By Noreen Kompanik, TravelPulse

It is widely believed that Mark Twain said “Twenty years from now, you will be more disappointed by the things you didn’t do than those you did. So, throw off the bowlines. Sail away from the safe harbor. Catch the wind in your sails. Explore. Dream. Discover.”

There’s just something special about sailing. The open water, sunshine on your face, the wind in your hair and a total sense of freedom, relaxation and centering, a perfect antidote to the stresses of living in today’s modern world.

Whether you decide to be part of a crew manning the sails or just along for the ride, we are so fortunate to have so many incredible destinations here in the U.S. to sail, whether it be a tranquil lake or riding the ocean waves.

Newport, R.I.

Often referred to as the “sailing capital of the world,” Newport offers a deep maritime history, ideal sailing conditions and an important role in international competitive sailing. The coastal town hosted the America’s Cup from 1930 to 1983 and continues to attract sailors from around the globe to its annual sailing events.

Newport has been a longtime training hub for Olympic and professional sailors, and there’s nothing like moving under the impressive Newport Bridge, the longest suspension span in New England.

Chesapeake Bay, Annapolis, Md.

Sailing in Annapolis is a major part of the city’s identity, other than being the location of the United States Naval Academy, where future naval officers are trained in the art. Located where the Severn River meets the Chesapeake Bay, the area offers easy access to both open water and protected coves, making it a sailor’s haven.

The bay’s deep navigable waters make it ideal for recreational and competitive sailing, and the destination hosts numerous sailing and regatta events and boat shows throughout the year.

Charleston, S.C.

This southern belle consistently ranks as one of the top places in the U.S. for sailing, offering incredibly picturesque views. With its historic charm, great sailing conditions and a vibrant maritime culture, it’s only natural that sailors want to be out on the water.

Charleston has some top-notch marinas and yacht clubs, sailing schools and charters, and the College of Charleston sailing team is nationally ranked. My favorite time to sail is at day’s end with an impressive combination of historic skyline, calm harbor waters and glowing sunsets over the Charleston Peninsula, creating an unforgettable experience.

Florida Keys, Fla.

The Florida Keys are home to the only barrier coral reef in North America and the third largest in the world, and sailing here is a tropical dream. The Keys’ multihued waters, warm trade winds and laid-back island culture make for a paradise without having to venture further into the Caribbean with a passport.

Stretching over 129 miles from Key Largo to Key West, the island chain with more than 800 keys offers countless places to sail, anchor, dock and explore. Constant trade winds, shallow warm waters (especially on the Gulf side) and easy access to snorkeling, diving and fishing right off the boat make the Florida Keys a popular sailing destination.

Santa Barbara, Calif.

Known for its mild weather, rich maritime history, picturesque coastline and vibrant sailing community, Santa Barbara is a haven for sailors of all levels. Affectionately known as “The American Riviera,” this jewel of the California coast’s mild winds, calm seas and near-constant sunshine makes for picture-perfect sailing conditions.

Those into competitive sailing can join in the adventure on Wet Wednesday races at the Santa Barbara Yacht Club, a beloved tradition in the sailing community. The region also hosts several regattas and sailing festivals throughout the year.

Finger Lakes, N.Y.

This region consists of 11 glacial lakes and one Great Lake (Ontario), making it a superb destination for the sailing fan. Visitors can choose from a number of sailing companies or use private charters such as Sail True Love out of Watkins Glen and Sail Seneca from Geneva.

The lakes are long and narrow, creating consistent and moderate wind channels that funnel down the length of the lake, making for reliable sailing conditions. Many of the Finger Lakes are deep and clear, good for keelboats, helping to avoid hazards like submerged rocks or sudden shoals. And it’s hard to beat the views, with waters surrounded by hills, vineyards and charming small towns.

San Diego, Calif.

America’s finest city, as it’s often called, is home to almost year-round picture-perfect weather, reliable winds and a stunningly picturesque and protected sheltered bay with easy access to the open Pacific.

San Diego has a long naval and maritime history, which means sailors will not only get great views of the city, Embarcadero and Coronado Island from the water, but also a myriad of U.S. Navy ships. It’s also a great chance to view gray whales, blue whales, dolphins and a slew of various seabirds.

With its vibrant racing and cruising community and notable yacht clubs, this Southern California gem is a true sailor’s city.

San Juan Islands, Wash.

Located in the Pacific Northwest, the San Juan Islands, with more than 170 islands and reefs, are a hidden gem for sailors seeking peaceful tranquility while surrounded by stunning landscapes and quiet coves. Yet they are still considered one of the top sailing destinations in the region.

Situated in the rain shadow of the Olympic Mountains, the islands offer calmer seas, less wind and rain than the outer coast, ensuring smoother, safer sailing. Sailors regularly spot seals, sea lions, porpoises, bald eagles and orcas, especially around San Juan Island.

San Francisco, Calif.

An individual sail might be a challenge here unless you’re a skilled sailor or racer, due to the bay’s strong winds and currents. However, there are plenty of opportunities to get out on the water by a guided catamaran.

Seeing the City by the Bay skyline via water is a rewarding experience, as is sailing beneath one of the world’s most recognizable bridges and past the haunting site of the abandoned Alcatraz Island. You’ll encounter calm waters turning gusty, choppy and tide-driven, but it’s all part of the fun. The city hosts world-class regattas including the America’s Cup and SailGP events.

U.S. Virgin Islands

Sailing the cerulean waters of the U.S. Virgin Islands provides an exhilarating, authentic Caribbean experience without needing a passport. It’s best to hire a boat captain for the day or take a catamaran sail, as you would need a passport to enter British Virgin Island waters.

The three islands making up the U.S. Virgin Island chain are only a few miles apart, making for easy navigation and line-of-sight sailing. Warm water temperatures and steady trade winds make for nearly perfect sail conditions, and the crystalline waters with their colorful, stunning coral reefs and tropical fish make for amazing snorkeling or diving conditions.

©2025 Northstar Travel Media, LLC. Visit at travelpulse.com. Distributed by Tribune Content Agency, LLC.

By Karla Marie Sanford, Los Angeles Times

LOS ANGELES — The Cortez family piled out of their car and stretched their legs. Finally, after an hour and a half drive from their Long Beach home, they had made it to Little Tokyo — specifically, to One Piece Cafe.

“I was just sitting in the car like, ‘I’m going to be at the One Piece Cafe,’” said Cammy Cortez, who was introduced to the popular manga and anime franchise by her older brother and now runs a “One Piece” fan account on X. “It’s going to be a good day.”

Timed to the Los Angeles Anime Convention, the largest exposition dedicated to Japanese pop culture in North America, the new permanent restaurant is the second official location of One Piece Cafe, in collaboration with Toei Animation, from Andy Nguyen, a serial entrepreneur behind several themed restaurants. The first One Piece Cafe opened in Las Vegas in May 2024.

“One Piece” follows the adventures of protagonist Monkey D. Luffy, who dreams of becoming the Pirate King, and his band of Straw Hat Pirates as they seek the “One Piece” treasure. Fans of the anime have flocked to the Little Tokyo storefront, eager to try Japanese dishes inspired by “One Piece” characters like Sanji’s “Diable Jambe” Chicken Katsu Sando, with 24-hour brined chicken served on sweet honey milk bread, and Zoro’s Onigiri, in honor of the character’s love of rice and a nod to his precision as a swordsman.

The interior dons a nautical theme, with walls that mimic the wooden deck of a pirate ship and characters depicted inside portholes. Branded merchandise includes Luffy’s signature straw hat, themed key chains and even a “Wanted” license plate. Drinks, ranging from slushies to matcha horchata, come in collectible cups.

“It’s not [like] just they slapped the name ‘One Piece’ onto a random restaurant,” said customer Imelda Cardenas. “They really did it justice with the interior and the menu, and the merch they sell inside is really great too.”

Initially premiering in 1999, the “One Piece” anime has 1,136 episodes and counting, with ardent fans deeply immersed in the lore. The manga, by creator Eiichiro Oda, is the bestselling manga of all time. New audiences were also introduced to the franchise in 2023, when Netflix released a massively successful live-action rendition of the anime.

“If you’re a fan of ‘One Piece,’ then you think it’s the best anime of all time,” explained Karime Benmbarek, who came with his older brother Yassine from Northridge to experience the Little Tokyo restaurant. “Even if you’re just a chill fan, you still feel the love through the community.”

Restaurants themed around Japanese pop culture have recently gained footholds in L.A., with Gudetama Cafe and Hello Kitty and Friends Cafe — both within the Sanrio universe — opening in 2024. Local excitement for “One Piece,” however, seems to be approaching the mainstream. In June, the Los Angeles Dodgers hosted a One Piece Night, featuring a limited edition “One Piece” card drawn by Oda. The Los Angeles Lakers collaborated with “One Piece” for their February matchup against the Clippers; exclusive merch from the match now resells for up to $250.

“‘One Piece’ has a pretty big community, and especially with the Lakers and Dodgers collaborating with One Piece, L.A. is bringing anime into their culture as well,” said Yassine, who immediately alerted his younger brother after seeing a TikTok about the restaurant opening. The brothers bond over watching the show and, lured by the chicken katsu sandwich in particular, quickly made a plan to visit in person.

Karime, who tried the chicken katsu sandwich and curry, said, “I’d definitely come back — if my brother can take me.”

As anime, manga and other elements of Japanese pop culture have become mainstream, the understanding of Little Tokyo as a place where people can engage in those interests has also skyrocketed, said Kristin Fukushima, the executive director of Little Tokyo Community Council. This interest in Japanese subcultures — evidenced in the virality of One Piece Cafe — can have a positive impact on other small businesses in Little Tokyo.

After the Benmbarek brothers finished their meal, they planned to make a day of wandering through Little Tokyo. Another group of friends planned to hunt down a collectible in the nearby shops after visiting the restaurant.

“If you become more into anime and manga, that means you’re seeing depictions of not just culture, but also food,” Fukushima said. “So you have more people knowing what real ramen is versus the Maruchan instant ramen, or people who want real sushi and not just California rolls that they can buy in Ralphs.”

“I think it’s just a growing familiarity with what Little Tokyo has to offer,” she said. “Like, how do I further participate in this?”

The timing of One Piece Cafe’s opening comes as Little Tokyo is emerging from June’s ICE protests. Located minutes from City Hall and the Metropolitan Detention Center, Fukushima said many small business owners found themselves in a “lose-lose situation,” with images from the local news keeping people away from downtown out of fear.

Fans of “One Piece,” with its themes of friendship and freedom, are primed to be attuned to these tensions.

“I really like how ‘One Piece’ has a lot of nuanced messages about government powers and how oppressed people can come together,” said Daniel Orozco, who first learned about the restaurant at Anime Expo. “It’s really cool and especially relevant right now with everything going on politically.”

Cardenas started watching “One Piece” during the pandemic and quickly caught up by watching 12 episodes a day. Describing that time, she said, “Everything was really scary and uncertain, and people just wanted answers and a distraction.”

“There’s a message of hope in ‘One Piece’ because the protagonist Luffy wants to be the Pirate King, but underneath it all he’s just fighting for justice,” she said. “There’s a lot of symbolism that can be taken into the real world.”

One Piece Cafe is located at 241 S. San Pedro Street and open 11 a.m. to 10 p.m. daily.

©2025 Los Angeles Times. Visit at latimes.com. Distributed by Tribune Content Agency, LLC.

By Daniel Chang and Sam Whitehead, Kaiser Health News

MIAMI — GOP lawmakers in the 10 states that refused the Affordable Care Act’s Medicaid expansion for over a decade have argued their conservative approach to growing government programs would pay off in the long run.

Instead, the Republican-passed budget law that includes many of President Donald Trump’s priorities will pose at least as big a burden on patients and hospitals in the expansion holdout states as in the 40 states that have extended Medicaid coverage to more low-income adults, hospital executives and other officials warn.

For instance, Georgia, with a population of just over 11 million, will see as many people lose insurance coverage sold through ACA marketplaces as will California, with more than triple the population, according to estimates by KFF, a health information nonprofit that includes KFF Health News.

The new law imposes additional paperwork requirements on Obamacare enrollees, slashes the time they have each year to sign up, and cuts funding for navigators who help them shop for plans. Those changes, all of which will erode enrollment, are expected to have far more impact in states like Florida and Texas than in California because a higher proportion of residents in non-expansion states are enrolled in ACA plans.

The budget law, which Republicans called the “One Big Beautiful Bill,” will cause sweeping changes to health care across the country as it trims federal spending on Medicaid by more than $1 trillion over the next decade. The program covers more than 71 million people with low incomes and disabilities. Ten million people will lose coverage over the next decade due to the law, according to the nonpartisan Congressional Budget Office.

Many of its provisions are focused on the 40 states that expanded Medicaid under the ACA, which added millions more low-income adults to the rolls. But the consequences are not confined to those states. A proposal from conservatives to cut more generous federal payments for people added to Medicaid by the ACA expansion didn’t make it into the law.

“Politicians in non-expansion states should be furious about that,” said Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank.

The number of people losing coverage could accelerate in non-expansion states if enhanced federal subsidies for Obamacare plans expire at the end of the year, driving up premiums as early as January and adding to the rolls of uninsured. KFF estimates as many as 2.2 million people could become uninsured just in Florida, a state where lawmakers refused to expand Medicaid and, partly as a result, now leads the nation in ACA enrollment.

For people like Francoise Cham of Miami, who has Obamacare coverage, the Republican policy changes could be life-altering.

