The next few days will be critical for Senate Republicans’ effort to repeal and replace key parts of the Affordable Care Act. Senate Majority Leader Mitch McConnell will release a new version of the bill Thursday, and aims to hold a key vote on it early next week.

If that process fails, McConnell has floated the idea of working with Democrats on a bipartisan measure. “No action is not an alternative,” he said in Kentucky during the July 4^th recess. “We’ve got the insurance markets imploding all over the country.”

Democrats aren’t exactly sitting by the phone waiting for that call.

“I don’t think they’ll do it until they’re sure they can’t do it their way,” said Sen. Claire McCaskill, D-Mo.

But if it does happen, Democrats are prepared to drive a hard bargain. A broader measure would need 60 votes to advance, not 50 like the current GOP measure. That means moderate Democrats would suddenly be the key swing votes who have leverage over the bill’s language.

Democrats like North Dakota Sen. Heidi Heitkamp and Montana Sen. Jon Tester are both up for reelection next year in deep red states. Both say they’d be happy to deal — but that Republicans would need to drop their push to scale back Medicaid spending. “That has to come off the table,” said Heitkamp. “We cannot be turning back the clock on Medicaid.”

“If eliminating Medicaid, or trimming it back, or however they want to put it is the price for admission, then it’s going to be very difficult,” said Tester.

Interestingly, Tester doesn’t have as firm a line on another defining aspect of Obamacare — its mandates, like the one requiring that every adult American purchase health insurance.

“I hate them,” Tester said. “But they’re there for preexisting conditions and lifetime caps, and insurance for 26-year-olds. If you figure out a different way to do it, my ears are open.”

Most other Democrats are a bit more definitive than Tester on the law’s trademark coverage mandate — they wouldn’t deal if it were threatened.

The third key Democratic demand is ditching the tax breaks in previous versions of the Republican bill. “Of course not,” said Vermont Sen. Bernie Sanders, an independent who caucuses with Democrats. “This is a health care bill. What does that have to do with tax breaks?”

But there’s one increasingly popular Democratic idea that senators say they wouldn’t bring to the negotiating table: Single-payer health care.

In recent years, more and more Democrats have rallied around a large, government-run health care program as their preferred position. Even a majority of Americans approve of such a system according to a Kaiser Family Foundation survey.

While party leaders aren’t quite embracing single-payer, it’s become the default starting point on health care policy for large swaths of the party’s base, as well as many rank-and-file lawmakers.

“It’s irrelevant. It’s irrelevant for us,” said Sen. Sherrod Brown of Ohio. “The issue is stopping Medicaid cuts and stopping this awful bill.”

Sanders has championed the single-payer push, but agrees that in the current political environment, it’s a fight for another day. “I have no illusions that under a Republican Senate and a very right-wing Republican House, and an extremely right-wing president of the United States, that suddenly we’re going to see a Medicare-for-all, single-payer pass. You’re not going to see it. It’s obvious,” he said.

Sanders does plan on introducing a single-payer bill in the coming weeks, but said, “Right now, my immediate concern is that thousands of people, every single year, do not die when we throw 22 million people off of health insurance.” He was referring to a Congressional Budget Office estimate that the original version of the Senate GOP bill would result in 22 million fewer Americans with coverage in 10 years, compared to current law.

Minority Leader Chuck Schumer and other Democrats say they’d focus on stabilizing current health insurance markets, and expanding options for people stuck in markets with limited coverage options.

Of course all this remains hypothetical, unless McConnell isn’t able to round up the votes he needs to pass a GOP bill under special budget rules that only require 51 votes.

While he does that, Democrats will continue making their case to voters, raising their warnings about people losing health insurance and hoping to keep enough Republicans from voting for the bill they settle on in the coming days.

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Michael McBrayer of St. Paul, Minn., needs to pay a lot attention to his health.

“I give myself shots multiple times a day, as well as controlling my diet and exercise,” he says.

Ten years ago, McBrayer learned he has Type 1 diabetes. Now he knows he faces dire consequences if he fails to control his blood sugar.

