Your 2024 credit card checklist for summer travel

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By Craig Joseph | NerdWallet

Checklists are a key step in travel preparation for many people. Passport — check. Phone charger — check. But have you checked to make sure you’re fully utilizing the travel perks offered by your credit card?

Whether you’re a seasoned jetsetter or a novice traveler seeing the world for the first time, benefits from the right credit card can make a trip more convenient and more comfortable. That’s good news for the 50% of Americans who plan to travel more in 2024 than 2023, according to a survey by IPX1031, a Fidelity National Financial Company.

Here’s a credit card checklist to review before you hit the road this summer.

1. Bring a card

First things first — be sure to bring a credit card! Many airlines, and even entire airports, are now cash-free. That means you’ll need a card to pay for that pre-departure drink or in-flight snack. You might even earn bonus rewards.

For example, if restaurants are a bonus category for your card, sit-down establishments within the airport will usually still earn that higher rewards rate. If your card earns a bonus on travel purchases, you’ll usually earn that bonus for in-flight purchases.

2. Register for TSA PreCheck, Global Entry or Clear

Airports are more crowded than ever, with air passenger growth up 6% and foreign travel up 24% year over year, according to a study conducted by the U.S. Travel Association and Tourism Economics.

To ease the burden of long lines, check if your card offers a credit that covers the cost of TSA PreCheck, Global Entry or Clear. These programs allow you to speed through the line at security or customs, but since they all require a background check and an in-person interview, you’ll need to register well before your trip. Even if you haven’t been verified for this trip, register today to prepare for your next trip.

3. Register for lounge access

Airport lounges offer a reprieve from the hustle and bustle of the airport terminal, with most offering free food and drinks. If your card offers access to Priority Pass lounges, you’ll need to register for that benefit before you hit the road.

Don’t forget your physical membership card, or even easier, download the Priority Pass app and use your phone to access the lounge.

4. Notify your issuer of your travel plans

Few things can create issues like having your card unexpectedly stop working when you’re away from home, especially internationally. With rates of credit card fraud increasing, it’s possible your card could stop working if you’re spending outside of your normal patterns or locations. To preempt this, notify your issuer before you travel. Often you can do this online or through the app, but just in case, be sure to travel with at least two cards.

5. Avoid paying foreign transaction fees

If you’re traveling abroad, make sure you have a card that doesn’t charge foreign transaction fees. If your card does levy those fees, try to get a different card before you leave the country.

6. Pay with your most rewarding card

Be sure to identify opportunities to leverage your trip and earn outsized rewards. For example, if you know you’ll be staying at a Hilton brand hotel, you might consider applying for one of the Hilton credit cards offered by American Express and earn up to 14 Hilton points per dollar you spend at the hotel. Those points can stack up fast and easily defray costs for your future travel.

But you’ll need to bring the physical card with you. Many hotels aren’t able to accept digital wallet payments, so if you can’t swipe your card, you’ll miss out on those heightened rewards.

7. Check your card’s money-saving offers

Many issuers have programs, such as AmEx Offers, Chase Offers and BankAmeriDeals from Bank of America, that let you add rotating promotional offers to your card and earn additional points or cash back for making purchases at specific merchants. Be sure to review these offers for any merchants where you might spend during your travels. Just be aware of the fine print — often these offers exclude, or only include, international merchants.

Craig Joseph writes for NerdWallet. Email: cjoseph@nerdwallet.com.

Move over, Fabio. Romance novels have changed — and so has the community

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By Jackie Varriano | The Seattle Times (TNS)

SEATTLE — I remember blushing over my first romance novel, liberated from my mother’s bookshelf. The clinch cover featured legendary Italian model Fabio in a passionate, shirtless embrace with our heroine. It was a neon sign that screamed “EROTICA.” There was no way I could read it in public or even admit I was reading it. Romance novels were cheesy and embarrassing — even if I enjoyed them.