Before she had insurance, the 62-year-old single mom said she would donate blood just to get her cholesterol checked. Once a year, she’d splurge for a wellness exam at Planned Parenthood. She expects to make about $28,000 this year and currently pays about $100 a month for an ACA plan to cover herself and her daughter, and even that strains her budget.

Cham choked up describing the “safety net” that health insurance has afforded her — and at the prospect of being unable to afford coverage if premiums spike at the end of the year.

“Obamacare has been my lifesaver,” she said.

If the enhanced ACA subsidies aren’t extended, “everyone will be hit hard,” said Cindy Mann, a health policy expert with Manatt Health, a consulting and legal firm, and a former deputy administrator for the Centers for Medicare & Medicaid Services.

“But a state that hasn’t expanded Medicaid will have marketplace people enrolling at lower income levels,” she said. “So, a greater share of residents are reliant on the marketplace.”

Though GOP lawmakers may try to cut Medicaid even more this year, for now the states that expanded Medicaid largely appear to have made a smart decision, while states that haven’t are facing similar financial pressures without any upside, said health policy experts and hospital industry observers.

KFF Health News reached out to the governors of the 10 states that have not fully expanded Medicaid to see if the budget legislation made them regret that decision or made them more open to expansion. Spokespeople for Republican Gov. Henry McMaster of South Carolina and Republican Gov. Brian Kemp of Georgia did not indicate whether their states are considering Medicaid expansion.

Brandon Charochak, a spokesperson for McMaster’s office, said South Carolina’s Medicaid program focuses on “low-income children and families and disabled individuals,” adding, “The state’s Medicaid program does not anticipate a large impact on the agency’s Medicaid population.”

Enrollment in ACA marketplace plans nationwide has more than doubled since 2020 to 24.3 million. If enhanced subsidies expire, premiums for Obamacare coverage would rise by more than 75% on average, according to an analysis by KFF. Some insurers are already signaling they plan to charge more.

The CBO estimates that allowing enhanced subsidies to expire will increase the number of people without health insurance by 4.2 million by 2034, compared with a permanent extension. That would come on top of the coverage losses caused by Trump’s budget law.

“That is problematic and scary for us,” said Eric Boley, president of the Wyoming Hospital Association.

He said his state, which did not expand Medicaid, has a relatively small population and hasn’t been the most attractive for insurance providers — few companies currently offer plans on the ACA exchange — and he worried any increase in the uninsured rate would “collapse the insurance market.”

As the uninsured rate rises in non-expansion states and the budget law’s Medicaid cuts loom, lawmakers say state funds will not backfill the loss of federal dollars, including in states that have refused to expand Medicaid.

Those states got slightly favorable treatment under the law, but it’s not enough, said Grace Hoge, press secretary for Kansas Gov. Laura Kelly, a Democrat who favors Medicaid expansion but who has been rebuffed by GOP state legislators.

“Kansans’ ability to access affordable health care will be harmed,” Hoge said in an email. “Kansas, nor our rural hospitals, will not be able to make up for these cuts.”

For hospital leaders in other states that have refused full Medicaid expansion, the budget law poses another test by limiting financing arrangements states leveraged to make higher Medicaid payments to doctors and hospitals.

Beginning in 2028, the law will reduce those payments by 10 percentage points each year until they are closer to what Medicare pays.

Richard Roberson, president of the Mississippi Hospital Association, said the state’s use of what’s called directed payments in 2023 helped raise its Medicaid reimbursements to hospitals and other health institutions from $500 million a year to $1.5 billion a year. He said higher rates helped Mississippi’s rural hospitals stay open.

“That payment program has just been a lifeline,” Roberson said.

The budget law includes a $50 billion fund intended to insulate rural hospitals and clinics from its changes to Medicaid and the ACA. But a KFF analysis found it would offset only about one-third of the cuts to Medicaid in rural areas.

Trump encouraged Florida, Tennessee and Texas to continue refusing Medicaid expansion in his first term, when his administration gave them an unusual 10-year extension for financing programs known as uncompensated care pools, which generate billions of dollars to pay hospitals for treating the uninsured, said Allison Orris, director of Medicaid policy for the left-leaning think tank Center on Budget and Policy Priorities.

“Those were very clearly a decision from the first Trump administration to say, ‘You get a lot of money for an uncompensated care pool instead of expanding Medicaid,’” she said.

Those funds are not affected by Trump’s new tax-and-spending law. But they do not help patients the way insurance coverage would, Orris said. “This is paying hospitals, but it’s not giving people health care,” she said. “It’s not giving people prevention.”

States such as Florida, Georgia, and Mississippi have not only turned down the additional federal funding that Medicaid expansion brings, but most of the remaining non-expansion states spend less than the national average per Medicaid enrollee, provide fewer or less generous benefits, and cover fewer categories of low-income Americans.

Mary Mayhew, president of the Florida Hospital Association, said the state’s Medicaid program does not adequately cover children, older people and people with disabilities because reimbursement rates are too low.

“Children don’t have timely access to dentists,” she said. “Expectant moms don’t have access nearby to an OB-GYN. We’ve had labor and delivery units close in Florida.”

She said the law will cost states more in the long run.

“The health care outcomes for the individuals we serve will deteriorate,” Mayhew said. “That’s going to lead to higher cost, more spending, more dependency on the emergency department.”

(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.)

©2025 Kaiser Health News. Visit khn.org. Distributed by Tribune Content Agency, LLC.

By Zachary Hansen, Tribune News Service

Electric vehicle startup Rivian plans to hold two ceremonial events to christen the forthcoming construction of its long-delayed $5 billion factory an hour east of Atlanta.

The company will play host to a community event Sept. 14 and a formal groundbreaking ceremony Sept. 16 with stakeholders, media and government officials, including Gov. Brian Kemp. The events at the roughly 2,000-acre project site along I-20 bolster promises by Rivian leaders to begin vertical construction of the factory next year, following multiple delays and setbacks.

“The governor remains excited about the generational opportunity Rivian’s commitment will bring to hardworking Georgians,” a Kemp spokesperson said in a statement. “He, along with the first lady, look forward to joining Rivian and state and local leaders to break ground on this next chapter in Georgia’s ongoing economic success story.”

A Rivian spokesperson added the company is “excited to welcome our future neighbors” at the Sept. 14 community event, which will feature vendors, food, live music and off-road course rides in its vehicles.

“We look forward to continuing our work with our partners and surrounding communities as we strive to provide thousands of new, good paying jobs in this fast-moving industry,” the spokesperson said.

Since its announcement in late 2021, Rivian’s factory plans in Georgia have resembled a roller coaster ride.

Rivian first announced plans to open the factory in southern Walton and Morgan counties in 2024. But the project was pushed back and ultimately paused indefinitely as the company sought to cut costs. But Rivian said it would fulfill its promises to open the plant and meet its commitment to employ 7,500 workers. Rivian has said a $6.6 billion federal loan approved days before President Joe Biden left office would help accelerate the Georgia plant’s launch.

At the time of its announcement, the factory was the state’s largest-ever economic development project. Since Rivian’s announcement, Hyundai has announced and opened an even larger EV factory near Savannah, Georgia.

To recruit the Rivian factory, state and local officials offered the company a $1.5 billion incentive package, which requires the automaker to build its promised plant and meet hiring requirements to see the bulk of those financial benefits and tax savings.

Similarly, Rivian has to break ground on its factory to tap into the federal loan.

The loan’s approval by the Department of Energy’s Loan Programs Office has been criticized by some Georgia Republicans and allies of President Donald Trump, including members of his campaign’s transition team. Georgia’s senators, Jon Ossoff and Raphael Warnock, lobbied for many of those clean energy incentives, including Rivian’s loan.

“The loan is set up as more of a project finance instrument,” Claire McDonough, Rivian’s chief financial officer, told The Atlanta Journal-Constitution last month. “So it does require Rivian to have broken ground and continue to invest in the site before we’ll have a timeline for an initial (loan) draw out of the facility, which is really by design.”

The site has been graded and is undergoing utility installation. Vertical construction is planned to begin at an unspecified date in 2026, with vehicle production starting by 2028.

Rivian has said the Georgia factory will be the site of expanded production of its upcoming R2 crossover.

“The work that we’ve been doing over the course of the last handful of years is to ensure that we can reduce the timeline between start of construction (of the Georgia factory) and start of production for future vehicles out of the site,” McDonough said.

Jerry Silvio, chairman of the local development authority that helped manage the Rivian project, congratulated the company.

“There is no question about the project’s future — it is secure,” Silvio said in a statement. “And we are charging ahead to deliver jobs, growth and opportunity for our communities.”

Harry Black, Bloomberg News

Artificial intelligence, touted for its potential to transform medicine, led to some doctors losing skills after just a few months in a new study.

AI helped health professionals to better detect pre-cancerous growths in the colon, but when the assistance was removed, their ability to find tumors dropped by about 20% compared with rates before the tool was ever introduced, according to findings published Wednesday.

Health care systems around the world are embracing AI with a view to boosting patient outcomes and productivity. Just this year, the UK government announced £11 million ($14.8 million) in funding for a new trial to test how AI can help catch breast cancer earlier.

The AI in the study probably prompted doctors to become over-reliant on its recommendations, “leading to clinicians becoming less motivated, less focused, and less responsible when making cognitive decisions without AI assistance,” the scientists said in the paper.

They surveyed four endoscopy centers in Poland and compared detection success rates three months before AI implementation and three months after. Some colonoscopies were performed with AI and some without, at random. The results were published in The Lancet Gastroenterology and Hepatology journal.

Yuichi Mori, a researcher at the University of Oslo and one of the scientists involved, predicted that the effects of de-skilling will “probably be higher” as AI becomes more powerful.

What’s more, the 19 doctors in the study were highly experienced, having performed more than 2,000 colonoscopies each. The effect on trainees or novices might be starker, said Omer Ahmad, a consultant gastroenterologist at University College Hospital London.

“Although AI continues to offer great promise to enhance clinical outcomes, we must also safeguard against the quiet erosion of fundamental skills required for high-quality endoscopy,” Ahmad, who wasn’t involved in the research, wrote a comment alongside the article.

A study conducted by MIT this year raised similar concerns after finding that using OpenAI’s ChatGPT to write essays led to less brain engagement and cognitive activity.

©2025 Bloomberg L.P. Visit bloomberg.com. Distributed by Tribune Content Agency, LLC.

By Anna Claire Vollers, Stateline.org

As more hospitals have gobbled up private physician practices, costs for childbirth and other services have gone up, according to a new study.

Since the early aughts, the share of physicians in the United States working for hospitals has nearly doubled, according to the study published by the National Bureau of Economic Research, a nonprofit research organization.

And as fewer doctors work in physician-owned practices, patients or their insurers end up paying more, the study’s authors found.

For example: Two years after a hospital buys an OB-GYN practice, prices for labor and delivery jump an average of $475 and physician prices rise by $502, according to the study. Researchers focused on births, which are the most common reason for hospital admission among people with private insurance.

This rapid acquisition by hospitals is reshaping a U.S. industry once dominated by tens of thousands of small, physician-owned practices.

Only about 42% of U.S. physicians work in a physician-owned private practice, according to the most recent survey data from the American Medical Association. Nearly 47% work for hospitals, a sharp rise over the past several years. Most emergency room physicians are now employed by hospital systems or by private equity-owned staffing groups.

The new research offers further evidence for how hospital acquisitions of private practices “can result in anticompetitive price increases,” said Matthew Grennan, one of the study’s authors and an associate professor of economics at Emory University, in a news release.

“As a result, I think economists and others in the antitrust community are likely to give more careful consideration to these potential sources of harm,” he said.

Medical debt is a leading cause of bankruptcy in the United States, with about 14 million Americans owing more than $1,000 in medical debt, according to research nonprofit KFF.

These post-merger price increases are driven by reduced competition, Grennan and his fellow researchers found. Yet there’s been little effort by federal or state regulators to halt hospital mergers that could lead to higher prices for consumers.

But states have taken some steps toward lowering medical costs in recent years.

Bipartisan groups of lawmakers in more than a dozen states have addressed so-called “facility fees,” which are charges that some hospitals tack on for patient visits to hospital-owned physician offices.

This year in Oklahoma, Republican lawmakers passed a bill requiring hospitals to make the cost of many of their services more transparent to patients so they’re aware of the costs. Providers can face penalties for noncompliance. A similar Oklahoma law authored by Democrats and passed last year requires debt collectors to submit evidence of a hospital’s compliance with price transparency rules before filing to collect on medical debts from patients.

Some states have capped the rates hospitals or physicians can charge. Colorado sets provider and hospitals rates based on a specific formula if insurance plans aren’t able to lower peoples’ premiums to a certain level, while Montana and Oregon limited the amount hospitals and other providers can charge for their state employee health plan.

Stateline reporter Anna Claire Vollers can be reached at avollers@stateline.org.

©2025 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

By Amanda Hernández, Stateline.org

U.S. families lose nearly $350 billion each year due to the incarceration of a loved one in jail or prison, according to a recent report from the criminal justice advocacy group FWD.us. The estimate includes both direct expenses and long-term losses in household income.

The findings are based on a national survey of just over 1,600 adults conducted in partnership with researchers at Duke University and the National Opinion Research Center at the University of Chicago.

Families reported losing an average of $1,803 in income per month when a loved one is incarcerated. That includes the loss of the incarcerated person’s wages and may also reflect reduced work hours by family members to manage court proceedings or provide child care, according to the report.

The researchers also found that families spend an average of $4,200 annually per incarcerated relative.