“Kidney failure, blindness, heart disease — all those things are looming out there,” he says.

McBrayer has health insurance through his wife’s employer, the state of Minnesota. It’s a HealthPartners health insurance plan that charges extra to employers — in this case, the state — to cover diabetes care. So for the past several years, McBrayer’s plan has paid for everything he needs to keep his diabetes in check. He doesn’t spend a dime on supplies.

Diabetes, high blood pressure and other chronic conditions account for the vast majority of health spending in the U.S., according to the Centers for Disease Control and Prevention. Almost half of American adults have one or more chronic physical or mental health conditions, and spending on them adds up to some $2.3 trillion a year.

Some health plans are beginning to offer free maintenance care for people with chronic health problems, hoping that spending a little more early on will save a lot money in the long run.

“We’ve been trying change the health care conversation in the United States from how much we spend to how well we spend,” says Dr. Mark Fendrick, head of the University of Michigan’s Center for Value-Based Insurance Design.

He says it makes both medical and economic sense to make properly managing chronic conditions affordable.

“I want the health insurance plan my patients have to charge my patients the least for the services that are going to make them healthier,” he says. “Let’s allow those to be covered on a pre-deductible basis; you’re not leaving the patients paying 100 percent of the cost.”

That may seem like common sense, but health plans have been running hard in the opposite direction. Consumers are on the hook for a rapidly increasing amount of their health costs — in large part to try to curb health costs.

But corporate buyers of health insurance are starting to realize that people may be putting off necessary care, says Mike Thompson, who runs the National Alliance of Healthcare Purchaser Coalitions. The organization advises around 12,000 organizations that buy health plans for tens of millions of Americans. He says those who provide insurance need to take a thoughtful look at what they pay for and what consumers should pay for.

“So that people are more prudent on discretionary care but are more compliant with the care they need and certainly the case they need to stay healthy,” Thompson says.

If people have to pay out-of-pocket for care they might not need, they may think twice, but their day-to-day health needs are taken care of.

One major obstacle to this approach, known as “value-based health insurance,” is an IRS rule that does not allow free maintenance care for chronic conditions for the 20 million Americans with health savings account-qualified, high-deductible insurance.

The enhanced insurance benefit that pays for all McBrayer’s Type 1 diabetes maintenance is paying off for state taxpayers, according to HealthPartners, his provider.

That program has helped quadruple the number of diabetes patients with optimal care, saving the state about $1 million on medical services since its inception almost 10 years ago, says Dan Rehrauer, a program manager at HealthPartners.

“We’ve shown that we’ve reduced hospitalization and emergency department utilization, which is exactly what we want to see,” Rehrauer says. “You’ve got a healthy employee and that results in not ending up in the hospital and saving money.”

This story is part of a reporting partnership with NPR, Minnesota Public Radio and Kaiser Health News.

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Senate Republican leader Mitch McConnell warned his GOP colleagues they may have to work with Democrats if they can’t pass their own health care bill. NPR takes a look at what Democrats would want if that happened.

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When people take medicine at home, mistakes happen.

Some people end up taking the wrong dose of a medication or the wrong pill. Sometimes, they don’t wait long enough before taking a second dose.

Other times, it’s a health professional who’s at fault. A pharmacist might have dispensed a medication at the wrong concentration, for example.

These kinds of mistakes are on the rise, according to a study published Monday in the journal Clinical Toxicology.

The researchers looked at a small subset of the medication errors that happen in the U.S. every year. The FDA estimates that about 1.3 million people are injured by medication errors annually in the U.S.

The study analyzed data collected by poison control centers across the U.S. and counted only errors that happened outside health care facilities and resulted in serious medical outcomes. That’s defined in the study as symptomsthat typically require some treatment to life-threatening situations and even death.

They found that the number of these cases doubled, from 3,065 cases in 2000 to 6,855 cases in 2012. In the 13 years covered by the study, more than 67,000 such errors occurred, and 414 people died as a result. Most of the mistakes were preventable, the study finds.

