By Noam N. Levey, Katheryn Houghton and Arielle Zionts, KFF Health News

With the Trump administration scaling back federal efforts to protect Americans from medical bills they can’t pay, advocates for patients and consumers have shifted their work to contain the nation’s medical debt problem to state Capitols.

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Despite progress in some mostly blue states this year, however, recent setbacks in more conservative legislatures underscore the persistent challenges in strengthening patient protections.

Bills to shield patients from medical debt failed this year in Indiana, Montana, Nevada, South Dakota, and Wyoming in the face of industry opposition. And advocates warn that states need to step up as millions of Americans are expected to lose insurance coverage because of President Donald Trump’s tax and spending law.

“This is an issue that had been top of mind even before the change of administrations in Washington,” said Kate Ende, policy director of Maine-based Consumers for Affordable Health Care. “The pullback at the federal level made it that much more important that we do something.”

This year, Maine joined a growing list of states that have barred medical debt from residents’ credit reports, a key protection that can make it easier for consumers to get a home, a car, or sometimes a job. The measure passed unanimously with bipartisan support.

An estimated 100 million adults in the U.S. have some form of health care debt.

The federal government was poised to bar medical debt from credit reports under regulations issued in the waning days of former President Joe Biden’s administration. That would have helped an estimated 15 million people nationwide.

But the Trump administration did not defend the regulations from lawsuits brought by debt collectors and the credit bureaus, who argued that the Consumer Financial Protection Bureau exceeded its authority in issuing the rules. A federal judge in Texas appointed by Trump ruled that the regulation should be scrapped.

Now, only patients in states that have enacted their own credit reporting rules will benefit from such protections. More than a dozen have such limits, including California, Colorado, Connecticut, Minnesota, New York, and Vermont, which, like Maine, enacted a ban this year.

Still more states have passed other medical debt protections in recent years, including caps on how much interest can be charged on such debt and limits on the use of wage garnishments and property liens to collect unpaid medical bills.

In many cases, the medical debt rules won bipartisan support, reflecting the overwhelming popularity of these consumer protections. In Virginia, the state’s conservative Republican governor this year signed a measure restricting wage garnishment and capping interest rates.

And several GOP lawmakers in California joined Democrats in support of a measure to make it easier for patients to access financial assistance from hospitals for big bills.

“This is the kind of commonsense, pocketbook issue that appeals to Republicans and Democrats,” said Eva Stahl, a vice president at Undue Medical Debt, a nonprofit that buys up and retires patients’ debts and has pushed for expanded patient protections.

But in several statehouses, the drive for more safeguards hit walls.

Bills to ban medical debts from appearing on credit reports failed in Wyoming and South Dakota, despite support from some GOP lawmakers. And measures to limit aggressive collections against residents with medical debt were derailed in Indiana, Montana, and Nevada.

In some states, the measures faced stiff opposition from debt collectors, the credit reporting industry, and banks, who told legislators that without information about medical debts, they might end up offering consumers risky loans.

In Maine, the Consumer Data Industry Association, which represents credit bureaus, told lawmakers that regulating medical debt should be left to the federal government. “Only national, uniform standards can achieve the dual goals of protecting consumers and maintaining accurate credit reports,” warned Zachary Taylor, the group’s government relations director.

In South Dakota, state Rep. Lana Greenfield, a Republican, echoed industry objections in urging her colleagues to vote against a credit reporting ban. “Small-town banks could not receive information on a mega, mega medical bill. And so, they would in good faith perhaps loan money to somebody without knowing what their credit was,” Greenfield said on the House floor.

Under the Biden administration, CFPB researchers found that medical debt, unlike other debt, was not a good predictor of creditworthiness.

But South Dakota state Rep. Brian Mulder, a Republican who chairs the health committee and authored the legislation, noted the power of the banking industry in South Dakota, where favorable regulations have made the state a magnet for financial institutions.

In Montana, legislation to shield a portion of debtors’ assets from garnishment easily passed a committee. Supporters hoped the measure would be particularly helpful to Native American patients, who are disproportionately burdened by medical debt.