These expenses include phone and email communication, travel for visits, child care and commissary purchases — such as food, hygiene products and clothing — some of which are marked up as much as 600% above retail prices, according to the report.

The burden is especially acute for Black families, who reported significantly higher expenses, according to the report. Black families reported spending an average of $8,005 per year supporting incarcerated loved ones — 2.5 times more than white families with an average of $3,251.

One in 5 family members reported being forced to move due to a loved one’s incarceration, including 1 in 3 children of incarcerated parents, according to the report. Overall, 9% of family members said they experienced a period of homelessness, a figure that rose to 18% — or roughly 1 in 6 — among those who had an incarcerated parent.

Low wages for incarcerated people, often just cents per hour, only deepen this strain, leaving families to fill in the financial gaps, according to the report. Meanwhile, extended prison lockdowns, staff shortages and overcrowded conditions have further limited access to basic services, including phone calls, visitation, medical care and rehabilitative programming.

Researchers also identified long-term economic consequences after incarceration. Collectively, formerly incarcerated individuals lose an estimated $111 billion in wages each year due to limited job opportunities, according to the report. The report also found long-term financial consequences for children of incarcerated parents, who collectively lose $215 billion in annual earnings — an average of nearly $4,500 per adult child each year.

The survey has some limitations. Many of the cost estimates were self-reported and rounded by participants. Still, previous research has reached similar conclusions. A 2017 report from the Prison Policy Initiative, a nonprofit and nonpartisan research organization, estimated that mass incarceration costs governments and the families of incarcerated people at least $182 billion annually.

In 2023, the most recent year available, state governments spent more than $66 billion on corrections, according to the U.S. Census Bureau’s Annual Survey of State and Local Government Finances. That total does not include the additional financial support provided by families of incarcerated people.

Preliminary national data from the federal Bureau of Justice Statistics shows the U.S. prison population is once again on the rise. At the end of 2023, there were more than 1.25 million people in state and federal prisons, a 2% increase from the previous year. The vast majority were serving sentences longer than one year and were held in state prisons.

The male prison population rose by 2% in 2023, while the number of incarcerated women rose by 4%. Still, both figures remain below their 2013 levels.

Researchers projected that if incarceration rates remain steady, families could face $3.5 trillion in cumulative financial losses over the next decade.

Stateline reporter Amanda Hernández can be reached at ahernandez@stateline.org.

©2025 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

By Ben Warren, The Detroit News

More than a dozen Hmong and Laotian Americans living in the Detroit area received a letter summoning them to the city’s Immigration and Customs Enforcement field office on July 30.

Many thought it was a request for a routine check-in. It wasn’t, their families say.

Instead, the individuals were taken into ICE custody and have been detained ever since in northern Michigan, Texas and Louisiana. They are awaiting deportation to Laos, a country where the Hmong refugees have never set foot, but which U.S. officials say has agreed to take some detainees.

The Hmong individuals detained came to the U.S. as refugees in the 1970s and 1980s, most from refugee camps in Thailand. ICE says all have criminal records and removal orders, but families, local elected officials and immigrant rights advocates say they are being unfairly targeted.

“The families and elected officials accept that they had been convicted of a crime, but they served their time, and they deserve a second chance,” said Christine Sauve, policy and communications manager at the Michigan Immigrant Rights Center.

A spokesperson for ICE, in an email Friday to The Detroit News, said the agency detained “a known gang member who obstructed a murder investigation, multiple child sex abusers, drug traffickers and other Laotian nationals with criminal histories” in the July 30 operation. The spokesperson did not clarify whether all individuals detained had criminal records or provide the names of all detainees.

Many of those detained received removal orders after being convicted of crimes years ago, but were never deported because neither Laos nor Thailand considered them citizens, according to Sauve. Instead, they were required to report for annual check-ins with ICE.

Family members and local elected officials on Friday held a press conference to argue against the deportations.

“This past week has been a nightmare for these family members,” said state Rep. Mai Xiong, a Democrat who represents Warren, Roseville and St. Clair Shores, at the press conference.

Xiong is herself Hmong American, a refugee who fled Laos with her family at a young age. Like hers, the families of the Hmong detainees fled to the U.S. from United Nations-run refugee camps in Thailand, where they went after being persecuted in Laos for their role in the CIA-backed “Secret War” in the 1960s and 1970s.

Under the Trump administration, Xiong said, things have changed. She believes Laos may accept the deportees in exchange for being excluded from a travel ban list. The ICE spokesperson said the agency recently obtained the necessary travel documents to remove the detainees to Laos.

At the press conference at the Hannan Center in Detroit, Xiong, State Sen. Stephanie Chang and state Rep. Donovan McKinney — both Democrats who represent districts that stretch across south Macomb and Oakland counties as well as Detroit — joined the family members of detainees Wa Kang Lor and Sufeng Yang to call for the release of the Hmong refugees being held by ICE.

After reporting to the office for what they thought was a routine check-in, Xiong said, the individuals were detained.

In a matter of days, ICE transported the individuals from Detroit to North Lake Processing Center in northern Michigan, then to Port Isabel Service Processing Center in Texas. Two days ago, ICE transferred them to the Alexandria Staging Facility in Louisiana, where Xiong expects the next step will be deportation.

“It’s like trying to find missing people,” she told The News. She called on ICE to be more transparent about who had been detained and when they might be deported.

Maiyia Xiong, the wife of Wa Kong Lor, one of the detainees, was overcome with emotion as she stepped to the podium, so Rep. Xiong read her prepared statement.

“I never imagined it would be the last time I would see him,” she had written.

When they reported to the ICE office, she said, a woman took her husband’s driver’s license. “Within minutes, his name was called,” Xiong said. “He walked through the door to the back room and never returned.”

Xiong and Lor have four children. Without him, she said, she faces the “unimaginable task of explaining to them that they may never see their father again.”

The ICE spokesperson said Lor was arrested in Pontiac in 2007 for breaking and entering a vehicle, drug possession and carrying an unlawful firearm. He was sentenced to at least 5 months in prison and received a removal order.

Anissa Lee, 20, also spoke. She is the daughter of Sufeng Yang, a Macomb County resident who was also detained on July 30. She came up to the podium, visibly upset, carrying a poster with her father’s face on it.

“The U.S. is the only place he’s ever known, his only home,” said Lee, her voice breaking. “He’s not just a resident here, he’s a taxpayer, a provider and a caregiver.”

Yang takes care of his 82-year-old mother, Lee said, buying her groceries and picking up her medications. “Without him, she won’t be able to get by,” she said.

Yang, according to ICE, was convicted of robbery in Toledo in 2007 and sentenced to three years in prison. Like Lor, he was given a removal order, but never deported.

One of the detainees, Lue Yang, 47, of St. Johns, had his criminal record expunged under a Michigan “Clean Slate” law in 2018. After he came to the United States as an asylum seeker in the 1980s, he pled guilty in 2001 as an accessory to a home invasion and was issued a removal order.

Since then, Lue Yang has turned his life around, advocates say. He serves as president of the Hmong Family Association, a nonprofit that provides services and programming to the Hmong community. According to a letter from more than two dozen Michigan lawmakers to ICE Detroit field director Kevin Raycraft, Yang is the “primary breadwinner” for a family of eight.

He is the only detainee currently being held in Michigan, at the North Lake Processing Center in Baldwin.

McKinney, whose state House district includes parts of Detroit and Warren, sees the detentions and likely deportations as civil rights violations.

As a result of the ICE operation, he said, families are left knowing little to no information about where their loved ones are being held or how they are doing. It’s cruel.”

Aisa Villarosa, an attorney with the Asian Law Caucus, which is representing some of the detainees, worries that they will become stateless. She says travel documents are just part of the removal process, citing a number of cases in Laos and nearby Bhutan in which detainees were turned away.

“The Trump administration has made its priorities clear, abusing its power to attack all of us. None of us are safe when families are ripped apart,” she said.

Xiong and Chang said they sent a letter to Raycraft asking him to “immediately release” the Hmong detainees. In total, 28 Michigan lawmakers signed the letter, including Ranjeev Puri, the Democratic House minority leader; and Gabriela Santiago-Romero, who represents southwest Detroit on the City Council.

“ICE should expend its resources by targeting individuals who are truly a threat, instead of indiscriminately detaining and deporting immigrants and refugees without consideration for their contributions to society and our economy or their personal history,” Xiong and Chang wrote.

By Christie D’Zurilla, Los Angeles Times

LOS ANGELES — Actor Kelley Mack, who played Addy in Season 9 of “The Walking Dead” in addition to doing national commercials and voice-over work, has died at age 33, her family said on social media.

“It is with indelible sadness that we are announcing the passing of our dear Kelley. Such a bright, fervent light has transitioned to the beyond, where we all eventually must go,” the family wrote Tuesday on her Instagram account. She died in Cincinnati after battling glioma of the central nervous system, according to a notice posted on her CaringBridge page.

“Kelley passed peacefully on Saturday evening with her loving mother Kristen and steadfast aunt Karen present. Kelley has already come to many of her loved ones in the form of various butterflies … She will be missed by so many to depths that words cannot express.”

Mack, born Kelley Lynne Klebenow in Cincinnati on July 10, 1992, was raised in towns around Ohio and also in Missouri, Connecticut, North Carolina and Illinois. She moved to Los Angeles after earning a cinematography degree from Chapman University’s Dodge College of Film in Orange in 2014.

Her commercial work included playing Becky in “Fansville” ads for Dr Pepper and her voice-overs could be heard in spots for the Hyundai Ioniq, Budweiser, Credit Karma and more. Her “Walking Dead” character, Addy, was one of the young residents of Hilltop who had a crush on Henry while he had feelings for Lydia. Addy’s reanimated head wound up on a pike at the border of the Whisperers’ territory along with those of Henry and a handful of others who fought bravely but unsuccessfully after being kidnapped by Alpha.

After experiencing pain last fall in her lower back and legs, Mack was diagnosed in late November with a diffuse midline glioma, a rare type of astrocytoma, a cancer that starts in the central nervous system. “Due to the biopsy surgery on my spinal cord,” she said on Instagram in January, “I have lost the use of my right leg and most of my left leg, so I now get around with a walker and a wheelchair.”

She started proton radiation treatments in Cincinnati in mid-January — “It felt like I was filming an episode of my new TV show, set on a space ship floating somewhere in our infinite galaxy,” she wrote on Instagram — and by March had regained some ability to walk despite continuing pain in her lower body.

“Some days are challenging,” she said in April on CaringBridge, listing all the “healthy” things she was trying to do with aid from caregivers — her family members. “We have our emotional hiccups,” she said, “but we remind each other of our positivity and strength. We continue to feel confident in our path forward, God, and in our love for each other all leading up to overcome.”

By July, however, Mack was receiving respite care, which was described as “the toughest part of her journey.”

She is survived by her mother and father, Kristen and Lindsay Klebenow, sister Katherine, brother Parker, grandparents Lois and Larry Klebenow and her boyfriend, Logan Lanier. A celebration of life will be held Aug. 16 in Glendale, Ohio, and at a future date in Los Angeles.

©2025 Los Angeles Times. Visit at latimes.com. Distributed by Tribune Content Agency, LLC.

By Katie Kelton, CCC, Bankrate.com

When it comes to back-to-school shopping, some of us might think fondly of new backpacks and the scent of fresh pencils. But Bankrate’s 2025 Back-to-School Shopping Survey shows others might simply see dollar signs.

Stubborn inflation continues to change how nearly 1 in 3 back-to-school shoppers (30%) shop, but that percentage has trended down in recent years, perhaps indicating Americans have become more accustomed to paying higher prices.

Ronda Sunderhaus, Bankrate senior account manager in Charlotte, North Carolina, has lengthy back-to-school shopping lists for her three kids. In addition to school supplies, they buy several new outfits, backpacks and lunch boxes — “Those never seem to last when you pack lunch every day of the week,” she says.

That’s why her family looks for deals and compares prices together.

“I involve (my kids) in price comparison and decision-making when it comes to clothes, shoes and backpacks, too,” she says.

One category they can skimp on is electronics. “Because my kids are younger, the only ‘technology’ needs they have are generally headphones,” she explains. “I usually opt for a low-cost pair, since kids are prone to losing or breaking things, and replace annually.”

Almost half of shoppers (49%) plan to employ money-saving strategies this fall, from finding cheaper brands to budgeting to buying less.

“The cumulative effects of higher prices and high interest rates are still weighing on many households,” says Ted Rossman, Bankrate senior industry analyst. “Tariff concerns are also significantly impacting consumer sentiment.”

Bankrate’s key insights on back-to-school shopping

• Today’s prices have nearly 1 in 3 back-to-school shoppers rethinking how they shop. Thirty percent of shoppers say they’re changing how they shop due to inflation. That’s down from 41% in 2022 and 32% in 2024, perhaps indicating that Americans are adjusting to higher price tags.
• Compared to 2022, a smaller percentage of back-to-school shoppers feel financially strained for the upcoming school year. Twenty percent of shoppers (down from 31% in 2022) say they’ll feel a strain on their budget, and another 11% (down from 26% in 2022) feel pressured to spend more than they’re comfortable with.
• Half of back-to-school shoppers are using money-saving strategies this season. Forty-nine percent of shoppers have taken or plan to take action — buy cheaper brands, look for deals, budget or buy fewer supplies — for the upcoming school year.

Inflation continues to plague back-to-school shoppers, but less so than in years past

Nearly 1 in 3 back-to-school shoppers (30%) say inflation is changing how they shop. That’s down from 32% in 2024 and 41% in 2022, during peak inflation.