“We know that a third of the cases in this study resulted in hospital admissions, so these aren’t minor errors. These can be pretty significant,” says Nichole Hodges, a research scientist at Nationwide Children’s Hospital in Columbus, Ohio, and the study’s lead author. She says errors at home represent a significant public health burden and are likely undercounted.

“Since we’re only including those non-health care facility errors that are reported to poison control centers, it’s an underestimate of the true number,” she says.

Jay Schauben, a former president of the American Association of Poison Control Centers, points out that not everyone calls a poison control center when they experience one of these events. And he says there could be “minor inaccuracies” in the data from poison control, because the employees who answer calls are relying on what the caller tells them, and if a physician calls about a patient, that physician might not know exactly what happened to the patient.

Despite these limitations, he says the study’s findings are still valid and useful. And he says he’s glad to see this study draw attention to medication errors happening at home.

“We focus on medication errors in health care facilities, and we tend to forget that these types of errors do occur in the home scenario and potentially go uncorrected, maybe unrecognized,” Schauben says.

Cardiovascular drugs, including drugs used to treat high blood pressure, were associated with about one in five serious medication errors — more than any other pharmaceutical category.

The number of errors with cardiovascular drugs doubled over the time period of the study, and errors linked to hormones and hormone antagonists – mainly drugs used to treat diabetes – more than tripled.

Hodges says they can’t be sure about the reasons for these increases, but they have a theory.

“We know that use of cardiovascular medications is increasing. That’s consistent with the findings of other studies,” she says. “The same with the use of insulin. Because we have rising rates of diabetes in the U.S., prescribing of insulin is increasing. So we think that some of these increases in errors are a reflection of the increase in prescribing.”

Cardiovascular medications and analgesics – essentially painkillers, including acetaminophen and opioids — were responsible for two-thirds of the deaths included in the study.

So what should people do to keep themselves safe from medication errors at home? Hodges has a few recommendations.

People who use weekly pillboxes to organize medicines should make sure they have some kind of lock and keep them out of sight of children, she says.

“The locks are great, but they’re just child-resistant. They’re not going to be child-proof,” she says. “It basically buys you a little bit more time, but it’s not going to keep the child out of it completely, so you still want to use safe storage.”

And keeping a close eye on kids who are taking medication can also help them avoid taking the wrong pills, she says. The study found that kids in the 6- to 12-year-old groupwere the most likely to unintentionally take or be given another person’s medication.

“Perhaps they are giving themselves their medication, especially if it’s a daily,” Hodges says. “They might be more likely to accidentally take someone else’s medication.”

She also recommends that parents and caregivers keep a written log to track the date and time when medications are given and the dose given – especially when more than one person is giving medicine to the same person.

Schauben recommends that people call a poison control center if they have questions about medicines they’re taking at home.

“It doesn’t have to be an exposure,” he says. “Those are questions that we could answer for them.”

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Senate Majority Leader Mitch McConnell, R-Ky., plans to release an updated Republican health care bill on Thursday and is delaying the body’s annual August recess by two weeks in an effort to generate momentum for the beleaguered legislation.

“In order to provide more time to complete action on important legislative items and process nominees that have been stalled by a lack of cooperation from our friends across the aisle, the Senate will delay the start of the August recess until the third week of August,” McConnell said in a statement. Originally senators were supposed to head home at the end of July.

The GOP will also release an updated version of their Better Care Reconciliation Act, which so far has drawn opposition from both moderate Republicans who say it goes too far in reducing Medicaid funding and conservatives who argued the bill doesn’t go far enough to fully repeal regulations and subsidies in the Affordable Care Act, or Obamacare.

McConnell had wanted to have a vote on the bill before the July 4th recess, but he didn’t have the votes he needed to pass it after at least five GOP lawmakers came out against the current version. There are currently 52 Republicans in the Senate and 50 need to support it to pass.