Decades later I have fallen into a rabbit warren of romance and romance-adjacent novels with glee. I’ve changed, romance novels have changed and the romance reading community has changed. Forget Fabio, being a romance reader now is all about fun — even when the characters are morally gray.

“If you think about the romance genre, the staying power is there. It’s just the shame has been removed,” said Andrea Pangilinan, bookseller at Third Place Books in Seward Park. The caveat — and appeal — of a romance novel for her is that “you’re guaranteed a happy ending.”

However, Pangilinan notes the romance world is “so big,” and the idea of what could be seen as a romance book isn’t universally agreed upon. Rebecca Yarros’ book “Fourth Wing,” about an elite school of dragon riders, has spent 47 weeks on The New York Times bestseller list. Today, they span from dark themes to fantastical worlds, making it difficult to get your arms around just how popular the genre is, but easy to find the perfect romance novel for you.

Bookseller Andrea Pangilinan has expanded the romance book section at Third Place Books Seward Park, Tuesday, April 2, 2024, in Seattle. (Ken Lambert/The Seattle Times/TNS)

Growth in community

Chelsea Castor’s day job is in health care, but she’s also a social media influencer on TikTok and Instagram, making hilarious, rapid fire book recommendation videos for people who are on the hunt for their next great read, racking up millions of views. A lifelong reader, Castor fell in love with romance novels after picking up “The Cruel Prince,” a young adult (YA) fantasy romance by Holly Black during the pandemic.

“I was looking for the next thing to scratch the itch, but I wasn’t friends with people who were readers. That’s when I heard about TikTok and started making content,” Castor says. “There wasn’t anything to do, I was mass-consuming books and I am now averaging 100 books a year.”

One of the biggest things that has changed for romance readers over the past few years is the community. BookTok and Bookstagram (book-centered content on social media platforms TikTok and Instagram) allowed readers to connect with each other in new ways, helping to remove the stigma that once surrounded “dirty” books like “50 Shades of Grey,” an erotic series that got its start as a spicier fan fiction retelling of the popular YA vampire “Twilight” series.

“Romance readers love word-of-mouth and they’re voracious readers,” said Pangilinan, the Third Place bookseller. It’s only natural that they would flock to one another online. Now instead of hiding your romance book behind a book cover, readers are flaunting tattoos from their favorite reads, wearing sweatshirts that mention fictional places from books and adorning their e-readers with “in my smut era” stickers. They’re all beacons of light, attracting other romance readers and helping to forge new friendships.

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Like Castor, Eugene, Oregon-based Kodie Dorman’s introduction to the romance reading community was through BookTok. Dorman was recording funny reaction videos of her husband reading Sarah J. Maas’ “A Court of Thorns and Roses,” which caught the eye of Jordan Day, a Fairfax, Virginia-based author and reader. They bonded over their mutual enjoyment of romantasy books and now they’re gearing up for the third iteration of a multiday event they run called Books, Gowns & Crowns, scheduled for Oct. 17-19 in Seattle.

The event is one of a few romance-centered bookish events that have sprung up in the past few years. Like Emerald City Comic Con — the most recent iteration of which included a book signing by popular romantasy author Yarros — Books, Gowns & Crowns allows readers to get up close and personal with some of their favorite authors. There’s a book signing, a cosplay event and a ball where guests are encouraged to dress up in lavish gowns and “fully immerse yourself because tonight, you are the main character in this story.”

They held the first event in Portland in September 2022, followed by a second in Tampa, Florida, in May 2023. “I’ve never felt anything like this outside of these events. It’s pure joy, pure magic and such a sense of belonging,” she says.

Dorman says for her, the welcoming community of romance readers isn’t so tough to figure out — it’s simply a natural progression. “Our generation grew up as Harry Potter kids. We have embraced uniqueness and being true to yourself,” she says.

Day agrees, noting that when she finally picked up “A Court of Thorns and Roses,” “I thought this is so great, the characters are so relatable. Things we loved about ‘Harry Potter’ or ‘Twilight’ just adapted to fit where we were in our stages of life. It had adventure, real arguments and real spice.”