Inflation is currently at 2.4%, well below the 9% peak in June 2022, but prices are still 23.7% higher than they were before the pandemic. However, our polling shows this is becoming less of an issue for shoppers. While the Bureau of Labor Statistics doesn’t specifically track the price of school supplies, we can look at the prices of a few similar categories this year (as of May 2025) versus last year.

Stationery, stationery supplies and gift wrap are 4.7% more expensive than last year.

Boys’ apparel is 2.1% more expensive, but girls’ apparel is 1.3% cheaper.

Computers, peripherals and smart home assistance are 3.5% cheaper. But computer software and accessories are 6.1% more expensive.

Educational books and supplies are 9.4% more expensive.

One in 5 shoppers (20%) say these costs will or are straining their budgets, which is down from 31% in 2022. And around 1 in 10 shoppers (11%) feel pressured to spend more than they’re comfortable with, which is down from 26% in 2022.

• More millennials and Gen Zers are back-to-school shopping than older generations Overall, more than 1 in 3 U.S. adults (36%) are back-to-school shopping this year — for themselves or for a child. That includes nearly half of millennials (ages 29-44; 49%) and Gen Zers (ages 18-28; 44%). Only 1 in 3 Gen Xers (ages 45-60; 33%) and around 1 in 5 boomers (ages 61-79; 21%) are back-to-school shopping.
• Most back-to-school shoppers won’t take on debt this season Six percent of shoppers plan to take on debt for back-to-school shopping this year. “We do not worry about the start of school debt, but know many families do,” Sunderhaus says.

Nearly half of Americans (46%) have credit card debt, according to Bankrate’s 2025 Credit Card Debt Report. But nearly half of those debtors (45%) say it’s because of emergency expenses, like car repairs or medical bills. Armed with a budget and money-saving strategies, it’s possible to avoid debt this back-to-school season.

Nearly half of shoppers plan to use money-saving methods

Alene Laney, a personal finance writer in Provo, Utah, and mom of five, finds creative ways to save on back-to-school shopping. Their local public schools provide supplies, but her family is still on the hook for new school clothes, technology, backpacks and so on.

“I try to keep costs as low as possible, and the extra expenses come from a monthly budget category for essential home items,” Laney says.

She’s among nearly half of back-to-school shoppers (49%) who are employing one or more of these money-saving strategies in 2025.

1 in 5 will buy cheaper brands

Twenty percent of back-to-school shoppers say they bought or will buy cheaper brands than usual, down from 35% in 2022.

Try opting for generic versions of your kids’ favorite brands or comparing prices between stores to trim down your budget. “I buy cheaper brands for the things that don’t matter (paper, binders, scissors),” Sunderhaus says. “I also price compare between in-store deals (Target, Walmart) and Amazon online. I usually find that highlighters, expo markers, and ironically, glue sticks in bulk and then divided among my kids, are cheaper via Amazon.”

1 in 5 will look for deals

Twenty percent also have or plan to find more deals and coupons than in the past. But that’s down from 47% in 2022.

With five kids, it’s important for Laney and her kids to buy things that will last without breaking the bank. “I don’t go for the cheapest brands — I try to get the highest quality for the lowest price,” she explains. “For that, I’m a big Costco fan. I also shop all the discount stores like TJ Maxx, Ross, Marshall’s and Burlington Coat Factory.”

Nearly 1 in 5 will budget for back-to-school

Eighteen percent already did or plan to set money aside and/or budget for back-to-school shopping, which is down from 33% in 2022.

Budgeting prevents impulse buying, which is a weakness for many Americans. And it helps you identify other categories where you might be able to spend less this season, so there’s enough money to go around. You could also start saving up for back-to-school shopping a couple of months in advance.

About 1 in 6 will buy fewer school supplies

Sixteen percent are buying fewer school supplies than in previous years due to the cost, compared to 36% in 2022.

“Consider asking your child’s teacher what’s essential on day one versus what can wait until later in the year,” Rossman says. Your kids may not need everything on the list right away. They might also be able to use last year’s backpack, folders, pens and pencils and more.

5 ways to save money this back-to-school season

Once summer camps are over and schools start sending emails again, here are a few lessons to help you shop affordably for back-to-school.

• Set a budget. With a monthly budget that fluctuates by season, you can plan ahead for back-to-school spending by pulling money from other everyday categories. For example, if you budget $500 for school supplies, you might be able to cut $200 from your family’s dining out budget, $200 from entertainment and another $100 by skipping pricey snacks and only buying in bulk that month.
• Make a shopping list. With a list in hand — that you actually stick to — you won’t get sucked into buying more than you need or what your kids throw in the cart. Base the list on your budget and recommendations from the school, but also look for ways to reuse supplies from last year.
• Stack discounts. Try “combining a rewards credit card with store promotions, online shopping portals and/or card-linked offers,” Rossman advises. Those small savings can add up for a big shopping list.
• Include your kids in the process. Back-to-school shopping is a way to teach your kids about budgeting while minimizing bickering over what to buy. “I make my elementary kids responsible for holding onto their list in the store and marking off what we have as we go,” Sunderhaus says. “We also talk about the brands and prices of the items they are picking out.” When her 6-year-old wanted a video game-themed pencil box, he chose to compromise for a more affordable lunch box.
• Shop secondhand. Thrifting clothes and supplies, when possible, can help you get lower prices while helping the environment. Laney and her kids often shop secondhand and re-wear items. “I’m always surprised at the high quality of clothes I can get secondhand,” she says. “We’re happy to wear hand-me-downs or yard sale treasures.”

Methodology: Bankrate commissioned YouGov Plc to conduct the survey. All figures, unless otherwise stated, are from YouGov Plc. Total sample size was 2,616 adults, of which 914 have or will do back-to-school shopping this year. Fieldwork was undertaken between June 2-4, 2025. The survey was carried out online. The figures have been weighted and are representative of all US adults (aged 18+).

©2025 Bankrate.com. Distributed by Tribune Content Agency, LLC.

By Carson Hartzog, The Minnesota Star Tribune

Color-coded folders and notebooks. A fresh stash of pens and pencils. A new outfit.

Millions of American students from preschool through college, and their (often) bankrolling parents, back-to-school shop ahead of each fall. But as prices rise, technology evolves and new products hit the shelves, families are seeking ways to keep checking off the school supply list affordably.

“When I was young, I had $50 to go to the grocery store. I go now, and that’s, like, three or four items,” said Matt Marsh, Minneapolis managing partner at Deloitte. “Everything costs more. So families are getting squeezed a bit, and it’s creating a level of anxiety.”

According to PwC’s inaugural back-to-school survey, nearly 3 in 4 parents said they’ll spend the same or more than they did last year on school supplies, even with higher prices and economic volatility.

“There’s still this underlying element of consumer confidence,” said Kelly Pedersen, a partner at PwC. “Even though we hear a lot of uncertainty in the market, people still need to shop for back-to-school.”

Plan and budget

Before shopping, take inventory of last year’s supplies. About a third of parents plan to reuse items, according to PwC.

Budgeting, paired with a specific shopping list, can prevent impulse buying.

In Minneapolis, parents Deloitte surveyed expected to spend $682 per child this year. That’s 20% more than the national average.

Niki Kroll of Minneapolis typically starts her back-to-school shopping in July and has already noticed higher prices. Various name-brand notebooks, folders and backpacks seem to be more expensive than previous years. But she has had success finding pencils, glue sticks and other basics on sale.

Those surveyed planned to spend less on clothing and more on school supplies. They also plan to spend more of their budget on tech than last year, though experts expect the total of those tech purchases to stay flat in comparison to last year’s $520 per family.

Assess need

As kids progress in school, more advanced classes might require new tech purchases, like a different calculator model, nearly each year. Delaying that purchase if possible or downgrading it — such as buying an older or used version — can free up room for more necessities like binders, scissors and pencil cases.

“Consider asking your child’s teacher what’s essential on day one vs. what can wait until later in the year,” wrote Ted Rossman, Bankrate senior industry analyst, in an analyst note.

Shop now

More than a third of parents PwC surveyed said they’re starting earlier this year to snag better prices and beat the rush.

“There’s this thought that the better deals are out there earlier before the heart of back-to-school in August,” Pedersen said.

Deloitte’s survey found more than two-thirds of Minneapolis parents plan to finish most of their school shopping by the end of July. They were able to cash in on recent sales like Target’s Circle Week and Amazon’s Prime Day. But several retailers are hosting back-to-school promotions through August.

Target announced Tuesday “Back-to-School-idays” discounts from July 27-Aug. 2. The retailer is maintaining its 2024 prices on key items, and some stores will have personalization stations with embroidery and patches for backpacks, lunchboxes, towels and pillows.

Walmart is offering lower prices than last year on select items, such as highlighters, erasers and notebooks.

Use AI

One in five parents told PwC they plan to use artificial intelligence to find the best deals this season.

“The biggest change we’ve seen with AI shopping is the agent concept, basically putting in your shopping list and budget to optimize your list and what you buy,” Pedersen said. “It’s really taking all of the searching work out of having to do back-to-school shopping.”

AI tools like app and website ChatGPT allow users to paste in a list of school supplies and make requests, like “find these items for the cheapest prices online or in-store within 20 miles of Minneapolis.” Users can also ask to search specific stores and keep the total under a certain amount.

Don’t fall for influencers

Deloitte’s data shows parents who use social media are likely to spend 1½ times more on back-to-school than others. Higher education, bigger wages, better access to the internet and more leisure time spent online all play a role.

“Generally, retailers are moving marketing dollars toward influencers, and influencers are creating behaviors that might result in that splurge purchase,” Marsh said.

More than two-thirds of Minneapolis parents said their child’s preferences often steer them to spend more, and 63% are willing to spend a little extra on their child’s first-day outfit compared with 57% nationally.

Make it fun

In Bloomington, Mall of America is hosting giveaways, limited-time promotions and events for back-to-school. Shoppers can scan the Mall of America app once per day for a chance to win a gift card or rewards points. The mall plans to give away more than $10,000 in gift cards between Aug. 11-31.

Deals are also available for the Nickelodeon Universe theme park and Crayola Experience from Aug. 4-Sept. 30.

“For parents and families coming to Mall of America, it’s a one-stop shop,” said Jill Renslow, Mall of America’s chief business development and marketing officer. “It’s a destination where people have that tradition of coming for not only shopping, but to go on some rides or grab lunch.”

Many cities also offer local events for free or low-cost school supplies, just look on city events calendars.

In store vs. online

Younger parents are leading a small resurgence of in-store shopping.

“Every year in our stats, Gen Zs are the ones who are visiting physical stores the most,” Pedersen said. “[They] value in-person experiences, and in some cases, they’re willing to pay a premium price for that.”

Gen Z also reported a higher likelihood of buying in-store. In previous years, younger shoppers more commonly browsed stores to try on or test products but made final purchases online.

Income also plays a role. Families earning under $75,000 are nearly twice as likely to shop only in-store, while higher-income households tend to prefer online shopping.

Be strategic

While inflation has cooled to 2.4%, prices are still up nearly 24% compared with pre-pandemic levels, according to Bankrate.

“It’s not like when the rate goes down, prices go down. They just don’t go up as fast anymore,” Marsh said. “But there’s a lot of economic anxiety about pricing.”

Looking for generic versions of favorite brands or comparing prices across stores can save money. So can thrifting, Pedersen said. About a fifth of shoppers said they’re looking to shop secondhand.

Shoppers can stack discounts by combining a rewards credit card with store promotions or other available offers, which can add up to considerable savings, Rossman wrote in an analyst note.

For Kroll, she enjoys letting her kids pick their most personal items, like lunchboxes. Despite higher prices, those moments are some of her family’s favorite memories.

“We really like shopping for backpacks and things that have more wiggle room for the kids’ own style. The lists have gotten quite specific, so it’s fun when they can pick out their own stuff,” Kroll said. “My son knows immediately what he wants, and my daughter tries on about 10 backpacks while looking in the mirror.”

©2025 The Minnesota Star Tribune. Visit at startribune.com. Distributed by Tribune Content Agency, LLC.

By Kate Ruder, KFF Health News

More states are passing laws to protect information generated by a person’s brain and nervous system as technology improves the ability to unlock the sensitive details of a person’s health, mental states, emotions and cognitive functioning.

Colorado, California, and Montana are among the states that have recently required safeguarding brain data collected by devices outside of medical settings. That includes headphones, earbuds and other wearable consumer products that aim to improve sleep, focus and aging by measuring electrical activity and sending the data to an app on users’ phones.

A report by the Neurorights Foundation, an advocacy group that aims to protect people from the misuse of neurotechnology, found that 29 of 30 companies with neurotechnology products that can be purchased online have access to brain data and “provide no meaningful limitations to this access.” Almost all of them can share data with third parties.

In June, the American Medical Association called for greater regulation of neural data. In April, several Democratic members of the U.S. Senate Committee on Commerce, Science, and Transportation asked the Federal Trade Commission to investigate whether companies are exploiting consumers’ brain data. Juliana Gruenwald Henderson, a deputy director of the FTC’s Office of Public Affairs, said the agency had received the letter but had no additional comment.

Although current devices gather relatively basic information like sleep states, advocates for brain data protection caution that future technologies, including artificial intelligence, could extract more personal and sensitive information about people’s medical conditions or innermost thoughts.

“If you collect the data today, what can you read from it five years from now because the technology is advancing so quickly?” said Democratic state Sen. Cathy Kipp, who sponsored Colorado’s 2024 neural data protection bill when she was in the state House of Representatives.

