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

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

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

"This is an issue that had been top of mind eve

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