Talking about those books with others was another way to connect with people.

Megan Futej is another Bookstagrammer who has found joy in the romance reading community. Futej, who lives in West Seattle and works in social media management for Starbucks grew up going to midnight movie premieres for the “Harry Potter” and “Twilight” series but now attends midnight book release parties at Pegasus Book Exchange, a used-book store in her neighborhood.

“As you get older it is harder to make friends, but I think books are this language that so many of us can speak. As soon as you meet someone and find out they are a reader too, you know you’re going to be friends,” Futej says. “I have very much enjoyed the community and friendships that have come into my life because of books and reading.”

The first video Castor posted that took off was her playing a character asking for a love story book recommendation. As she tries to home in on what exactly that means, book covers appear as she’s giving more and more genre-specific recommendations. The caption is “I’m going to need you to be as specific as possible when asking for recs.” It was posted nearly a year ago, but she’s still fielding comments from people who resonated with the video.

For example, if you wanted to read a story about a down-on-her-luck woman who gets an unconventional job at a sperm bank catering to minotaurs, you’ve got it! Just read “Morning Glory Milking Farm” by independent author C.M. Nascosta.

Of course there’s a love story in there — but it’s not just for shock value. Romance novels these days can contain real depth, portraying character growth and healthy relationship fluff as well as smut.

“I went into that book for the ha-ha’s,” Castor says. “I tell you that is one of the most wholesome, Hallmark movie books I’ve read in a long time.”

Bookseller Andrea Pangilinan has expanded the romance book section at Third Place Books Seward Park, Tuesday, April 2, 2024, in Seattle. (Ken Lambert/The Seattle Times/TNS)

An adapting genre

As a romance author herself, Pangilinan, the Third Place bookseller, has grown the store’s romance offerings from half a bookcase to three full bookcases of diverse titles to attract all kinds of readers — ones who love legacy romance authors like Nora Roberts and Lisa Kleypas, as well fans of contemporary romance authors like Emily Henry. She also helps point readers to romantic books that might not be shelved in her section.

Pangilinan has a joke with her book-loving friends, “Is it romantasy or was it [fantasy] written by a woman?” she said. “I’m very discerning about what I put in romance — I don’t put Sarah J. Maas in romance because it’s more of a contained plot with world building.”

Like many, Maas’ books were my entry point into “romantasy” and since then I’ve read dozens of romantasy books, but also books that could slot into general fiction or be further distilled into microgenres of romance like historical, western, fantasy and more.

There are still the same tropes that have been popular with romance novels for decades — virgins, surprise pregnancy, fake dating, forced proximity — but themes contained in all of these different types of romance novels are changing. It’s becoming more common to read about main characters managing mental illness or recovering from trauma and for a page with potential trigger warnings to be slotted in just after the dedication.

“I appreciate trigger warnings myself but they’re also a hot topic, just like talks about consent. Now on the page there’s verbal consent and discussions about how to perform safe sex,” Lauren Roux, an Everett-based author and president of the Emerald City Romance Writers, which oversees a membership of around 150 PNW-based romance writers.

This emphasis on healthy relationships is also a shift in the romance genre. While Pangilinan still recommends what she calls “foundational” romance books — what our grandmothers would’ve called “bodice rippers” — she now cautions readers to enjoy them with a critical eye warning of “dubious consent.”

“Lisa Kleypas, [an author who has] been writing since the ’80s, pulled her whole catalog and has been rereleasing it to address the problematic stuff,” Pangilinan says.

The moral of this story is that there’s something for everyone in the romance world. If you’re waiting for a sign to pick up a romance novel, this is it. And if you’re reading them secretly — this is also your sign to tell someone about it.

“Read what you want to read,” Futej, the West Seattle bookstagrammer says. “Own it.”

©2024 The Seattle Times. Visit seattletimes.com. Distributed by Tribune Content Agency, LLC.