But when the bill reached the House floor, opponents “showed up en masse,” talking one-on-one with Republican lawmakers an hour before the vote, said Rep. Ed Stafman, a Democrat who authored the bill. “They lassoed just enough votes to narrowly defeat the bill,” he said.

Advocates for patients and legislators who backed some of these measures said they’re optimistic they’ll be able to overcome industry opposition in the future.

And there are signs that legislation to expand patient protections may make headway in other conservative states, including Ohio and Texas. A proposal in Texas to force nonprofit hospitals to expand aid to patients facing large bills picked up support from leading conservative organizations.

“These things can sometimes take time,” said Lucy Culp, who oversees state lobbying efforts by Blood Cancer United, formerly known as the Leukemia & Lymphoma Society. The patients’ group has been pushing for state medical debt protections in recent years, including in Montana and South Dakota.

More concerning, Culp said, is the wave of uninsured patients expected as millions of Americans lose health coverage due to cutbacks in the recently passed GOP tax law. That will almost certainly make the nation’s medical debt problem more dire.

“States are not ready for that,” Culp said.

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

By GARY FIELDS, Associated Press

WASHINGTON (AP) — Historically, the U.S. military has been an engine for cultural and social change in America. Defense Secretary Pete Hegseth’s vision for the armed forces he leads runs counter to that.

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In comments Tuesday to hundreds military leaders and their chief enlisted advisers, Hegseth made clear he was not interested in a diverse or inclusive force. His address at the Marine Corps base in Quantico, Virginia, verbalized what Hegseth has been doing as he takes on any program that can be labeled diversity, equity or inclusion, as well as targeting transgender personnel. Separately, the focus on immigration also is sweeping up veterans.

For too long, “the military has been forced by foolish and reckless politicians to focus on the wrong things. In many ways, this speech is about fixing decades of decay, some of it obvious, some of it hidden,” Hegseth said. “Foolish and reckless political leaders set the wrong compass heading, and we lost our way. We became the woke department, but not anymore.”

Hegseth’s actions — and plans for more — are a reversal of the role the military has often played.

“The military has often been ahead of at least some broader social, cultural, political movements,” said Ronit Stahl, associate professor of history at the University of California, Berkeley. ”The desegregation of the armed forces is perhaps the most classic example.”

President Harry S. Truman’s desegregation order in 1948 came six years before the Supreme Court ordered school desegregation in the Brown vs. Board of Education case — and, Stahl said, “that obviously takes a long time to implement, if it ever fully is implemented.”

U.S. military senior leadership listen as Secretary of Defense Pete Hegseth speaks at Marine Corps Base Quantico, Tuesday, Sept. 30, 2025 in Quantico, Va. (Andrew Harnik/Pool via AP)

It has been a circuitous path

Truman’s order was not a short progression through American society. Although the military was one of the few places where there was organizational diversity, the races did not mix in their actual service. Units like the Tuskegee Airmen, the Navajo Code Talkers and the Buffalo Soldiers, formed in 1866, were segregated until the order opened the door to integrated units.

Women were given full status to serve in 1948 with the Women’s Armed Services Integration Act. There were restrictions on how many could serve and they were generally not allowed to command men or serve in combat. Before then, they had wartime roles and they did not serve in combat, although hundreds of nurses died and women were pilots, including Women Airforce Service Pilots, or WASPs.

The WASPs and Tuskegee Airmen were among the first groups this year to be affected when Hegseth issued his DEI order. The Air Force removed training videos of the airmen along with ones showing the World War II contributions of the WASPs at the basic training base in San Antonio. The videos were restored after widespread bipartisan outcry over their removal.

Other issues over time have included “don’t ask, don’t tell,” the policy that allowed gay and lesbian service members to serve as long as their sexual orientation was not public. That was repealed during the Obama administration. Women were allowed to serve on combat aircraft and combat ships in the early 1990s — then all combat positions after a ban was lifted in 2015.

“The military has always had to confront the question of social change and the question of who would serve, how they would serve and in what capacity they would serve. These are questions that have been long-standing back to the founding in some ways, but certainly in the 20th century,” said David Kieran, distinguished chair in Military History at Columbus State University in Columbus, Georgia. “These are not new questions.”