As both excitement and trepidation about AI build, at least 28 states and the U.S. Virgin Islands have enacted some type of AI regulation separate from the privacy bills protecting neural data. President Donald Trump’s “One Big Beautiful Bill” included a 10-year halt on states passing laws to regulate AI, but the Senate stripped that provision out of the budget reconciliation bill before voting to approve it on July 1.

The spirit of laws in Colorado, California, and Montana is to protect the neural data itself, not to regulate any algorithm or AI that might use it, said Sean Pauzauskie, medical director for the Neurorights Foundation.

But neurotechnology and AI go hand in hand, Pauzauskie said. “A lot of what these devices promise is based on pattern recognition. AI is really driving the usability and significance of the patterns in the brain data.”

Cristin Welle, a professor of neurosurgery at the University of Colorado School of Medicine, said that AI’s ability to identify patterns is a game changer in her field. “But contribution of a person’s neural data on an AI training set should be voluntary. It should be an opt-in, not a given.”

Chile in 2021 became the first country to adopt a constitutional amendment for neurorights, which prioritize human rights in the development of neurotechnology and collection of neural data, and UNESCO has said that neurotechnology and artificial intelligence could together pose a threat to human identity and autonomy.

Neurotechnology can sound like science fiction. Researchers used a cap with 128 electrodes and an AI model to decode the brain’s electric signals from thoughts into speech. And two years ago, a study described how neuroscientists reconstructed the Pink Floyd song “Another Brick in the Wall” by analyzing the brain signals of 29 epilepsy patients who listened to the song with electrodes implanted in their brains.

The aim is to use neurotechnology to help those with paralysis or speech disabilities, as well as treat or diagnose traumatic brain injuries and brain disorders such as Alzheimer’s or Parkinson’s. Elon Musk’s Neuralink and Synchron, funded by Bill Gates and Jeff Bezos, are among the companies with clinical trials underway for devices implanted in the brain.

Pauzauskie, a hospital neurologist, started worrying four years ago about the blurring of the line between clinical and consumer use of neural data. He noted that the devices used by his epilepsy patients were also available for purchase online, but without protections afforded by the Health Insurance Portability and Accountability Act in medical settings.

Pauzauskie approached Kipp two years ago at a constituent meetup in his hometown of Fort Collins to propose a law to protect brain data in Colorado. “The first words out of her mouth that I’ll never forget were, ‘Who would be against people owning their own brain data?’” he said.

Brain data protection is one of the rare issues that unite lawmakers across the political aisle. The bills in California, Montana, and Colorado passed unanimously or nearly unanimously. Montana’s law will go into effect in October.

Neural data protection laws in Colorado and California amend each state’s general consumer privacy act, while Montana’s law adds to its existing genetic information privacy act. Colorado and Montana require initial express consent to collect or use neural data and separate consent or the ability to opt out before disclosing that data to a third party. A business must provide a way for consumers to delete their data when operating in all three states.

“I want a very hard line in the sand that says, you own this completely,” said Montana state Republican Sen. Daniel Zolnikov, who sponsored his state’s neural data bill and other privacy laws. “You have to give consent. You have the right to have it deleted. You have complete rights over this information.”

For Zolnikov, Montana’s bill is a blueprint for a national neural data protection law, and Pauzauskie said support of regulatory efforts by groups like the AMA pave the way for further federal and state efforts.

Welle agreed that federal regulations are needed in addition to these new state laws. “I absolutely hope that we can come up with something on a national level that can enshrine people’s neural rights into law, because I think this is going to be more important than we can even imagine at this time.”

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

By Fiona Rutherford and Micah Barkley, Bloomberg News

Nonalcoholic beer needs a second act.

The category boomed in recent years as the likes of Anheuser-Busch InBev, Heineken NV and Diageo Plc poured in money. But after those gains made it one of brewing’s few bright spots, it’s still just 2% of the global beer market’s volume, according to IWSR.

And now growth rates are slowing. After a surge late last decade and another jump in 2021, recent increases have settled into the single digits. IWSR now projects annual gains of about 8% through 2029. That would only boost its market share to a little less than 3%.

The push into nonalcoholic beer is a reminder of how much the industry is struggling. Craft beer peaked. The hard seltzer boom fizzled. Younger adults are going out less. Legalized cannabis is replacing six packs. Weight-loss drugs are a threat. Global beer volume has declined the past two years. Meanwhile, stocks of the world’s big brewers haven’t returned to their pre-pandemic levels.

“They have no choice but to get into alcohol free,” said Kenneth Shea, senior analyst at Bloomberg Intelligence. It’s one of the few remaining growth levers for large brewers as they adapt to changing consumer habits, he said.

Brewing has consolidated about as far as it can, with the five biggest companies controlling more than half the global market. Investors are looking for organic growth, and that’s why nonalcoholic beer has become the sector’s latest shiny object. But at this point it’s far from a panacea. IWSR projects that global beer volumes will be flat over the next five years, even with the growth in nonalcoholic brews.

The first phase of nonalcoholic beer’s expansion came from startups that focused on it. Firms such as Athletic Brewing Co. pushed the category toward craft brewing with tastier styles like IPA. They marketed around wellness, moderation and active lifestyles.

Breweries are now trying to broaden nonalcoholic beer’s appeal to win over more habitual beer drinkers. There’s been a shift in marketing. Nonalcoholic beer ads used to lean heavily on responsibility and reducing alcohol consumption. Heineken 0.0 ran a spot featuring Formula 1 superstar Max Verstappen promoting designated driving.

Now brands pitch nonalcoholic beer as a casual, anytime drink. Heineken’s newer “0.0 Reasons Needed” campaign encourages people to drink it whenever they want, with no explanation required. The marketing is part of the brewer’s push to reduce the stigma around nonalcoholic beer. One survey Heineken cited showed that about 40% of Gen Z men would only consider such options if their friends did.

Guinness emphasizes how closely its nonalcoholic version matches the original and brought in NFL legend Joe Montana to promote the brand.

AB InBev, the world’s largest brewer, turned Michelob Ultra into its best-selling beer in the US by pitching it as a lower calorie option for sporty types. It announced a nonalcoholic version — Michelob Ultra Zero — in September. A commercial features young adults taking a break from beach volleyball to crack one open and then running back to play as the voiceover states: “Stay in the game.”

Heineken 0.0, which in 2023 became the first nonalcoholic beer to air a Super Bowl ad, is now one of the five most-seen beer or seltzer brands on US television, according to researcher iSpot. It’s offered in more than 100 countries and grew more than 10% last year.

The spending on US advertising has helped grow nonalcoholic beer more than other markets. IWSR expects US nonalcoholic volume to gain 16% a year over the next decade.

Mark Ruf, a longtime beer drinker, has been won over. The 31-year-old from Columbus, Ohio, now drinks a nonalcoholic beer for every regular one — a practice that’s been dubbed zebra striping — to cut back on his booze consumption when he’s at home or out with friends. He got so into the category that he started a blog and nonalcoholic beer subscription service.

“I still hate to put an end to a good time,” Ruf said. “But I start mixing it in with NA beer, so I’m not regretting it the next day.”

Nonalcoholic beer used to be a category dominated by options such as O’Doul’s, owned by AB InBev, and similar legacy brands. These brews often struggled to win fans because the process of getting rid of the alcohol included heating up the beer, which muted flavors.

Brewers have been investing in new techniques to improve taste. At AB InBev’s research center in Belgium, scientists have spent more than a decade refining nonalcoholic brewing. The company now removes the alcohol using low-temperature methods, then adds back key aromas to preserve more of the original flavor and smell.

“It is really an art, and it is also a science,” said David De Schutter, AB InBev’s vice president of global innovation.

AB InBev has also launched alcohol-free versions of Budweiser, Stella Artois and Corona. In May, Chief Executive Officer Michel Doukeris told investors that its nonalcoholic portfolio was growing more than 30%. Corona Cero was the first ever beer sponsor of the Olympics at last year’s games in Paris.

Diageo has invested more than 60 million euros (about $70 million) in Guinness 0 production since the product launched globally in 2021. In the US, Guinness 0 made up more than half of the Guinness brand’s growth last year, the company said. And there’s been little cannibalization, with just 2% consumer overlap between Guinness 0 and the brand’s traditional beers.

All that focus has led to consumers now expecting nonalcoholic beer to taste good, according to Laura Merritt, president of beer and pre-mix at Diageo North America.

“It’s not like 10 years ago, where you just had to take what you got,” Merritt said of NA beer’s lack of choices. “The standards for great nonalcoholic beverages are the same high standard for great alcoholic beverages.”

But meeting standards doesn’t mean more and more people will convert to beer with the alcohol removed. There are many examples of food and beverages that initially do well by offering moderation and less harm. The question is whether nonalcoholic beer will recede the same as plant-based meat or become a sustainable category like diet soda.

©2025 Bloomberg L.P. Visit bloomberg.com. Distributed by Tribune Content Agency, LLC.

By Beth Dooley, The Minnesota Star Tribune

Like a good summer movie, a great sandwich should be full of delightful familiar ingredients sparked with a few good surprises. And like a good plot, the sandwich should be built on a sturdy foundation.

But first, let’s agree on the definition of a sandwich as opposed to a hamburger, hot dog, taco, wrap, empanada or burrito. To quote the Merriam-Webster dictionary, “a sandwich consists of two or more slices of bread or split roll having a filling in between.” (Open-faced sandwiches are a whole different category, and they deserve a story of their own.)

There are few rules to govern sandwich fillings, but it’s clear that the foundation must be very good bread. Thanks to our local artisan bakeries, there are now plenty of great options. As with all local foods, the best tasting bread is created with local flour milled fresh. Here are a few classic combos built on our bakeries’ best.

The bread

Rye bread: The dark, dense malty Hundred Rye Bread from Baker’s Field Flour & Bread is the perfect platform for my hometown hero: the New Jersey Joe. The triple-decker beauty layers turkey, Swiss cheese, roast beef and coleslaw, slathered with Russian dressing on three layers of thinly sliced rye. It’s the sandwich of birthday parties and reunions, a specialty of the Millburn Deli, and the first thing I eat when back home. Rye bread is a great match for smoked meats.

Multigrain bread: Toasty, nutty, whole-grain slices match the flavorful plant-based filling of a classic California Avocado and begs the question: How can something that tastes so good be good for you? Fat wedges of avocado, fistfuls of sprouts and thick slices of tomato are all married with rough, garlicky lemon hummus. Hearty and healthy, this is the bread for veggie-based creations.

Baguette: Filling the traditionally light, crusty French baguette with bold Vietnamese flavors is an elegant and innovative pairing. While the version in today’s recipe doesn’t pretend to be an authentic bánh mì — pickled vegetables, daikon-carrot slaw, cucumbers and seasoned meat (i.e. rotisserie chicken), hot peppers and fish sauce — it is a mouth-tingling and faster version of the classic with ingredients that are easy to find. Baguette and crusty rolls work beautifully with drippy, bountiful fillings.

White bread: Soft, slightly sweet white bread griddled to golden perfection is the key to a great Cubano. The iconic sandwich of Florida is a hefty variation of the ham and grilled cheese with a layer of pulled pork and lots of personality. Pickles add a punchy counterpoint to the melty Swiss cheese and mustardy-mayo. Of course the definition of a Cubano lies in the hands of its maker — some add salami to the equation, too.

Key ingredients

Often the best sandwiches are last-minute inventions sparked by hunger and whatever is at hand — crisp chips, tangy-salty kimchi, hot sauce, a lick of bright berry jam. But with a little planning, you can have the key ingredients on hand to create the iconic sandwiches: Coleslaw and Russian dressing for New Jersey Joes, Garlicky-Lemon Hummus for California Avocado sandwiches, Quick Daikon-Carrot Pickle for bánh mì and Tangy Mustardy Mayo for the Cubano.

None of these examples is meant to dissuade you from creating the sandwich of your summer dreams. Be bold and savor the flavor and the joy of eating a meal with your hands.

Coleslaw

Serves about 4.

Make this just a few hours ahead of time so that the flavors marry. Don’t hesitate to toss in your favorite chopped herbs — basil, parsley, thyme, etc. From Beth Dooley.

• ½ c. mayonnaise
• 2 tsp. apple cider vinegar
• Pinch sugar
• Salt and freshly ground black pepper, to taste
• 1 small head green cabbage (about 1 ¼ to 1 ½ lb.), cored and shredded
• 1 carrot, shredded

Directions

In a medium bowl, stir together the mayonnaise, vinegar and sugar, and season with salt and pepper to taste. Add the cabbage and carrot and toss until the ingredients are well coated (use your hands for best results).

Russian Dressing

Makes about ¾ cup.

Though similar to Thousand Island dressing, this is spicier and not as sweet. From Beth Dooley.

• 3 tbsp. ketchup or chili sauce
• 1 tbsp. chopped shallot
• 1 tsp. prepared horseradish, to taste
• ½ c. mayonnaise
• Salt and freshly ground black pepper, to taste

Directions

Put all of the ingredients into a small bowl and whisk to combine. Taste and adjust the seasonings.

Make it a New Jersey Joe: The order of the popular triple-decker sandwich is: bottom slice of thinly sliced rye, turkey or roast beef, coleslaw, Russian dressing, Swiss cheese, middle slice of rye, turkey or roast beef, coleslaw, Russian dressing, Swiss cheese and top slice of rye.

Garlicky-Lemon Hummus

Makes 2 cups.

You’ll end up with more than you’ll need for a sandwich, so save the extra for dipping chips and veggies. This speedy version comes together in minutes. From Beth Dooley.