Garden variety: Containers are the perfect way to add color to your porch, patio and lawn

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Container gardens offer instant gratification to those who want to enjoy flowers and plants all summer long. Fill a pot with soil, pick your plants and voila! The payoff comes in having a beautiful garden to enjoy.

Gardens in a pot are perfect for those who crave variety. “You can change things every year and through the seasons,” says Annie Huston, co-owner of Denver boutique Birdsall & Co. and a longtime garden designer. A mixture of eye-popping annual flowers might suit you one spring, while a mix of tropical plants and succulents might be to your liking the next. And when summer turns to fall, you can replace plants with new ones to transition into the cooler months.

With so many choices, where do you begin? We asked Huston to break down the process.

Annie Huston, owner of Birdsall & Co., right, shows a collection of flowering plants that make for good container gardens at Birdsall & Co in Englewood, Colorado on April 24, 2024. In the photo Huston is holding from left to right clockwise a Super Moon red zonal geranium, left, a Main Street Oxford Street coleus, and a Star Dust Super Flash grassleaf spurge, right. (Photo by Helen H. Richardson/The Denver Post)

Sun or shade

One of the first things to determine is whether the pot will be mostly in sun or shade, because some plants will wither and die if exposed to too much sun, and others won’t thrive without it.

Huston says that if your container will get western exposure or strong southern sun for most of the day, pick plants that will do best in sun. Containers receiving eastern or northern sun, very filtered sun, or those located under a roof or trees will do best with shade-loving plants. A sun-loving annual will not die in shade or part shade, but it will not produce the expected color or bloom.

Pick your pot

Bigger is better when you are making a container garden as smaller pots dry out quickly. “A collection of smaller containers makes the plantings less interesting and more difficult to maintain,” Huston says. “The idea when choosing containers is to imagine them in the winter months when they are empty of lush colors. They should make a statement on their own, although no pot should ever be empty.”

The size of the container is dictated by the space and scale of the location. While bigger pots make more of a statement, they can be heavy and hard to move when filled with soil and plant material. Huston’s trick for filling them is to invert plastic pots with drain holes and place them inside the larger pot so you’ll need to use less soil overall.

The material of the container -– stone, terra cotta, glazed ceramic, synthetic materials -– doesn’t make a big difference as long as the right soil is used and the plants get enough water, Huston says.

Cast stone containers tend to be more formal and best used for a home’s front entrance or on a large pool deck. “Because of their weight, they need to be placed in a permanent location and become part of the architecture of the house,” she says.

Annie Huston, owner of Birdsall & Co., shows some of the hundreds of pots available at her store that make for good container gardens at Birdsall & Co in Englewood, Colorado on April 24, 2024. (Photo by Helen H. Richardson/The Denver Post)

Huston is a fan of terra cotta and glazed containers because they are available in a variety of styles, textures, colors and shapes to enhance and complement the architectural style of the home and garden.

Lightweight containers are popular for rooftop terraces or balconies and allow for very large sizes without the cumbersome weight. Using plant caddies with wheels can make pots easy to move around depending on weather and light requirements.

Whatever type of pot you use, make sure it has a drainage hole in the bottom.

Select the right soil, plants

Garden centers offer a variety of types of soil mixes for containers. Huston likes Espoma organic potting mix, which includes earthworm castings, alfalfa meal, kelp meal, feather meal and a proprietary blend of mycorrhizae (fungi that have a symbiotic relationship with plant roots).

A ficus tineke, or rubber fig, the larger plant in the arrangement, helps make for an interesting arrangement with other plants in a large container that would be suitable to grow in shady location at Birdsall & Co in Englewood, Colorado on April 24, 2024. (Photo by Helen H. Richardson/The Denver Post)

There are scores of plant options for full-sun containers, so select colors, colors, textures and growth patterns that appeal to your eye, Huston says. The plant tags are an easy way to determine which plants will do well in the sun.

“You cannot go wrong with grasses, verbenas, lantanas and the old-fashioned but reliable geraniums,” she says, adding, “Canna lilies come in different sizes and are perfect for a centerpiece.”

