AUSTIN, Texas - Despite a new poll showing the majority of Americans don't want big changes to Medicaid, Texas lawmakers haven't given up on efforts to wrest control of the program from Washington.

State legislators during the current special session have revived a bill that would instruct the federal government to give Texas its share of Medicaid dollars in lump sums, allowing more flexibility in how the money's spent. If passed, the plan would still need federal approval. That's a tough hurdle as long as the White House and the Senate are controlled by Democrats.

So far, only the GOP-led U.S. House has said "yes" to such an overhaul of Medicaid, in a budget that also would cut the program by a third. States could get by with less money, Republicans argue, if it came in the form of block grants.

Kathleen Stoll, director of health policy for the consumer group Families USA, disagrees. She says states, and ultimately families, would bear the burden of a shortfall.

"A block grant does not provide more flexibility; that flexibility exists now. It simply shifts costs. If you've got a tornado that hit and a lot more people on Medicaid, you're going to have to foot the bill yourself."

The Texas measure says the state should decide who's eligible for Medicaid, set co-payment levels, and generally encourage "a culture of individual responsibility" by using various private-sector ideas to overhaul the program.

A new study by the Kaiser Foundation shows that about 60 percent of Americans want to keep Medicaid in its current form, and just over half don't want federal contributions cut. It's a level of support similar to that for Medicare and Social Security.

Julie Weckel, with the National Association of Social Workers, says some lawmakers seem to think reducing entitlement spending would somehow reduce the need for care. They're fooling themselves, she says.

"If we don't provide for the basics of survival - housing, food, basic medical care - how is it that we can say that we're this great nation, when we are taking away the supports that are needed for our most vulnerable?"

Currently, Medicaid is an open-ended program, with federal funds covering 50 to 80 percent of each state's expenditures. Texas ranks 49th in reimbursement rates, meaning the gap between the cost of care and Medicaid payouts for that care is the second-largest in the nation.

National survey results are at bit.ly/iFLcbm.

A study on the state impact of the GOP plan is at bit.ly/jbAOxE




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Pennsylvania's landscape is undergoing a transformation, paid for with billions in federal funding from the Inflation Reduction Act and the Bipartisan Infrastructure Law.

The state is expected to receive more than $13 billion over five years for highways and bridges.

David Gunshore described himself as a "semiretired inspector," working on a bridge project in Clarks Summit and said it's being paid for 100% by federal dollars. Gunshore said the crumbling bridge was built in 1959 and last rehabbed in 1983, and stands 65 feet above railroad tracks.

"Like a lot of the concrete, it rots out and it falls, that means it deteriorates and breaks out," Gunshore explained. "So you cut all that out, and you re-patch it with new stuff, so that the rot can't go any deeper into the pillars. We're redoing the bridge deck and the piers, the pillars, the columns that hold it up."

Gunshore estimated the bridge project will be finished by next fall. As of March of this year, the Bipartisan Infrastructure Law had allocated more than $15 billion to Pennsylvania, for more than 450 projects. Of those funds, $6.7 billion are for highways and just over $1 billion for bridges.

Gunshore pointed out in his years on the job, the construction industry seems to have struggled more under Republican administrations but thrived during President Bill Clinton's tenure and with the Fixing America's Surface Transportation Act during Barack Obama's presidency to fix roads and transit lines. Gunshore thinks it has been money well spent, noting the Biden-Harris administration's support for construction, manufacturing and apprenticeship programs.

"Big government spends the money but you're building roads, people get jobs, and money goes into the economy, and you're still ending up with new roads and new infrastructure," Gunshore emphasized. "I think that's one of the best investments going, that and health care, because the better the health care, the less people are going to get sick."

Gunshore noted the last major federal project he worked on, the Twin Bridges project, is underway to replace two mainline bridges in Lackawanna County. He added there is a lot of work to be done and jobs are available for the project.


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Nebraska is one of four states with measures about state funding of private-school vouchers on the ballot this year. Referendum 435 asks voters to decide whether to repeal the school voucher program passed on the last day of the 2024 legislative session.

Backers of the law claim vouchers are needed by low-income families who can't otherwise afford to send their children to a private school. But studies show that in a number of states, most who benefit from school vouchers are not from low-income families.

Tim Royers, president of the Nebraska State Education Association, said this has been borne out in Iowa.

"In Iowa, for example, who just implemented their voucher system last year," he said, "the median income for the voucher recipients is roughly $120,000."

Iowa data also show that more than two-thirds of the students using vouchers had already been attending a private school.

Another of NSEA's objections is that the law doesn't benefit all of Nebraska, since more than half the counties have no private schools. Critics of the voucher programs say they siphon state funds away from the public school system.

Royers said choice is fine - as long as it's publicly accountable choice.

"As long as private schools can discriminate and deny certain children admission; as long as they don't have to follow the same testing and reporting requirement that we do, we just don't feel public tax dollars should go to those institutions," he said.

Arizona's private-school voucher program has ballooned in scope and cost, and contributed to the need for significant state budget cuts. Dave Wells, research director at the Grand Canyon Institute, a "centrist think tank" in Phoenix, says Arizona's voucher program means the state is essentially supporting two school systems - public and private.

"In Arizona, we can't afford to do that, and it's had really negative impacts," he said. "And I think it has especially negative impacts on rural areas where there aren't private schools even to pick from. And the people who benefit the most from this are people who can already afford to go to private schools, is what we've found in Arizona."

Former President Donald Trump and Vice President Kamala Harris are trying to appeal to labor groups on the campaign trail.

A much-debated policy blueprint is lighting a fire under Minnesota unions, who warn about the threat to workers. Republicans, including Trump, have tried to distance themselves from Project 2025, a wish list of policy moves drafted by a conservative think tank. But attempts to disavow the project are not easing the concerns of those opposed to it, including the Minnesota Association of Professional Employees, which represents more than 15,000 state government workers.

Megan Dayton, president of the union, found the overall tone from Trump and his advisers troubling.

"This plan promises to dismantle government services," Dayton pointed out. "Donald Trump wants to privatize the Department of Veterans Affairs. This really hits home for us in Minnesota and for MAPE because we have members who help veterans receive specialized care."

Project 2025 lays out a number of union-related reforms, including regulations dealing with overtime rules. In 2018, Trump signed executive orders weakening unions' ability to negotiate contracts and cut hours union reps were able to tend to member complaints. While the former president downplays connections to the plan's authors, other conservatives argued the initiative is about government accountability.

The Minnesota Association of Professional Employees and other Minnesota unions, including the American Federation of State, County and Municipal Employees Council 5, argued the conservative vision under Project 2025 aligns with broader efforts to chip away at individual rights. Dayton noted like so many other populations, it affects their members.

"They (conservatives) are consolidating power by removing the checks and balances that I think have defined our republic since its founding," Dayton asserted.

On a national scale, Harris has the backing of a number of key unions, including the AFL-CIO and the United Auto Workers. However, the International Association of Firefighters and the International Brotherhood of Teamsters declined to endorse anyone in the presidential election.