• 2 cloves garlic
• 1 tsp. lemon zest
• 2 to 3 tbsp. fresh lemon juice, to taste
• 1 c. tahini
• Generous pinch coarse salt
• 1 tsp. ground cumin
• ½ c. ice water, plus more as needed
• 1 (15-oz.) can chickpeas, drained and rinsed

Directions

In a food processor fitted with a steel blade, pulse together the garlic, lemon zest, lemon juice, tahini, salt, cumin and water. Add the chickpeas and process until the mixture is smooth. Taste and adjust the seasonings and add more water if needed to reach desired consistency.

Make it a California Avocado: Between thick slices of multigrain bread, layer wedges of avocado, sprouts and the garlicky-lemon hummus.

Quick Daikon-Carrot Pickle

Makes about 3 cups.

A quick, simple pickle brightens a range of sandwiches from bánh mì to the all-American BLT. It will keep in a covered container in the refrigerator for about 3 weeks.

• 1 large carrot, cut into matchstick-size pieces
• 1 lb. daikon radish, cut into matchstick-size pieces
• ¼ c. sugar
• ½ c. water
• 1 c. rice wine vinegar
• Salt and freshly ground black pepper, to taste

Directions

Put the carrot and daikon slices into a glass container. In a small saucepan, stir together the sugar, water, vinegar and a pinch of salt and pepper and set over low heat, stirring to dissolve the sugar. Cool slightly and pour over the vegetables. Allow the vegetables to marinate at least 1 hour before using or refrigerate for up to 3 weeks. Drain the vegetables from the pickling juices before using in a bánh mì or other sandwich.

Make it a bánh mì: While not authentic by any means, get the idea of the traditional sandwich by filling a crusty baguette with pickled daikon-carrot slaw, cucumbers, rotisserie chicken, hot peppers with a drizzle of fish sauce.

Tangy Mustardy Mayo

Makes about ⅔ cup.

Sandwich pairing: The Cubano, that delicious, drippy variation on a grilled ham and cheese with a bump of pulled pork, relies on a tangy mustardy-mayo sauce to pull together the honey-kissed ham, mild creamy Swiss cheese and punchy pickles. You may end up with more sauce than needed, but it keeps in a covered container in the refrigerator for at least 2 weeks.

• ½ c. good mayonnaise, such as Duke’s or Hellman’s
• 2 tbsp. yellow mustard
• 1 tbsp. dill pickle juice
• 1 tsp. honey, optional

Directions

Put all the ingredients into a small bowl and whisk together.

Make it a Cubano: Slather the tangy mustardy mayo on the inside of sliced white bread before adding ham, Swiss cheese, pulled pork and pickles.

©2025 The Minnesota Star Tribune. Visit at startribune.com. Distributed by Tribune Content Agency, LLC.

By Jordan Rau and Irena Hwang, KFF Health News

Rehab hospitals that help people recover from major surgeries and injuries have become a highly lucrative slice of the health care business. But federal data and inspection reports show that some run by the dominant company, Encompass Health Corp., and other for-profit corporations have had rare but serious incidents of patient harm and perform below average on two key safety measures tracked by Medicare.

Yet even when inspections reveal grave cases of injury, federal health officials do not inform consumers or impose fines the way they do for nursing homes. And Medicare doesn’t provide easy-to-understand five-star ratings as it does for general hospitals.

In the most serious problems documented by regulators, rehab hospital errors involved patient deaths.

In Encompass Health’s hospital in Huntington, West Virginia, Elizabeth VanBibber, 73, was fatally poisoned by a carbon monoxide leak during construction at the facility.

At its hospital in Jackson, Tennessee, a patient, 68, was found dead overnight, lying on the floor in a “pool of blood” after an alarm that was supposed to alert nurses that he had gotten out of bed had been turned off.

In its hospital in Sioux Falls, South Dakota, a nurse gave Frederick Roufs, 73, the wrong drug, one of 26 medication errors the hospital made over six months. He died two days later at another hospital.

“I can still see Fred laying in the bed as they shut each little machine off,” said his widow, Susan Roufs. “They clicked four of them, and then the love of my life was gone.”

Encompass, which owns 168 hospitals and admitted 248,000 patients last year, has led the transformation of this niche industry. In 2023, stand-alone for-profit medical rehabilitation hospitals overtook nonprofits as the places where the majority of annual patient admissions occur, a KFF Health News and New York Times analysis found. A third of all admissions were to Encompass hospitals. Such facilities are required to provide three hours of therapy a day, five days a week.

Across the nation, there are now nearly 400 stand-alone rehab hospitals, the bulk of which are for-profit. These hospitals collectively generate profits of 10%, more than general hospitals, which earn about 6%, and far more than skilled nursing homes, which make less than 0.5%, according to the most recent data from the Medicare Payment Advisory Commission, an independent congressional agency.

At the same time, the number of small, specialized units within acute care hospitals — where most rehab used to be provided — has dwindled. There are now around 800 of those, and most are nonprofits.

In its latest annual report, Encompass, which is publicly traded, reported an 11% net profit in 2024, earning $597 million last year on revenues of $5.4 billion.

Federal data on the performance of about 1,100 of the rehab facilities show Encompass tends to be better at helping most patients return home and remain there. In a two-year period ending in September 2023, Medicare rated 233 rehab facilities as performing better than the national rate for this major metric, called “discharge to community.” Most rehabs with better community discharge rates are for-profit, and Encompass owns 79 of them.

But data from Medicare also reveals Encompass owns many of the rehabs with worse rates of potentially preventable, unplanned readmissions to general hospitals. Medicare evaluates how often patients are rehospitalized for conditions that might have been averted with proper care, including infections, bedsores, dehydration, and kidney failures.

Encompass accounts for about 1 in 7 rehab facilities nationally, but owned 34 of the 41 inpatient rehab facilities that Medicare rated as having statistically significantly worse rates of potentially preventable readmissions for discharged patients. (Overall, rates of readmission after discharge ranged from 7% to 12%, with a median of 9%.)

And it owned 28 of the 87 rehab facilities — 65 of which were for-profit — that had worse rates of potentially preventable readmissions to general hospitals during patient stays. (The median for these kinds of readmissions was 5%, and rates for individual rehabs ranged from 3% to 9%.)

Patrick Darby, the executive vice president and general counsel of Encompass, strongly defended the company’s record in written responses to questions. He dismissed Medicare’s readmissions ratings of “better,” “worse,” and “no different than the national rate” as “a crude scoring measure” and said “performance is so similar across the board.” He called the violations found during health inspections “rare occurrences” that “do not support an inference of widespread quality concerns.”

“The simplest and most accurate reason for EHC’s success is that our hospitals provide superior care to patients,” he said, referring to Encompass by its corporate initials.

Chih-Ying Li, an associate professor of occupational therapy at the University of Texas Medical Branch at Galveston School of Health Professions, said in an interview that a research study she conducted found the profit status of a rehab facility was the only characteristic associated with higher unplanned readmissions.

“The finding is pretty robust,” she said. “It’s not like huge, huge differences, but there are differences.”

Alarming Mistakes

VanBibber was admitted to Encompass’ Huntington hospital in 2021 for therapy to strengthen her lungs. At the time, the hospital was undergoing a $3 million expansion, and state regulators had warned the company that areas of the hospital occupied by patients had to be isolated from the construction “using airtight barriers,” according to a health inspection report.

In her room, which was about 66 feet from the construction zone, she began having trouble breathing, the report said. When she told the staff, they ignored her and shut her door, according to a lawsuit brought by her estate. Staff members eventually noticed that she was “lethargic and gasping for air,” and called 911.

When the emergency medical squad arrived, the carbon monoxide detectors they wore sounded. By that time, VanBibber’s blood oxygen levels were dangerously low, the inspection report said. She died three days later from respiratory failure and carbon monoxide poisoning, according to the inspection report and the lawsuit. A plumber had been using a gas-powered saw in the construction area, but there were no carbon monoxide detectors in the hallways, the report said.

In court papers, Encompass and its construction contractors denied negligence for VanBibber’s death. The case is pending.

Inspectors determined Encompass failed to maintain a safe environment for all patients during construction and didn’t properly evaluate other patients for signs of poisoning, the report said.

Since 2021, the federal Centers for Medicare and Medicaid Services, or CMS, which oversees health inspections, has found that 10 Encompass hospitals, including the one that cared for VanBibber, had immediate jeopardy violations, federal records show. Such violations — like the ones that Medicare also found in connection with the deaths of Roufs and the patient who fell after leaving his bed — mean a hospital’s failure to comply with federal rules has put patients at risk for serious injury, serious harm, serious impairment, or death.

Darby, the general counsel for Encompass, said the company regretted any clinical problems and had promptly addressed all such findings to the satisfaction of inspectors. He said Encompass that has an “excellent compliance record,” including superior results from its accreditation agency, and that its overall number of health citations was tiny given how many hospitals Encompass owns and how many patients it treats.

Six other corporate-operated for-profit hospitals were also cited, while none of the 31 stand-alone nonprofit rehab hospitals received such violations from 2021 to 2024. (Inspection reports for general hospitals do not systematically specify in which part of the building a violation occurred, so rehab unit violations cannot be identified.)

An alert called a bed alarm was at the root of immediate jeopardies at Encompass hospitals in Morgantown, West Virginia, and Jackson, Tennessee. The devices are pressure- and motion-sensitive and emit a sound and display a light to alert staff members that someone at a high risk of falls has left his or her bed.

In its Morgantown hospital, a nurse technician discovered a patient face down on the floor with a large gash on her head after a defective alarm did not go off, an inspection report said. After she died, the nurse told inspectors: “We are having a lot of problems with the bed alarms.”

Medicare is not authorized by law to fine rehab hospitals for safety rule violations, even ones involving deaths uncovered during inspections, as it has done with nearly 8,000 nursing homes during the last three years, imposing average fines of about $28,000.

The only option is to entirely cut off a rehab hospital’s reimbursement for all services by Medicare and Medicaid, which cover most patients. That step would most likely put it out of business and is almost never used because of its draconian consequences.

“Termination is typically a last resort after working with the provider to come back into compliance,” Catherine Howden, a CMS spokesperson, said in an email.

As a result, because there’s no graduated penalty, even the most serious — and rare — immediate jeopardy violations effectively carry no punishments so long as the hospital puts steps in place to avert future problems.

“Only having a nuclear weapon has really hurt patient safety,” said Michael Millenson, a medical quality advocate.

One immediate jeopardy incident did result in a punishment, but only because the hospital was in California, which allows its health department to issue penalties. Encompass’ Bakersfield hospital paid a $75,000 fine last year for failing to control the blood sugar of a patient who died after her heart stopped.

Rapid Growth and a Troubled History

Encompass has accelerated its expansion in recent years and now operates in 38 states and Puerto Rico. It plans to open 17 more hospitals in Arizona, Connecticut, Florida, Georgia, Maine, Pennsylvania, South Carolina, Texas, and Utah by the end of 2027, according to its latest report.

It frequently moves into new markets by persuading local nonprofit hospitals to shutter their rehab units in exchange for an equity stake in a newly built Encompass hospital, company executives have told investors.

The president of Encompass, Mark Tarr, calls it a “win-win proposition”: The local hospitals can use their emptied space for a more lucrative line of service and Encompass gets a “jump start” into a new market, with partner hospitals often referring patients.

Tarr, who was paid $9.3 million in compensation last year, told investors that Encompass requires that the existing hospitals sign a noncompete deal. Sixty-seven Encompass hospitals are joint ventures, mostly with nonprofit hospitals as investors, according to the company’s June financial filing, the most recent available.

Darby said the company’s profits allow it to build hospitals in areas that lack intensive inpatient rehabilitation and improve existing hospitals. “High-quality patient care is not only consistent with shareholder return, but quality and shareholder return are in fact critical to one another,” he said.

The success of Encompass is particularly notable given that it barely survived what experts said was one of the largest modern accounting scandals in 2003.

The Securities and Exchange Commission charged that the company, then known as HealthSouth, overstated earnings by $2.7 billion to meet Wall Street analyst quarterly expectations, leading to the ouster of its founder and directors. In 2004, the company agreed to pay the government $325 million to settle Medicare fraud allegations without admitting wrongdoing. Darby credited the company’s new leaders for obtaining a $2.9 billion judgment on behalf of shareholders against the company’s founder.

The company changed its name to Encompass in 2018 after acquiring Encompass Home Health and Hospice. In 2019, the Justice Department announced the company had agreed to pay$48 million to settle whistleblower lawsuit claims that it misdiagnosed patients to get higher Medicare reimbursements, and admitted patients who were too sick to benefit from therapy. The company denied any wrongdoing, blaming independent physicians who worked at its hospitals. Darby said Encompass settled the case only to “avoid more years of expense and disruption.” He said the Justice Department never filed a lawsuit despite years of investigation.

Medication Harms

Rehab hospital inspection reports are not posted on Care Compare, Medicare’s online search tool for consumers. KFF Health News had to sue CMS under the Freedom of Information Act to obtain all its inspection reports for rehab hospitals. In contrast, Care Compare publishes all nursing home inspection reports and assigns each facility a star rating for its adherence to health and safety rules.

So people now choosing a rehab hospital would not know that at the Encompass hospital in Sioux Falls, South Dakota, in 2021, a nurse accidentally gave Roufs a blood pressure drug called hydralazine instead of hydroxyzine, his prescribed anti-anxiety medication, according to an inspection report. Roufs went into cardiac arrest. This type of error, called a“look-alike/sound-alike,” is one hospitals and staff members are supposed to be especially alert to.