For shade containers, “nothing beats impatiens for a splash of color,” Huston says. Coleus, begonias and upright fuchsias are other choices.

Design considerations

Those just starting out with container gardening can make things easy by choosing two to three varieties of plants with the same growth pattern and let them intertwine for a natural look. “Simple and healthy is better than a mixture of random plants picked at the garden center because they looked lovely that day,” Huston says.

Have patience as some plants will not look their best until they are given room to grow. Examples include euphorbia, sweet alyssum, verbena, creeping Jenny and calibrachoa.

While mixtures of plants are enticing, there’s also nothing wrong with using a single plant type, she says. “The maintenance is simplified and the results striking.”

Keep in mind that instead of relying on colorful flowers to provide the container’s eye appeal, a plant’s leaves can make the statement. “Foliage interest in all its variations and hues looks gorgeous when paired with a dash of contrasting bloom appearing between the leaves,”  Huston says.

Consider mixing indoor plants with annuals. “It’s not only surprising and sophisticated, it is also recycling when you bring them inside after the season,” she says. “Succulents make for wonderful full-sun containers when accompanied with blooming annuals.”

The appeal of succulents is their “enormous personality, their drought-resistant nature and sculptural forms.” Her favorite is the red yucca “shining by itself in a full sun container, and when it flowers, it attracts hummingbirds.” Others she likes outdoors in the summer and indoors in winter are large agaves, Mexican grass tree, and “the beautiful aloe for its structure, soft green and sunburn relief.”

A variegated dwarf smooth agave plant, the larger plant in the arrangement, helps make for an interesting arrangement with other plants in a large container at Birdsall & Co in Englewood, Colorado on April 24, 2024. (Photo by Helen H. Richardson/The Denver Post)

Containers can be made with edible plants as well as ornamental ones. “Some vegetables have the most luscious leaves and give a tropical feel to the design. Kale, artichoke, and broccoli are just a few of them,” she says.

Herbs should be used in full sun to “enchant us with their fragrance,” the garden designer says. Use basil, sage and lavender as centerpieces in a container, and plant strawberries and nasturtium on the edges where they can trail.

You can also incorporate perennials into containers. For sunny spots, add gaura, a long-blooming perennial that adds feathery lightness, and coral bells for foliage interest. For shade containers, hostas and Japanese forest grasses are great choices. When summer ends, you can plant the perennials in your outdoor landscape.

Water and fertilize

Once you’ve invested the time and resources to select and plant your containers, keep them healthy by fertilizing and watering.  Huston recommends applying a liquid fertilizer that contains fish and seaweed every couple of weeks.

For watering, if there is an irrigation system in the landscape near your containers, spaghetti tubing is easy to insert through the drainage hole.

Hand water early in the morning or evening when temperatures aren’t too high. In the hottest part of the summer, most containers need water daily. Watering the edges of the containers, under the grown leaves, is an important detail since these plants are more prone to drying out.

The French-born Huston calls her approach “watering with Champagne,” finding it relaxing to hold a watering wand in one hand and a beverage of choice in the other while taking a daily stroll among the plants to be watered.

Suzanne S. Brown is a freelance writer and the former features editor at The Denver Post.

More plants to try

ZZ Raven zamiaculca zamiafolla, in front, is a plant that is good for container gardens at Birdsall & Co in Englewood, Colorado on April 24, 2024. (Photo by Helen H. Richardson/The Denver Post)

Shade: ZZ plant (Zamioculcas zamifolia); snake plant (Sansevieria laurentii); begonia escargot; mistral orange begonia; spider plant (Chlorophytum comosum); wandering Jew (Tradescandia zebrina); creeping Jenny (Lysimachia nummularia)

Sun: red geranium; white lantana; rosemary; verbena lanai white or deep purple; calibrachoa cabrio yellow; petunia sanguna yellow

A how-to class

Birdsall is hosting a container planting party on May 19, from 10 a.m. to 3 p.m. Bring an empty 15- to 18-inch diameter (measured at the top) container from home, or purchase a new one at the store for 20% off the day of the workshop. Birdsall will provide the soil, plants, instruction, design advice, and help loading your container. The shade container workshop is 10 a.m. to noon; the sun container session is 1 to 3 p.m. Tickets are $65 per seminar at birdsallgarden.com. Birdsall The Garden Boutique, 2870 S. Broadway, Englewood; 303-722-2535.

