascular disease and have been able to maybe make some corrections in their lives as a result of that awareness," he explained.

More than 340,000 construction workers have been diagnosed with cardiovascular disease, according to the American Heart Association.

Experts are traveling across the Commonwealth to help community professionals better understand and advocate for policies that help Kentuckians needing assistance with health care, housing, food, transportation, child care, suicide prevention and other resources. Thrive Roadshow workshops are free and available to the public.

Emily Beauregard, executive director of Kentucky Voices for Health, said attendees will receive updates on policy changes and funding for programs that impact folks in their communities.

"Our focus with the roadshow is to make sure community professionals who are interacting with folks on a daily basis really have the resources and skills that they need to advocate for the policies and programs that are right for their communities," she explained.

More information on Thrive Roadshow events happening in Frankfort, Pikeville, Williamsburg, Murray and elsewhere is online at ThrivingCommunities2024.

Tiffany Taul-Scruggs, patient service outreach manager with Mount Sterling Healthcare, said her team of Community Health Workers relied on the Thrive program to better understand the Medicaid Renewal process, so they could improve serving their patient population.

"One of the things that I really found useful is that they are a group that I can depend on, or if I need to call them to talk about things, they really do a lot of prep work behind the scenes, " she explained.

According to the healthcare advocacy group KFF, more than 1.6 million million people in Kentucky are covered by Medicaid. More than half of the Commonwealth's Medicaid spending is for people who are elderly or those with disabilities.