Months before, an internal safety committee had identified a trend of medication errors, including when a nurse accidentally gave a patient 10 times the prescribed amount of insulin, sending him to the hospital, the inspection report said. The nurse had misread four units as 40. Since Roufs’s death, inspectors have faulted the hospital six times for various lapses, most recently in April 2024 for improper wound care.

An Encompass hospital in Texarkana, Texas, misused antipsychotic medications to pacify patients, resulting in an immediate jeopardy finding from CMS, the report said. And the company’s hospital in Erie, Pennsylvania, was issued an immediate jeopardy violation for not keeping track of medication orders in 2023, when a patient had a cardiac arrest after not receiving all of his drugs, according to the inspection report.

The federal government’s overall quality oversight efforts are limited. Medicare docks payment to rehab facilities for patients readmitted to a general hospital during shorter-than-average rehab stays, but unlike at general hospitals, there are no financial penalties when recently discharged rehab patients are hospitalized for critical health issues.

The Biden administration announced last year it intended to develop a rating scale of 1 to 5 stars for rehab facilities. The industry’s trade association, the American Medical Rehabilitation Providers Association, requested a delay in the creation of star ratings until the current quality measures were refined. The Trump administration has not determined whether it will continue the effort to rate rehab facilities, according to a CMS spokesperson.

Deadly Bedsores

The family of Paul Webb Jr., 74, claimed in a lawsuit that the Encompass hospital in Erie left Webb unattended in a wheelchair for hours at a time, putting pressure on his tailbone, in 2021. His medical records, provided to reporters by the family, list a sitting tolerance of one hour.

Webb — who had been originally hospitalized after a brain bleed, a type of stroke — developed skin damage known as a pressure sore, or bedsore, on his bottom, the lawsuit said. The suit said the sore worsened after he was sent to a nursing home, which the family is also suing, then home, and he died later that year. In his final weeks, Webb was unable to stand, sit, or move much because of the injury, the lawsuit said.

In court papers, Encompass and the nursing home denied negligence, as Encompass has in some other pending and closed lawsuits that accused it of failing to prevent pressure sores because nurses and aides failed to regularly reposition patients, or notice and treat emerging sores. Darby said Webb’s death occurred three months after his Encompass stay and was not related to his care at Encompass. He said no hospital with long-term patients could prevent every new or worsening pressure sore, but that Encompass’ rates were similar to the 1% national average.

One of Webb’s sons, Darel Webb, recalled a warning given to the family as they left an appointment their father had with wound specialists: A doctor brought up Christopher Reeve, the actor who played Superman in movies in the 1970s and 1980s.

“He goes, ‘Remember, Superman was paralyzed from falling off the horse, but he died from a bedsore,’” he said.

____

Jordan Rau has been writing about hospital safety since 2008. Irena Hwang is a New York Times data reporter who uses computational tools to uncover hidden stories and illuminate the news.

____

METHODOLOGY

To examine the medical rehabilitation hospital industry, we obtained and analyzed a database of inspection reports of freestanding rehabilitation hospitals from the federal Centers for Medicare & Medicaid Services, or CMS. We also obtained inspection reports from several states through public records requests.

We analyzed inpatient rehabilitation facility characteristics and patient volume data contained in hospital data files from the Rand Corp., a nonprofit research organization. This dataset compiles cost reports all hospitals submit each year to CMS. For each facility for the years 2012 to 2023, we categorized annual discharges by facility type (freestanding rehabilitation hospital or unit within an acute care hospital); facility ownership status (for-profit, nonprofit, or government); and which hospitals were owned by Encompass Health under its current or prior name, HealthSouth.

Financial information about Encompass Health was obtained from the company’s Securities and Exchange Commission disclosure filings.

We examined the readmission rates for all inpatient rehabilitation facilities that CMS publishes in its quality data. CMS evaluates the frequency with which Medicare patients were readmitted for potentially preventable reasons to an acute care hospital during their rehab stay. Separately, CMS also evaluates the frequency of potentially preventable readmissions to an acute care hospital within 30 days of discharge from rehab. We also examined the rate of successful return to home or community. Figures for all three metrics were available for about 1,100 of the roughly 1,200 rehab facilities in the CMS data. The most recent readmission data covered Medicare discharges from October 2021 through September 2023.

We examined nursing home penalties from the last three years from CMS’ data on nursing homes.

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

By Georgina Boos, Bloomberg News

Who’s paying for Donald Trump’s tariffs? So far, American businesses and consumers.

General Motors Co. was the latest U.S. company to disclose how the levies are raising costs, with the automaker saying Tuesday that the duties dented profits by more than $1 billion as it chose to absorb the blow. That helps explain why car prices didn’t rise in last week’s inflation data, while robust price increases for other commonly imported goods like toys and appliances showed those tariff expenses are being passed on to consumers.

Meanwhile, import prices excluding fuel were up notably in June, suggesting foreign companies aren’t shouldering the burden by offering U.S. firms lower prices — challenging the president’s claims that other countries pay the rate. Trump reiterated that characterization on Tuesday after a meeting with his counterpart in the Philippines, saying that country “will pay a 19% Tariff” in a post on social media.

While customs duties are giving a significant boost to U.S. revenues, the data show that those coffers are being filled domestically.

“The top-down macro evidence seems clear: Americans are mostly paying for the tariffs,” George Saravelos, global head of FX research at Deutsche Bank AG, said in a note Tuesday. “There is likely more pressure on U.S. consumer prices in the pipeline.”

Many economists agree, especially as relatively tame readings in the consumer price index this year underscore firms’ hesitation to pass on tariffs to customers. That’s also been evident in the producer price index, where the rate of increase in a measure of margins for wholesalers and retailers has slowed sharply in recent months.

“With little relief on import prices, domestic firms are stomaching the cost of higher tariffs and starting to pass it on to consumers,” Wells Fargo & Co. economists Sarah House and Nicole Cervi said in a note last week. “The recent rise in import prices points to foreign suppliers generally resisting price cuts.”

Granted, there are some signs that foreign suppliers are absorbing part of the impact to keep goods flowing to the U.S. Export prices in Japan have contracted for three straight months, and the country’s carmakers cut prices to the U.S. in June by a record in data going back to 2016.

But for many foreign companies, the slide in the U.S. dollar has incentivized them to raise their invoice prices to compensate, according to Wells Fargo. And Deutsche Bank’s Saravelos said the pressure on U.S. firms so far to bear tariff costs is another headwind for the greenback, which is already on its worst start to a year since the 1970s.

Forecasters doubt U.S. corporations will sacrifice profits for much longer. 3M Co. raised its earnings outlook last week as shifting production and pricing changes will help mitigate the impact of tariffs. Nike Inc. is planning “surgical” price hikes to help soften the blow, as the company expects the levies to increase costs by about $1 billion.

“If consumers and foreign firms are not bearing tariff costs, domestic firms are. That is something that eventually should be reflected in corporate earnings announcements,” Citigroup Inc. Chief U.S. Economist Andrew Hollenhorst said in a note Tuesday. “We will be listening this quarter, but firms may still emphasize uncertainty and (perhaps rightly) expect that the burden sharing can shift in coming months.”

(With assistance from Catherine Larkin and Carter Johnson.)

©2025 Bloomberg L.P. Visit bloomberg.com. Distributed by Tribune Content Agency, LLC.

By Shalina Chatlani, Stateline.org

States must begin verifying millions of Medicaid enrollees’ monthly work status by the end of next year — a task some critics say states will have a hard time carrying out.

A provision in the tax and spending bill President Donald Trump signed into law July 4 will require the 40 states plus Washington, D.C., that have expanded Medicaid to check paperwork at least twice a year to ensure those enrollees are volunteering or working at least 80 hours a month or attending school at least half time.

The new law provides states $200 million for fiscal year 2026 to get their systems up and running. But some experts say states will have difficulty meeting the deadline with that funding and worry enrollees might lose their health benefits as a result.

A year and a half to comply is likely not going to be enough time for most states, especially since the federal government must craft guidance on how they should implement their programs, said Dr. Benjamin Sommers, a health economist at Harvard T.H. Chan School of Public Health. He predicted it will be difficult to create technology simple enough — such as a phone app — to streamline the process for all enrollees.

“Two hundred million [dollars] is not going to cover the 40 expansion states that we have,” he told Stateline. “There is not a silver bullet here, and there isn’t a single app out there that’s going to keep people who should be in Medicaid from losing coverage. That’s just not realistic.”

A spokesperson for the North Carolina Department of Health and Human Services, Hannah Jones, told Stateline that “it will take a significant amount of time and investment in order to implement work requirements.”

Jones said an estimated 255,000 people in North Carolina could lose coverage because of these requirements and their “administrative burden.”

“More automation reduces manual work on beneficiaries and eligibility case workers, but it requires more time, funding, and staff resources to implement,” Jones wrote in an email.

Emma Herrock, a spokesperson for the Louisiana Department of Health, wrote in an email that the vast majority of the state’s Medicaid enrollees already work, and the agency expects few people to be disenrolled. Herrock said the department will establish work verification systems by the end of 2026.

“The department is taking a thoughtful approach to implementation,” Herrock wrote. “We are already working with several Louisiana agencies … in order to receive data on recipients who are working.”

She added that the department views work requirements “as a means to grow our economy, while reinforcing the value of work and self-sufficiency.”

In New York, it could cost the state $500 million to administer the new requirements, New York Department of Health spokesperson Danielle De Souza wrote in an email.

Between 600,000 and 1.1 million individuals who are eligible for and enrolled in Medicaid could potentially lose coverage because of work reporting requirements, she wrote, based on what happened when states were required to resume checking eligibility after the COVID-19 health emergency ended.

“The department will remain steadfast in its commitment to protecting the health of all New Yorkers and will work to mitigate the impacts of this law,” De Souza wrote.

The new rules apply to states that expanded Medicaid to adults between the ages of 19 and 64 with incomes below 138% of the federal poverty line (about $22,000 for an individual), an option that was made available under the 2010 Affordable Care Act. More than 20 million people were enrolled through Medicaid expansion as of June 2024 — those are the patients who will face work requirements.

Reapplying for Medicaid, which typically has been required once a year, already is burdensome for some patients, said Dr. Bobby Mukkamala, president of the American Medical Association.

“On top of that, now we’re going to be challenging so many people who were at least able to deal with it financially with things like … proving that they got a job,” Mukkamala said in an interview.

Previous attempts at implementing work requirements have ended up costing states millions in administrative and consulting fees. And in some cases, people who were eligible for Medicaid lost their coverage due to paperwork issues.

Arkansas’ example

Several states wanted to implement work requirements during the first Trump administration. But only Arkansas fully did so, in 2018, before a federal judge halted the requirements. More than 18,000 Arkansas residents lost Medicaid coverage during the 10 months the requirements were in effect.

Sommers, of Harvard, noted that most people were disenrolled because they didn’t know about the policy or made paperwork errors, not because they weren’t working.

“Red tape led to people losing their coverage,” he said. “They had more trouble affording their medications. They were putting off needed care.”

Brian Blase, president of the Paragon Health Institute, a conservative policy group that advises congressional Republicans, said he thinks concerns about the new requirements are overblown because there’s more advanced technology now.

“Lots of government programs have initial implementation challenges,” Blase told Stateline. “Arkansas was seven years ago, and if you just think about the change in the technological advancements over the past seven years … we didn’t have artificial intelligence and just the ability of modern tech.”

As it stands, each state has varying technological capabilities, and will have a different timeline and budget, said Michael Heifetz, a managing director at consulting firm Alvarez & Marsal and a former Medicaid director in Wisconsin. His team contracts with states to implement Medicaid, including work requirements, and other programs.

He also noted that the Trump administration can give states a deadline extension on implementing work requirements to Dec. 31, 2028, if they show they are making a “good faith effort.” States will need to share data across agencies in new ways, he said.

“It will require some form of data sharing and communications with educational agencies, workforce training agencies and some other agencies that typically aren’t in the Medicaid ecosystem,” Heifetz said.

State governments may resist hiring full-time positions for those tasks, he said, but “artificial intelligence and other tools can help work through these processes in a smoother fashion.”

Other state efforts

Efforts in other states to implement work requirements have had mixed results.

In Georgia, for example, an experimental work requirement program cost taxpayers more than $86 million in its first 18 months but enrolled just 6,500 people during that time, according to an investigation by ProPublica and The Current published in February. That’s 75% fewer participants than the state had estimated for the program’s first year.

The nonpartisan U.S. Government Accountability Office in 2019 looked at five states that tested systems to track Medicaid work requirements under the first Trump administration. Those demonstration projects were rescinded during the Biden administration.

The states estimated their projected administrative costs for implementing work requirements for one to three years, and the total far surpassed the $200 million Congress has provided in the new law. Kentucky alone estimated $270 million, Wisconsin $70 million, Indiana $35 million, Arkansas $26 million and New Hampshire $6 million.

Susan Barnidge, an assistant director on the GAO health care team and an author of the report, said the agency found that across states there wasn’t much federal oversight of administrative costs on test programs. Oversight will be key as states roll out their work requirement systems, she said.

“We found some weaknesses in [federal] Centers for Medicare & Medicaid oversight of certain federal funding for certain administrative activities. So we found examples of things that states sought federal funding for that didn’t appear to be allowable,” Barnidge said in an interview. “I think that will remain relevant.”