Their first baby came with medical debt. These parents won’t have another

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Noam N. Levey | (TNS) KFF Health News

Heather Crivilare was a month from her due date when she was rushed to an operating room for an emergency cesarean section.

The first-time mother, a high school teacher in rural Illinois, had developed high blood pressure, a sometimes life-threatening condition in pregnancy that prompted doctors to hospitalize her. Then Crivilare’s blood pressure spiked, and the baby’s heart rate dropped. “It was terrifying,” Crivilare said.

She gave birth to a healthy daughter. What followed, though, was another ordeal: thousands of dollars in medical debt that sent Crivilare and her husband scrambling for nearly a year to keep collectors at bay.

The Crivilares would eventually get on nine payment plans as they juggled close to $5,000 in bills.

“It really felt like a full-time job some days,” Crivilare recalled. “Getting the baby down to sleep and then getting on the phone. I’d set up one payment plan, and then a new bill would come that afternoon. And I’d have to set up another one.”

Crivilare’s pregnancy may have been more dramatic than most. But for millions of new parents, medical debt is now as much a hallmark of having children as long nights and dirty diapers.

About 12% of the 100 million U.S. adults with health care debt attribute at least some of it to pregnancy or childbirth, according to a KFF poll.

These people are more likely to report they’ve had to take on extra work, change their living situation, or make other sacrifices.

Overall, women between 18 and 35 who have had a baby in the past year and a half are twice as likely to have medical debt as women of the same age who haven’t given birth recently, other KFF research conducted for this project found.

“You feel bad for the patient because you know that they want the best for their pregnancy,” said Eilean Attwood, a Rhode Island OB-GYN who said she routinely sees pregnant women anxious about going into debt.

“So often, they may be coming to the office or the hospital with preexisting debt from school, from other financial pressures of starting adult life,” Attwood said. “They are having to make real choices, and what those real choices may entail can include the choice to not get certain services or medications or what may be needed for the care of themselves or their fetus.”

Best-laid plans

Crivilare and her husband, Andrew, also a teacher, anticipated some of the costs.

The young couple settled in Jacksonville, in part because the farming community less than two hours north of St. Louis was the kind of place two public school teachers could afford a house. They saved aggressively. They bought life insurance.

And before Crivilare got pregnant in 2021, they enrolled in the most robust health insurance plan they could, paying higher premiums to minimize their deductible and out-of-pocket costs.

Then, two months before their baby was due, Crivilare learned she had developed preeclampsia. Her pregnancy would no longer be routine. Crivilare was put on blood pressure medication, and doctors at the local hospital recommended bed rest at a larger medical center in Springfield, about 35 miles away.

“I remember thinking when they insisted that I ride an ambulance from Jacksonville to Springfield … ‘I’m never going to financially recover from this,’” she said. “‘But I want my baby to be OK.’”

For weeks, Crivilare remained in the hospital alone as COVID protocols limited visitors. Meanwhile, doctors steadily upped her medications while monitoring the fetus. It was, she said, “the scariest month of my life.”

Fear turned to relief after her daughter, Rita, was born. The baby was small and had to spend nearly two weeks in the neonatal intensive care unit. But there were no complications. “We were incredibly lucky,” Crivilare said.

When she and Rita finally came home, a stack of medical bills awaited. One was already past due.

Crivilare rushed to set up payment plans with the hospitals in Jacksonville and Springfield, as well as the anesthesiologist, the surgeon, and the labs. Some providers demanded hundreds of dollars a month. Some settled for monthly payments of $20 or $25. Some pushed Crivilare to apply for new credit cards to pay the bills.

