BISMARCK, N.D. – Medical professionals in North Dakota are facing pressure from all sides, feeling the pains of a growing shortage of doctors and potential changes to a visa program that helps supply doctors and wondering what will happen to health insurance at the federal level.

President Donald Trump's review of the H-1B visa program has raised anxiety for the Peace Garden State, where 4.7 percent of physicians come from the program, and the highest rate in the country.

Courtney Koebele, executive director of the North Dakota Medical Association, says the state's rural nature can make it hard to attract doctors.

"The H-1 visa program helps us recruit people that normally wouldn't consider North Dakota, and what we hope is that the people come here to work and they fall in love with North Dakota and they stay," she states.

There are around 400 foreign-born doctors working in North Dakota. In fact, the vice president of Koebele's association, Dr. Fadel Nammour, came to the United States from Lebanon through the visa program and now works as a gastroenterologist in Fargo.

Koebele says people in rural parts of the state sometimes have to drive hundreds of miles to see a specialist.

She's also worried about proposed changes to Medicare and Medicaid. Trump's recent budget proposal suggested cutting Medicaid by $800 billion over the next decade and the American Health Care Act could affect funding for Medicare.

Koebele says that could be bad news for North Dakotans looking for doctors.

"As we cut back on these low-income protections like Medicaid and Medicare, that really undercuts the whole system because if there's a shortage of doctors for Medicaid and Medicare, then there's a shortage of doctors for everybody," she stresses.

Koebele notes there also are problems with the Affordable Care Act that need fixing. The nation faces a shortage of doctors as the population ages.

According to the Association of American Medical Colleges, the country could be in need of an additional 95,000 doctors by 2025.





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Legislation in Albany would create the first right to counsel for people in immigration court.

The Access to Representation Act would provide immigrants the right to an attorney in their New York immigration cases, ending the tendency to represent themselves if they cannot afford one.

Estimates show a backlog of more than 330,000 immigration court cases, and fewer than half have attorneys. Studies show without legal counsel, migrants are less likely to remain in the U.S.

Marlene Galaz, director of immigrant rights policy for the New York Immigration Coalition, described what the bill would do.

"It has a six-year ramp-up to start implementing and building infrastructure," Galaz outlined. "Having a pipeline between law schools for law students to go into immigration practice, and getting to nonprofits and so on."

Galaz noted most opposition centers around the $150 million to fund the program but pointed out the total expenditure is less than 1% of the state's $229 billion budget. She added anti-immigrant rhetoric has also damaged support for the bill. Currently, it is in the state Senate Finance Committee.

The New York City Comptroller's office said enacting the bill would benefit the state financially. It could keep about 53,000 people from being deported, which would result in almost $8.5 billion in local, state and federal taxes over the next 30 years.

Galaz emphasized the influx of migrants has saturated the court system, leading to what could have been an avoidable backlog.

"I firmly believe that if these investments had been made when we first asked for them, I believe, like, three years ago, then we wouldn't be struggling," Galaz contended. "We would have had the infrastructure built to address an increase in welcoming our newest neighbors."

A Vera Institute survey showed 93% of New Yorkers across party lines and regions support access to attorneys for all people, including those in immigration court, and government-funded attorneys for them.


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Story has been updated to reflect late-night 5th Circuit Court of Appeals decision.(8:01 a.m. MST, Mar. 20, 2024)


The U.S. Supreme Court handed Texas Gov. Greg Abbott a big but temporary win Tuesday in his battle to stop the flow of migrants crossing the Texas-Mexico border.

Late Tuesday night, the 5th Circuit Court of Appeals put the law known as Senate Bill 4 on hold again. It would give state and local law enforcement the authority to arrest migrants as they cross into the U-S.

The Biden administration argued that the law would interfere with federal immigration law and is unconstitutional.

David Coale, an appellate attorney in Dallas, said if the state gets the authority to make arrests, he thinks it will move with caution.

"I think that Texas will want to make some very high-profile moves under this statute," Coale predicted. "But they also don't want to potentially expose themselves to massive civil rights liability if it turns out they're wrong."

Under SB-4, crossing the border illegally is a Class B misdemeanor, punishable by up to six months in jail. The appeals court hears oral arguments in the case today. Meanwhile, a Mexican government official said his country won't accept migrants deported under SB-4.

The Supreme Court justices did not issue a reason for allowing the law to go into effect and there's been no clear timetable for how or when Texas will start enforcing it. In 2012, the Supreme Court struck down parts of a similar law in Arizona, saying an impasse in Congress over immigration reform did not justify state intrusion.

Coale noted if the law is ultimately upheld, it would give each state the right to make its own immigration laws.

"If you give Texas a pass, you know, New York will have a different policy and California will have a policy and Montana will have a policy," Coale pointed out. "And they will not be consistent."

All six of the court's conservative justices agreed with the decision to allow the law to take effect - a ruling that, at least for now, was in effect for only a few hours.


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Both chambers of the New York state Legislature have included coverage for all legislation in their respective budgets.

The bills would update the state's Affordable Care Act Section 1332 waiver to make coverage available for all income-eligible people, regardless of their immigration status. Studies show half of likely undocumented immigrants and around 18% of lawfully present immigrants are uninsured.

Arline Cruz Escobar, health programs director for the group Make the Road New York, said the challenges stemming from a lack of coverage make life harder for the undocumented population.

"A lot of these preventable illnesses are going undetected and so, unfortunately, people are getting sicker," Cruz Escobar pointed out. "It also means that a lot of people who currently are sick aren't able to actually access the medication that they need."

One of the biggest obstacles to passing the bill is anti-immigrant rhetoric spreading across the country. However, many groups across the state submitted testimony declaring their support and need for this bill.

Cruz Escobar argued the growing migrant population in places such as New York City makes the bill more necessary. The New York City Comptroller's Office found the number of migrants not living in New York City but still in its care grew from 276 last May to more than 2,100 last September.

Beyond helping immigrants, supporters said the bill will benefit the state financially. The New York City Comptroller's office estimates passing coverage for all will generate $710 million in annual benefits.

Cruz Escobar described other elements of the bill.

"We have also included in our legislation language around giving the Commissioner of Health the ability to set up guardrails to ensure that for this expansion we don't over-cede the amount of surplus that's available."

She added the commissioner would also ensure there would be no additional cost through state dollars. Estimates showed New York State plans to spend more than $4 billion between 2022 and 2026 on issues related to migrants. Current spending is estimated at around $690 million.


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