A revised Congressional Budget Office score, showing the costs and impact on coverage of the new version of the bill, is expected on Monday or Tuesday of next week. The CBO score of the first version found that the BCRA would leave 22 million more people uninsured by 2026.

A vote on a motion to proceed on the revised bill is expected by the end of next week. If that preliminary procedural measure passes, there will be debate on the bill that could go on for days.

Some Senators have already begun offering alternatives which could make it into the revised bill. Sens. Ted Cruz, R-Texas, and Mike Lee, R-Utah, have an amendment which would let insurance companies sell any health insurance plan they wish as long as they also offer at least one plan that is compliant with all of the coverage mandates outlined in Obamacare.

That would allow insurers to offer plans that do not comply with ACA regulations, like providing so-called “essential health benefits,” and would therefore provide less robust coverage and cost less. Critics say it will cause costs for people with pre-existing conditions who need more services to rise sharply, undermining protections in place for them.

The White House supports the amendment, and Cruz told reporters on Tuesday that he believes that plan is the key to a deal.

“I think the reason is that it is the necessary ingredient to getting the votes that we have to have to follow through on our commitment to repeal Obamacare,” Cruz said. “I believe we can get there. It remains challenging. More work remains to be done. But there is a path forward.”

GOP senators are already warning that failure to uphold their seven-year campaign promise to repeal and replace Obamacare could have reverberations with their base.

“We should not be surprised if people are irritated with the Republican majority when we have been promising, and we do not deliver,” Sen. Chuck Grassley, R-Iowa, said on Fox News Tuesday. “I am very pessimistic.”

However, the bill overall has little support with the American public. An NPR/PBS NewsHour/Marist poll earlier this month found just 17 percent support the Senate GOP bill, and that even GOP support for it is soft.

Ultimately, if this doesn’t work, Republicans may need to find a way to bring Democrats to the table, and Sen. Lindsey Graham, R-S.C., has hinted he’s working on a way to do just that in the coming days.

“We’re not there yet, but we’re working with governors, and we may be taking some of the critics of the current bill and converting them to supporters,” Graham told reporters on Tuesday.

NPR’s Susan Davis contributed to this report.

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Senate Republicans regrouped on Tuesday, as they tried to forge a path forward on health care legislation. The White House and GOP leaders pressed forward with the goal of voting next week.

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Recovery coaches and peer mentors – known in Alcoholics Anonymous as “sponsors” — have for decades helped people who are addicted to alcohol or drugs. Now, peer support for people who have serious mental illness is becoming more common, too. Particularly in places like Texas, where mental health professionals are in short supply, paid peer counselors are filling a gap.

David Woodside, who has been living with bipolar and schizoaffective disorder his whole life, is getting help this way. Not too long ago, he wound up in Dallas County jail for the first time, at the age of 57. Woodside had become upset and kicked his brother.

“Nothing good happens in jail,” he says. “They don’t give you your medication.”

After his brothers, including the one he kicked, bailed him out, Woodside enrolled in an anger management class in Dallas at Metrocare, a nonprofit serving people with mental illness in North Texas.

At Metrocare, Woodside also started visiting David Yarborough’s office several times a week. Inside, there’s an American flag on the wall, a popcorn machine in the corner, and tissues on the wooden desk.

The two Davids have a lot in common.

Both are fathers and have worked as electricians, and both are taking the same antipsychotic medicine. That’s because Yarborough is also coping with mental illness. He’s not a volunteer — he’s a full-time, paid, peer specialist. Woodside says, for him, meeting with Yarborough has been better than seeing a psychiatrist.

“[Psychiatrists] see you for about six or seven minutes,” Yarborough says. “They don’t know what’s going on with you. And Dave’s been through a lot of the things I’ve been through — and vice versa.”

Metrocare employs five trained peer specialists, including two who are part of the statewide Military Veteran Peer Network. In Texas, more than 900 people have gone through the statewide certification training process provided by the nonprofit organization Via Hope. The peer specialist training takes 43 hours over five days, and covers topics such as ethics, effective listening, the role of peer support in recovery and how to use your own recovery story as a recovery tool for others. The certification is valid for two years, and a person needs to earn continuing education credits during that time period to apply to renew their certification.