Mukkamala, of the American Medical Association, said the burden will in some ways fall to doctors’ offices to help keep patients enrolled, as they work with patients to check eligibility and possibly help get them on Medicaid. He works in Flint, Michigan, as an otolaryngologist, or ear, nose and throat doctor, and said a third of his patients are on Medicaid.

“As if it’s easy to take care of their health care issue, given things like prior authorization,” Mukkamala told Stateline. “Now to add to the challenge, we have to figure out how to get them covered.”

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.

©2025 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

By Roberta Burkhart, Pittsburgh Post-Gazette

Many people don’t know it, but men under age 40 are the most likely age group to develop testicular cancer.

Just ask Jay Riepenhoff of Upper Arlington, Ohio, who was 29 and still adjusting to life as a new father when he discovered a suspicious lump.

He wasn’t thinking cancer. In fact, Riepenhoff got up for work the next morning and forgot all about it.

He felt the lump again that night, and thought he’d maybe set an alarm to remind himself to call the doctor the next day.

Riepenhoff didn’t feel the first twinge of worry until his doctor told him to come in immediately. And then sent him the same day for an ultrasound.

“Still, I even thought in my head, ‘I’ll go check it out. It’s not like it’s cancer,’” he said.

Soon, Riepenhoff discovered what many don’t realize: Of the approximately 10,000 cases of testicular cancer diagnosed annually, 51% are diagnosed in young men between the ages of 20 to 34, according to the National Cancer Institute, part of the NIH.

Yet a recent survey from The Ohio State University Comprehensive Cancer Center shows that few Americans — just 13% — associate the disease with young men.

“When you’re young, in your 20s or your 30s, you certainly do think your health is just something you might take for granted,” said Shawn Dason, a urologic oncologist at OSU’s cancer center and an associate clinical professor of urology at The Ohio State College of Medicine. “You’re more focused on other parts of life: your career, your family, your education.”

While 6% of testicular cancer cases are diagnosed in children and teens and another 8% affect those older than age 55, the vast majority of cases affect men aged 20 to 50. The average age of diagnosis is 33, according to the American Cancer Society.

It is the most common form of cancer among men 20 to 40 and the second most common cancer (trailing leukemia) in ages 15 to 19, but it can happen at any time, according to John Hopkins Medicine.

The Ohio State survey questioned 1,008 respondents about their knowledge of testicular cancer and found general awareness lacking in many areas.

While most — 63% — knew that testicular cancer is often curable if caught early, just over half correctly said that self-checks should be conducted every month. Additionally, two-thirds of respondents thought that medical evaluations should be conducted during annual exams after age 40.

But waiting until 40 would miss the men most at risk — young men like Riepenhoff.

Self-exams are most relevant between the ages of 20 and 40 and are especially important for anyone with a family history of testicular cancer or who has had an undescended testicle at any time during their life, Dason said.

A painless lump is the most common first sign that testicular cancer may be present, Dason said. Often, that lump will continue to grow and possibly harden.

Few men report that pain is associated with lumps, he said, adding that many incorrectly assume that the absence of pain means the lumps are harmless.

If the cancer has spread — becoming metastatic — other symptoms could develop, like abdominal and back pain, or a cough and shortness of breath if it has spread to the lungs.

Still, testicular cancer is among the rarer cancers compared to, for instance, prostate cancer, the second most common cancer in men after skin cancer. There are approximately 313,000 new cases of prostate cancer diagnosed annually and nearly 36,000 deaths from it every year, according to the American Cancer Society.

While not as prevalent as other cancers, testicular cancer is a fast-growing one, Dason said, and one that will spread to other parts of the body if left untreated.

The majority of testicular cancer cases are curable, however, especially when they’re caught early.

“Now that might beg the question, ‘Well, if it’s mostly curable, what would be the harm in just finding it later?’ And the harm is really that he might need more treatment to ultimately cure it. And these treatments, they can be pretty serious.”

When testicular cancer metastasizes, it often requires a far more invasive surgery — one with a longer, more challenging recovery, Dason said.

Chemotherapy, too, is generally necessary when the cancer spreads. It is a life-saving measure and “a critical instrument in achieving a cure in many patients,” but it can have a variety of both short- and long-term side effects, many of them unpleasant.

“We really do have evidence that some men will pass away from testicular cancer. And so could those men, if they had presented earlier, have been saved? Very, very possibly,” Dason said.

In Riepenhoff’s case, testing following his radical orchiectomy — the surgery to remove his cancerous testicle — revealed that the cancer had begun to spread, and he underwent three weeks of chemotherapy. All of his treatment took place at the OSU cancer center, although he was not treated by Dason.

Fertility especially becomes a concern when chemotherapy is necessary, Dason said.

Riepenhoff and his wife, Rana, had welcomed their first child, John Patrick Riepenhoff V, just five months before he discovered the cancerous lump. They had long hoped for three children, so before surgery, Riepenhoff chose to freeze sperm in case treatment affected his ability to have more children.

His fertility was not affected, and they expect to welcome their second son in August.

While testicular cancer is highly curable — the 5-year survival rate is 95%, per the National Cancer Institute — dismissing the early symptoms such as a newly discovered lump can make it much more challenging to treat.

Dason pointed out that younger men — and, often, men in general — have acquired a reputation for putting off medical care until absolutely necessary.

In his experience as a physician, Dason said, younger men tend to eschew annual physicals. “When you’re in your 20s and your 30s, there aren’t a lot of chronic health conditions that these young men have, and a lot of them are not regularly visiting their primary care provider.”

Plenty of patients put off seeking care “because they were embarrassed about it, or they were busy or they were hoping it would go away.” Often, a partner is the one who insists they finally see a doctor, he said.

“It’s normal to have a male sexual health complaint. It’s normal to feel something abnormal and go get it checked out. And that’s what our medical practitioners are there for: to help out with all of these concerns, not just a flu or an ankle injury.”

And like Riepenhoff once did, many young men see cancer as a far-off threat. And it’s just not discussed much, Riepenhoff said.

Riepenhoff pointed out that breast cancer awareness is everywhere. “You hear it from parents, schools and physicians,” he said. “But with testicular cancer, I don’t really recall. I’m sure in school we talked about it one time or something, but I don’t ever recall that being hammered into your brain the way that breast cancer is.”

He understands well the reasons men might wait to reach out to a physician.

“I’m sure there are a lot of men out there that got testicular cancer that waited to go to the doctor because they just thought it was an abscess or something. Nothing to be worried about. Had they known that this could be testicular cancer, they may have gone to the doctor earlier, and that can change your diagnosis pretty dramatically.”

Riepenhoff said he asked his doctor what would have happened if he had waited to come in or if he skipped the chemotherapy.

“He said within a year or two, I would have been dead.”

© 2025 the Pittsburgh Post-Gazette. Visit www.post-gazette.com. Distributed by Tribune Content Agency, LLC.

By Bernadette Joy, Bankrate.com

“Renting is throwing money away.” Has anyone ever told you this? Well, I’m here to say: It’s bad financial advice.

My husband and I have owned four different homes in three cities since 2010. If I wanted to, I could buy a house in cash today. But for the last three years, I’ve chosen to rent instead — and my net worth has grown by leaps and bounds because of that choice, not in spite of it.

This is always a hot topic, especially because renting challenges the traditional rhetoric that homeownership is the ultimate path to wealth. And I get it — owning a home is part of the “American Dream.” But if it doesn’t lead to financial freedom, homeownership may be more like a nightmare.

Let me show you how renting, when done intentionally, can actually make you richer.

Renting avoids the hidden costs of homeownership

When you own a home, you’re not just paying the mortgage — you’re also responsible for home maintenance, property taxes and insurance. In fact, Bankrate’s 2025 Hidden Costs of Homeownership Study found that the average annual cost of owning and maintaining a single-family home is more than $21,000.

Now, you’ll incur some of these costs when renting, too. Unless your rental unit includes utilities and internet, you’re probably going to have to pay out of pocket. You’ll probably pay less in electricity than you would in a large, single-family home, but for the sake of argument, let’s take these average costs at face value.

Omitting the expenses you’ll still have when renting, homeownership costs an average of $15,391 — that’s almost $1,300 you could free up each month.

While there aren’t any states that require renters insurance, most landlords have a provision in their rental contracts requiring this form of coverage. While typically less expensive than homeowners insurance, renters insurance is another cost to factor into your calculations.

And don’t forget about mortgage interest

My clients are always shocked when I have them review the amortization table for their 30-year mortgage. In the early years of your mortgage, a large percentage of your monthly payment goes toward interest. You’re not really building equity in the first few years of a mortgage — you’re mostly paying interest.

Let’s say you borrowed a $420,000 mortgage. You qualified for a 6.75 percent mortgage rate on a 30-year term. Your monthly payment is $2,724.

Of your first mortgage payment, only $362 pays down the principal balance — a whopping $2,363 goes toward interest. The balance does shift over time, and by the end of your 30-year term, the bulk of your payment goes toward the principal. But how likely is it that you’ll see the mortgage through to the bitter end, without selling or refinancing (and starting the clock all over again)?

I’ve helped five clients make the decision to sell their homes in 2025, and none of them lived there longer than a decade. So much of their money has gone to interest, and they won’t get much equity in return.

After five years of dutifully paying $2,724 every month, you’ve only gained about $25,000 in home equity. Meanwhile, your mortgage servicer will have made nearly $138,000 from your loan interest. Your five years’ worth of mortgage payments cost you $163,440, and in return, you got $25,000 in equity. Hardly seems worth it.

Rather than paying $15,000 per year in homeownership costs and vast sums of mortgage interest, I pay my rent. Sure, I won’t get a return on that money, but more cash stays in my pocket — cash I can put toward investments. Use a mortgage calculator to take a look at your amortization table and crunch the numbers for yourself.

Renting frees up capital for wealth-building

“Real estate always appreciates in value.” This one’s a myth — just ask anyone who sold a home during the 2008 financial crisis. My husband and I paid $10,000 out of pocket to sell his home at the time.

Yes, real estate can appreciate, but it’s also highly market- and location-dependent. In the past three years, the investments I’ve made in the stock market and my financial education business have significantly outpaced the return I would’ve made on a home in my local market — and with much less headache.

Unfortunately, several of my clients bought their homes at the height of the pandemic boom and are now seeing their home values decline from their peaks.

In today’s economy, renting is increasingly the more affordable option.

According to those numbers, you could save more than $9,000 per year by renting. That money could go a long way for many Americans, and even further if you reallocate that money into wealth-building assets.

After selling my home and returning to renting, I took the proceeds of the sale and invested in growing my business — that cash injection allowed me to surpass my first $1 million in revenue. In the time since, my husband and I have also contributed the maximum amount to our 401(k)s and individual retirement accounts (IRAs), allowing us to pursue early retirement.

When I transitioned from homeownership to renting, I used the proceeds from my home sale and invested in low-risk, interest-bearing accounts, like high-yield savings accounts, money market accounts and certificates of deposit (CDs). This passive income has covered my rent and other living expenses.

I have more money working for me as a renter than I did as a homeowner.

Renting can offer new social networks and income opportunities

Some of my older coaching clients tend to wrongly believe that renting equates to a decrease in quality of life. I’ve been happy to dispel that myth when they comment on the dance, improv and travel that my renting lifestyle accommodates.

I live in a one-bedroom rental in a walkable neighborhood filled with restaurants, music, theater and fitness. Post-COVID apartment buildings often feature co-working spaces, gyms and even social events that allow me to meet people from all walks of life. I felt a lot more isolated in the suburb where I used to live, which was more homogeneous, less active, and farther away from cultural events.

I’ve also been able to find more side hustles than when I lived on the outskirts, like teaching financial literacy classes or dog walking and babysitting for neighbors in my building.

The combination of downsizing and renting has also allowed me to pick up and move quickly to capitalize on potential business or job opportunities in other cities. I can afford global travel with business partners using the money I previously spent on lawn care and home DIY projects. I’ve expanded my social and professional networks and spend more time doing things that bring me joy.

Why renting can be strategic

According to Bankrate’s 2025 Emergency Savings Report, fewer than half of U.S. adults have enough emergency savings to cover three months of expenses, and about a quarter have no emergency savings at all. When you don’t have money set aside for a rainy day, it’s especially important to have tight control over your monthly spending — predictable monthly payments are key.

A fixed-rate mortgage may seem stable, but property taxes can always go up. Insurance premiums can rise, and maintenance is always more expensive than you think. Avoiding surprise repairs to water heaters, HVAC systems or roofing can also decrease the anxiety of not having enough cash savings on hand, especially when those repairs cost thousands of dollars.

Your next steps

• What expenses will actually help me build the life I want?
• Do I want a house in the suburbs because I believe it’s what’s expected of me?
• Could my money be better spent elsewhere?
• If I already own a home, have I considered the real-world costs associated with my mortgage, maintenance and other housing costs?
• How do my homeownership costs compare to rentals in my area?

Final thoughts: Owning a home can be great — if it fits your financial plan

As a first-generation American, I felt the weight of my family’s expectation to live out the American Dream — after all, they emigrated here so I could realize it. But I’m living proof that renting isn’t a step back, nor should you feel any shame for choosing to rent.

It’s been a strategic move that’s made me richer — financially, mentally, and emotionally.

Think of rent the same way you think of a gym membership or software subscription — it’s a monthly cost that may support the lifestyle you want. It’s not “throwing money away.” It’s buying peace of mind, freedom of movement and time to grow wealth in other ways.

For me, real wealth isn’t found in square footage. It’s in the daily opportunity to move and live freely according to what aligns with my own version of the American Dream.

©2025 Bankrate.com. Distributed by Tribune Content Agency, LLC.