Generally the answer has come down to what “the military writ large” has concluded. “’How do we achieve our mission best?’” Kieran said. “And a lot of these things have been really hotly debated.”

Secretary of Defense Pete Hegseth speaks to senior military leaders at Marine Corps Base Quantico, Tuesday, Sept. 30, 2025 in Quantico, Va. (Andrew Harnik/Pool via AP)

Part of a larger, longer debate

Kieran offered one example: changes the Army made in the 1960s when it was dealing with a climate of racism and racial tensions. Without that, he said, “the military can’t fight the war in Vietnam effectively.”

The same considerations were given to how to address the problem of sexual harassment. Part of the answer involved what was morally right, but “the larger issue is: If soldiers are being harassed, can the Army carry out its mission effectively?”

While “it is important to see these actions as part of a longer history and a larger debate,” Kieran said, “it’s certainly also true that the current administration is moving at a far more aggressive and faster pace than we’ve seen in earlier administrations.”

Michael O’Hanlon, director of research in the foreign policy program at the Brookings Institution, questioned some of the actions that Trump’s Defense Department has taken, including replacing the chairman of the joint chiefs, Air Force Gen. CQ Brown Jr.

“He was a fine Air Force officer,” O’Hanlon said. Even if he got the job in part because of his race, “it wouldn’t be disqualifying in my book, unless he was unqualified — and he wasn’t.”

Matthew Delmont, a professor of history at Dartmouth College, said the current attitudes he is seeing toward the military suggest a misunderstanding of the armed forces and why the changes have been made.

“The military, for more than seven decades now, has been more on the leading edge in terms of figuring out how to put together an organization that tries to take advantage of the talents and capacities of all Americans,” Delmont said. Since Truman signed his executive order, “the military has moved faster and farther than almost any other organization in thinking about issues of racial equality, and then later thinking about the issues related to gender and sexuality.”

Delmont said bias, prejudice and racism remain in the military, but the armed services have done more “than a lot of corporations, universities, other organizations to try to address those head-on.”

“I wouldn’t say it was because they were particularly interested in trying to advance the social agenda,” he said. “I think they did it because they recognized you can’t have a unified fighting force if the troops are fighting each other, or if you’re actively turning away people who desire to serve their country.”

During the most recent fiscal year, more New Yorkers reported not having heat in their apartments than any time on record. Here’s how to get help if your landlord won’t turn up the thermostat this “heat season,” which kicks off Oct. 1.

New York City landlords must keep temperatures above a certain threshold between Oct. 1 and May 31. (Adi Talwar/City Limits)

More New Yorkers than ever reported sleeping in the cold last year, city data suggests.

The Department of Housing Preservation and Development (HPD) responded to a record 161,773 unique heat and hot water problems in the 12 months that ended last June, according to the Mayor’s Management Report released in mid-September.

Heat and hot water violations were up 12 percent over the previous fiscal year, and 60 percent since 2016. Other housing code problems went up just 2 percent last fiscal year.

The report’s release came just before the start of the city’s “heat season,” which stretches from Oct. 1 to May 31, when landlords are legally required to keep apartments at 62 degrees during the night and 68 degrees during the day.

“People will work with a lot of other repairs,” said Andrea Shapiro, director of program and advocacy at the Met Council on Housing. “But heat and hot water [problems] get to people very fast. Especially if they have children.”

Just complaints for heat alone—excluding hot water—reached 250,000 between July 2024 and June 2025, according to a City Limits analysis.

That’s more than double the number of complaints in 2016.

More complaints, a spokesperson for HPD said, could also just mean that tenant education efforts are working and more tenants are aware of the tools and resources they can use.

It’s not just that more New Yorkers have called in problems over the past few years—HPD has found more problems. The agency issued over 9,000 violations for serious heat deficiencies in the past two fiscal years, city data shows. In the previous eight years, they issued an average of about 4,000 a year.

A spokesperson for HPD said that the number of heat violations issued decreased 2 percent this year, and hot water violations increased 7 percent.