Dennis Bach, Executive Director of Via Hope, says most of the certified peer specialists are employed by community mental health clinics and state hospitals.

Jim Zahniser, a licensed clinical psychologist, researcher and consultant with The Meadows Mental Health Policy Institute, says the idea of peer services has been around for decades, but it’s only recently that studies have shown how powerfully effective the approach can be.

“One of the problems with mental health is we’ve learned how to keep people ‘stable’ on their medications and get them out of the hospital. But recovery is about having a life in the community,” Zahniser says. “And peer services are often focused on those things: How do you get your life back?”

Studies show peer support specialists can do as well as traditional case managers — if not better — in keeping patients with severe mental illnesses out of psychiatric hospitals.

And, Zahniser says, when it comes to convincing people who are suspicious of doctors to seek help, peers are often the ones who can connect fastest, and convince those who need help to get treatment and services.

For many years, peer specialists were volunteers. But as the Centers for Medicare and Medicaid Services recognized their value, and more training programs were established and standarized, it became easier for hospitals and clinics to employ these specialists full-time.

Texas is one of more than 35 states that finance peer services through Medicaid. There’s a severe shortage of mental health care providers in the state, so certified peer specialists are bridging the gap.

Joanne Spetz, a researcher of workforce issues with the Institute for Health Policy Studies at the University of California San Francisco, says peers play a critical role in mental health teams — alongside doctors and social workers.

“When [programs] first brought in peers,” Spetz says, “[they] had to spend a lot of time with the social workers, explaining to them that we were not going to take their work and hand it off to a cheaper person — that what the peer did was complimentary, but it was different.”

Yarborough was offered a job as a peer specialist precisely because of his success in coping with his own mental illness and overcoming his past use of methamphetamines. When he works with clients, he can talk openly about how, decade ago, he, too, fell into a very dark place.

“I went from the outdoorsman — fishing, yard work, just really enjoying all that stuff — to … the guy who wants to lie in bed all day and stare out the window,” Yarborough remembers.

He even started having suicidal thoughts.

“I gave my wife the key to my gun safe,” Yarborough says, “because I did not feel comfortable having access to my pistols.”

Eventually, Yarborough was diagnosed with bipolar II disorder. His condition has been stable for seven years and he’s been clean of meth and alcohol use for 10.

When he trained to become a peer specialist, Yarborough says, he learned how to work with others while keeping a close watch on his own mental health. Today, he helps dozens of people every week manage their symptoms.

His mantra? “It’s not how you fall, it’s how you get back up,” he says. “And I’ve really stuck to that concept.”

There can be a lot of stumbling with a mental illness, Yarborough notes, and having a shoulder to lean on can make the journey much smoother.

The idea of relying on peer providers in this way isn’t unique to the U.S.

“There are many parts of the world where peer specialists are being deployed in the health care system to provide mental health care interventions,” says Dr. Vikram Patel, a psychiatrist and professor of global health and social medicine at Harvard Medical School.

Patel says nearly 450 million people are affected by mental illness worldwide. In developing countries, the vast majority go untreated, he says, because psychiatrists are in such short supply. Patel has looked at the potential of peer support to help meet mental health needs in India and Pakistan.

“We’ve completed trials showing people affected by schizophrenia can be very effective in supporting other people in their own community by befriending them and giving them social support,” he says.

Patel is now completing a study that trains community members in how to best help some of their neighbors — mothers suffering from depression.

He hopes Texas and other states in the U.S. continue to experiment with using peer providers, especially to serve people who are finding it difficult to get access to mental health professionals.

“Many groups experience such difficulties — for example, minorities and those who are homeless,” Patel says. “This model is one that should be adopted and integrated into the mental health care system.”

This story is part of NPR’s reporting partnership with KERA and Kaiser Health News.

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Not that long ago, Maria Nalubega, 16, suspected she was pregnant.