“It was a blur of just being on the phone constantly with all the different people collecting money,” she recalled. “That was a nightmare.”

Big bills, Big consequences

The Crivilares’ bills weren’t unusual. Parents with private health coverage now face on average more than $3,000 in medical bills related to a pregnancy and childbirth that aren’t covered by insurance, researchers at the University of Michigan found.

Out-of-pocket costs are even higher for families with a newborn who needs to stay in a neonatal ICU, averaging $5,000. And for 1 in 11 of these families, medical bills related to pregnancy and childbirth exceed $10,000, the researchers found.

“This forces very difficult trade-offs for families,” said Michelle Moniz, a University of Michigan OB-GYN who worked on the study. “Even though they have insurance, they still have these very high bills.”

Nationwide polls suggest millions of these families end up in debt, with sometimes devastating consequences.

About three-quarters of U.S. adults with debt related to pregnancy or childbirth have cut spending on food, clothing, or other essentials, KFF polling found.

About half have put off buying a home or delayed their own or their children’s education.

These burdens have spurred calls to limit what families must pay out-of-pocket for medical care related to pregnancy and childbirth.

In Massachusetts, state Sen. Cindy Friedman has proposed legislation to exempt all these bills from copays, deductibles, and other cost sharing. This would parallel federal rules that require health plans to cover recommended preventive services like annual physicals without cost sharing for patients. “We want … healthy children, and that starts with healthy mothers,” Friedman said. Massachusetts health insurers have warned the proposal will raise costs, but an independent state analysis estimated the bill would add only $1.24 to monthly insurance premiums.

Tough lessons

For her part, Crivilare said she wishes new parents could catch their breath before paying down medical debt.

“No one is in the right frame of mind to deal with that when they have a new baby,” she said, noting that college graduates get such a break. “When I graduated with my college degree, it was like: ‘Hey, new adult, it’s going to take you six months to kind of figure out your life, so we’ll give you this six-month grace period before your student loans kick in and you can get a job.’”

Andrew Crivilare, Heather Crivilare, and their 2-year-old daughter, Rita, sit at the dinner table at their home in Jacksonville, Illinois, on April 30, 2024. For millions of new parents, medical debt is now as much a hallmark of having children as long nights and dirty diapers. (Neeta Satam for KFF Health News/TNS)

Rita is now 2. The family scraped by on their payment plans, retiring the medical debt within a year, with help from Crivilare’s side job selling resources for teachers online.

But they are now back in debt, after Rita’s recurrent ear infections required surgery last year, leaving the family with thousands of dollars in new medical bills.

Crivilare said the stress has made her think twice about seeing a doctor, even for Rita. And, she added, she and her husband have decided their family is complete.

“It’s not for us to have another child,” she said. “I just hope that we can put some of these big bills behind us and give [Rita] the life that we want to give her.”

About this project

“Diagnosis: Debt” is a reporting partnership between KFF Health News and NPR exploring the scale, impact, and causes of medical debt in America.

The series draws on original polling by KFF, court records, federal data on hospital finances, contracts obtained through public records requests, data on international health systems, and a yearlong investigation into the financial assistance and collection policies of more than 500 hospitals across the country.

Additional research was conducted by the Urban Institute, which analyzed credit bureau and other demographic data on poverty, race, and health status for KFF Health News to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels.

The JPMorgan Chase Institute analyzed records from a sampling of Chase credit card holders to look at how customers’ balances may be affected by major medical expenses. And the CED Project, a Denver nonprofit, worked with KFF Health News on a survey of its clients to explore links between medical debt and housing instability.

KFF Health News journalists worked with KFF public opinion researchers to design and analyze the “KFF Health Care Debt Survey.” The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher.

Reporters from KFF Health News and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt.

___

(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 Kaiser Health News. Visit khn.org. Distributed by Tribune Content Agency, LLC.