How to get help

If you are one of the hundreds of thousands of tenants who have trouble with their heat each year, here’s how you can get help.

Try contacting the owner, manager, or super. Contacting the manager directly is an important first step. Make sure to document the fact that you reached out by saving your call records, emails, or texts. The most airtight way to contact your landlord is by certified mail, experts say, which can provide proof they received it.

If you live in NYCHA housing, you can call the customer contact center at (718) 707-7771 or use the MyNYCHA app.

Collect evidence of the temperature. You can buy a thermometer for low cost at a local hardware or corner store. Start logging the temperature and make sure to note the exact day and time of your temperature reading. It’s a good idea to note the temperature multiple times during the day and at night.

Once you have a log of the temperature, it might be a good idea to reach out to your owner again, sending them a letter by certified mail and saving a copy for yourself.

Contact 311 through the phone, the online portal, or the app. When you make a 311 report, HPD will send an inspector out to your apartment. There is no way to know exactly when the inspector will come, and it can take a few days. If you continue to not hear from HPD, consider filing another complaint.

Note that when you call 311, your landlord will be notified of the complaint. If your neighbors also have no heat, sending in multiple complaints can help bring attention to your building.

When the HPD inspector comes they can issue a violation. You can see the open violations as well as past violations for your building on HPD online.

Consider a lawsuit if the problem persists after HPD has issued a violation. You can file an “HP Action” by going to court in your borough (bring your documented evidence and the letter you sent your landlord). An HP Action costs $45 to file, but you can ask the judge to waive that fee.

The court clerk will give you paperwork for a complaint that you need to fill out and deliver to your landlord. Make sure to send the papers by certified mail, and keep the receipt. The nonprofit Housing Court Answers has a helpful Q&A if you are considering taking your landlord to court.

Most importantly, says Shapiro, “you don’t need to wait to do anything.” Some tenants, Shapiro says, can be intimidated to reach out to their landlord. She said knowing your rights can help: even if you’re behind on rent, you are still entitled to heat and protected from threats and harassment.

If you need more information, check out these helpful guides from JustFix and THE CITY. The Met Council also offers a tenants’ rights hotline which you can call at 212-979-0611.

Where are heat violations most present?

The burden of going without heat is not spread evenly throughout New York City. Problems tend to pop up in the same neighborhoods year after year.

A City Limits analysis shows that recent complaints of no heat were concentrated in Harlem, The Bronx, and Central Brooklyn.

Daniel Neill, a NYU professor and researcher, found that poorer neighborhoods tended to have more problems. “Neighborhoods with lower income tend to be ones with lower end buildings where perhaps the landlords are not taking as good care of them,” he said.

Last year, City Limits reported that housing maintenance code violations were more likely to be concentrated in those same neighborhoods. Those areas also tend to have more people of color, and have an older stock of housing.

A spokesperson for HPD says that they prioritize heat and hot water complaints and typically responds within less than a few days. In extreme cases, HPD will fix the problem themselves, then bill the landlord.

Met Council’s Shapiro said that a lot of the heat and hot water problems they see are in areas of the city like Washington Heights and Inwood, where there is a lot of older, rent stabilized housing. Because rent stabilized tenants have capped rent increases, they may be more likely to call in a complaint than market-rate tenants who fear retaliation, she suggested.

Property owners previously pointed to physical distress in the stock of rent stabilized housing in the city, where landlords sometimes defer maintenance, saying they cannot keep up with rising costs—a debate reignited by mayoral candidate Zohran Mamdani’s promise to freeze rents in rent stabilized buildings for four years, which landlords claim will exacerbate the problem.

Earlier this year, New York City’s Comptroller Brad Lander found that many heat issues were chronic—and that even as HPD hired more inspectors, some buildings were still falling through the cracks.

City Limits reported that in those buildings, tenants went months without working heat, frustrated by repairs requests that went unanswered.

Neill cautioned that in order to issue a violation, there needs to be a complaint. His research suggested that neighborhoods with more older folks and more people with limited English proficiency were less likely to report a heat and hot water problem.