The teen from Mbuya-Kinawataka, a slum in Uganda, had not been using contraception with her boyfriend of two years. She feared what her neighbors might think if they saw her buying condoms at the local shop. She was terrified to ask for advice from her single mother, who expected to her to abstain from sex until marriage.

And she simply thought she was too young to become pregnant.

In Uganda — where I also grew up — Nalubega’s circumstances are not unusual. It’s hard for young people to get information about sex and pregnancy. So they’re vulnerable to sexually transmitted infections and unintended pregnancies. In fact, one in four girls between the ages of 15 to 19 in Uganda has given birth or is carrying her first child, according to the country’s 2016 Demographic and Health Survey.

As a Global Health Corps fellow with a passion for adolescent health, I believe we can do better. I’m 28 and single, so I know that easy access to contraception and accurate information about birth control give women power over their bodies and lives.

Like Nalubega’s mother, my mother was a single parent. And she too never talked to me about sex. When I was about 9, I used to eavesdrop on my older siblings — who were about 10 years older than me — when they talked about sex. What was sex, exactly? Why was itsomething they spoke about in hushed tones? If I broached the subject, they said I was too young and would receive counselling on sex when I became “ripe” for marriage.

I was curious, so I joined a life skills class at school with the hopes that my questions would be answered. Peer educators from a local organization came in and put on shows with music, dance and drama to illustrate the dangers of sexually transmitted diseases like HIV/AIDS. They also talked relationship issues — like, how do you say no when a boy asks you for sex?

But the educators emphasized abstinence. They believed that you can’t trust anyone but yourself. Just because someone looks good or seems clean doesn’t mean they don’t have an STD. If you abstain, then you can save yourself a lot of trouble, they said.

I learned more about sex in my teens by reading books from the school library. I also got information from friends who were a lot more experienced. Some told me that it’s not worth it if you’re not ready.

Over a decade later, the subject of sex is still taboo in many homes across Uganda. Young people today have better ways to get the information themselves, from TV or the internet (although the internet is full of misinformation as well). But information alone doesn’t curb high-risk behavior, like not using condoms, that can result in teen pregnancies.

So how do we begin to teach young women what they need to know? Today, family planning stakeholders will meet in London for the Family Planning Summit to renew their commitmentto family planning, especially for adolescents and teen mothers. They’ll shine a spotlight on efforts that work, some of which I’ve seen first hand.

Currently, I work foran international organization on a project that helps pregnant teens and adolescent mothers in Uganda. We train health providers to offer teen mothers a range of contraceptive choices. And we encourage young mothers to tell their friends about family planning.

Health care workers need to have an open mind when they talk to pregnant teens. Instead of asking young women why they were having sex in the first place, they should ask: How can I support you to have a healthy pregnancy? How can we help prevent another pregnancy until your baby is at least two years old? On an emotional level, this can make it easier for women to talk to health care workers if they feel they’re not being judged.

We also need to keep girls in school.Although Uganda’s Ministry of Education encourages pregnant students to continue school as long as they can, stigma exists. Fellow students and school administrators often pressure pregnant girls to quit. They want to protect the image of the school.

Nalubegahad her baby three weeks ago. It’s a girl.Currently, she is taking a break from secondary school to care for her baby and breastfeed. Not being in school is “the most difficult part,” she says. “It hurts when my friends tell me all the exciting stuff that is going on. I feel like I have lost so much time.”

But that’s changing soon. Nalubega’s mom has offered to care for the baby so she can go back to school. She’s hoping to return in February.

All her future plans depend on it, she says.

And she has a definite goal in mind: Nalubega wants to become the kind of health worker that she wishes she had been able to speak with nine months ago.

Ritah Namwiza joined the Global Health Corps in July 2016 and has been working with the Uganda office of Jhpiego, an international health organization and affiliate of Johns Hopkins University.

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43 million Americans have medical debt that’s adversely affecting their credit, according to the Consumer Financial Protection Bureau’s most recent data.

Now, some relief may be on the way.