Knowing where to get help is a big part of that. “These are serious quality of life issues, and so it’s really important that when problems occur, people actually have what they need to make sure that those problems are fixed,” said Neill.

To reach the reporter behind this story, contact Patrick@citylimits.org. To reach the editor, contact Jeanmarie@citylimits.org

Want to republish this story? Find City Limits’ reprint policy here.

The post ‘No Heat’ Complaints in NYC Apartments Hit New Highs Last Year. Here’s How to Get Help appeared first on City Limits.

Twenty-four people were killed in domestic violence situations last year in Minnesota, including nearly half who were bystanders or intervenors, according to a report released Wednesday.

The 11 bystanders or intervenors killed are tied for the highest toll since Violence Free Minnesota began tracking intimate partner homicides in 1989.

The overall number of victims is down since 2023, when 40 people were killed in domestic violence situations — the most Violence Free Minnesota has seen since it began record keeping.

Last year’s killings included the high-profile ambush shootings of Burnsville officers Paul Elmstrand and Matt Ruge and firefighter/paramedic Adam Finseth. Police had responded to a 911 report of a domestic disturbance at a home.

“The Burnsville tragedy echoes so many others across the U.S.,” said Nikki Engel, Violence Free Minnesota interim co-executive director, pointing to the link between mass shootings and domestic violence.

Eighteen of the 24 victims last year were killed by a person who used a firearm. For at least five of the victims, the suspect was legally prohibited from possessing firearms, according to the Violence Free Minnesota report.

Violence Free Minnesota made a collage of photos of people who died in 2024 in situations of intimate partner violence, as bystanders or intervenors, or under suspicious circumstances as they released their annual report on Oct. 1, 2025, about such homicides in Minnesota. (Courtesy of Violence Free Minnesota)

‘Lives taken too soon’

Violence Free Minnesota’s annual report is not just about statistics.

“It is about lives — lives taken too soon, families forever changed and communities left with grief and questions that rarely find easy answers,” said Kaleena Burkes, director of Minnesota’s Missing and Murdered Black Women and Girls Office.

At the same time, “if we do not fully understand the scope, we cannot build the solutions,” Burkes said. “If we do not see the patterns, we cannot break the cycles.”

Twelve women and one man were killed last year in Minnesota by a current or former intimate partner, according to the new report.

Some of the violence against bystanders and intervenors last year involved multiple people killed at the same time, including the Burnsville shootings and two children who were shot along with their mothers in Duluth.

In both 1999 and 2023, there were also 11 bystanders or intervenors in domestic violence killed in Minnesota.

Intervening before a crisis

Alex Dominguez, program manager for Relationship Safety Alliance in Brainerd, said their community was shaken last year by the killing of 62-year-old Lyle Maske, who was trying to intervene in a domestic violence incident involving his neighbor and her children.

“His death is a devastating reminder that domestic violence doesn’t only harm intimate partners,” she said. “It pulls in neighbors, bystanders and anyone else who’s willing to act and try to help make change.”

While not every tragedy can be predicted, “many can be prevented when systems are equipped to act early and decisively,” Dominguez said. That includes enforcing firearm prohibitions, investing in culturally responsive services and “believing survivors the first time they reach out for help,” she added.

If people “are able to identify and intervene early in a domestic violence relationship, you are going to lower the risk of crisis point even developing,” said Jess Palyan, Violence Free Minnesota’s policy program manager.

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And intervention could mean “every single person in Minnesota knowing the number to a 24/7 domestic violence hotline, having it in your phone and sharing that with someone that you’re worried about,” Engel added. “Saying, ‘You might not need this number now. I might be overstepping my bounds … but I’m concerned about you.’”

Throughout Minnesota, the Day One crisis line can be reached around the clock by calling 866-223-1111 or texting 612-399-9995.

So far in 2025, Violence Free Minnesota has documented at least 18 instances of people killed due to intimate partner violence.

Prior to the high number of homicides in 2023, the previous high was 37 domestic-related homicides in 2013.

Minnesota averaged 26 victims of intimate partner violence annually between 2013 and 2022, Violence Free Minnesota data show.