Changes in the way credit agencies report and evaluate medical debt are in the works. They should reduce some of the painful financial consequences of having a health care problem.

Starting Sept. 15, the three major credit reporting agencies — Experian, Equifax and TransUnion — will set a 180-day waiting period before including medical debt on a consumer’s credit report. The six-month period is intended to ensure there’s enough time to resolve disputes with insurers and delays in payment.

In addition, the credit bureaus will remove medical debt from consumers’ credit reports once it’s paid by an insurer. Some credit scoring models don’t penalize paid medical debt from any source.

The changes grew out of two efforts by states to aid consumers: a 2015 settlement negotiated by New York State Attorney General Eric Schneiderman and the three major credit reporting agencies, and an agreement shortly afterward between the agencies and 31 other state attorneys general. The changes will be instituted nationwide.

For many consumers, an unexpected health care calamity can quickly burgeon into a financial calamity. Just over half of all the debt that appears on credit reports is related to medical expenses, the CFPB found in its 2014 study. For 15 million consumers, medical debt was the only blemish on their credit report.

Perhaps this isn’t surprising given the growth in the number of people with high-deductible health plans and significant out-of-pocket financial responsibilities for health care, says Chad Mulvany, policy director at the Healthcare Financial Management Association, a membership organization for finance professionals.

“More people who typically would have been a good credit risk are now saddled with big bills,” he says.

The 180-day waiting period is “a big step forward toward a more equitable process,” says Julie Kalkowski, executive director of the Financial Hope Collaborative at Creighton University in Omaha, Neb., which provides financial education and coaching to low-income, single mothers.

Rather than attempting to collect past-due medical bills themselves, hospitals and doctors’ offices typically engage collection agencies to chase down payments. But the timing on when providers take that step varies widely.

“Without a standardized process, some bills get sent to collections because they’re 30 or 60 days past due, as opposed to six months,” Kalkowski says, citing several of the women who went through the Creighton program. The total amount owed in most cases was under $150, she says.

In fact, the average amount of medical debt in collections was $579, compared with $1,000 for non-medical debt, the CFPB found in its study. But even small amounts of debt can lead to credit problems. A bad credit score can prevent someone from getting a car loan, credit card or a mortgage, for example.

Lenders use credit reports and credit scores to evaluate the risk that someone won’t repay a loan. The credit-scoring companies build algorithms that use the data in people’s credit reports to assign a three-digit credit score, typically between 300 and 850, that summarizes someone’s credit risk based on the information in a credit report at that time. Higher scores indicate lower risk.

Credit-scoring companies like FICO and VantageScore have been adjusting their formulas to account for the fact that medical debt isn’t necessarily an accurate predictor of whether someone is a good credit risk.

“Those with medical accounts are less likely to default on their accounts than non-medical accounts,” says Ethan Dornhelm, vice president of scores and analytics at FICO.

To address this issue, newer FICO and VantageScore models differentiate between medical and non-medical debt. People with medical debt in collections receive a smaller penalty than those with non-medical collections, says Sarah Davies, senior vice president at VantageScore Solutions.

Under FICO9, the newest model, someone whose only major credit blot is one or more medical collections would see their median score improve roughly 25 points over older versions, says FICO’s Dornhelm.

But there’s a catch: Many banks and other lenders haven’t yet adopted the newer versions of the credit-scoring models. So even though medical debt shouldn’t have as strong an impact on someone’s credit score now, in many cases it still could.

What’s a consumer to do? You can’t control which scoring model a lender uses, but you can check your credit report regularly to make sure it’s accurate. Consumers are entitled to a free credit report from each credit reporting company annually.

“If there’s medical debt that’s been paid, it should be removed going forward, and if it’s less than six months old, find out when it’s going to be removed,” advises VantageScore’s Davies.

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Follow Michelle Andrews on Twitter @mandrews110.

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Voters in Kentucky react to the efforts by Senate Republicans to repeal and replace the Affordable Care Act. The Senate bill is extremely unpopular, especially in Kentucky, where Obamacare had great success.

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