NASHVILLE, Tenn. - The number of Americans who now have health coverage under the Affordable Care Act (ACA) continues to grow, but a new analysis finds that especially in rural states, there are many who still cannot access affordable insurance. All states were given the option to expand their Medicaid programs, but many did not - and Jon Bailey, director, rural public policy program, Center for Rural Affairs, said those were mostly states with large rural populations.

"Then the converse is true for states that have a higher portion of their population in urban areas. They're more likely to have expanded Medicaid. So, if you live in a rural area, in a state that has a high rural population, it's less likely that you'll get the benefits of the Medicaid expansion," Bailey said.

Tennessee is among the states that have rejected federal dollars to expand their Medicaid programs - although the debate is about to resume, since the General Assembly reconvenes on Tuesday.

In rural states with no Medicaid expansion, there is a significant coverage gap for low-income workers who earn too much to qualify for Medicaid but not enough to receive tax credits so they can afford to buy policies in the new health insurance marketplaces. Bailey said the number of people falling into that coverage gap, percentage-wise, is about as large as the group of people whose policies did not comply with the ACA - and for that group, some action was taken.

"Congress introduced bills. The president came up with a plan to solve the problem for a year. That group of people is almost equal to the people in this coverage gap who have no insurance options at all. And really, very few people are talking about how to reduce those people's problems," he said.

Nationally, he estimated, nearly 1.8 million rural and small-city residents fall into the coverage gap.

The full study is available at http://bit.ly/1dq7Giu. TN Medicaid information is at http://bit.ly/19n5sok.




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A plan to use public money to fund vouchers for students to attend private schools is drawing pushback from Louisiana teachers, who say the plan could devastate the public school system.

The program making its way through the Louisiana Legislature would be first available to low-income students and by the 2027-2028 school year, it would be available to all students.

Larry Carter, president of the Louisiana Federation of Teachers, predicts the plan could cause significant budget cuts for public schools.

"These universal voucher bills are a step in the wrong direction," Carter argued. "We've seen in other states around the country, like Arizona and Ohio, where these bills have been passed, they're now facing a budget crisis, and we're hoping that we cannot go down that same road."

Carter pointed out the education savings account program known by the acronym LA GATOR would allow as much as $7,500 per student from families below 250% of the Federal Poverty Line, and $5,000 for those who make more.

The plan, House Bill 745 and companion Senate Bill 313, has been approved by the state House. The Senate is expected to vote on it by Friday or Monday.

Carter explained teachers are concerned classroom standards currently mandated for public schools would not be upheld in private or parochial schools.

"We want to make sure it has some accountability," Carter emphasized. "We think that's at least giving all education stakeholders and parents an opportunity to talk about whether this program is successful or not. And through accountability practices, we think that will help."

There is concern the plan would force public schools to eliminate many positions and needed programs. Carter fears the loss of funds could deprive students of the benefits of a public school education.

"If we're cutting that funding stream, Louisiana students will have fewer nurses and counselors, less options for after school program, and certainly limited access to field trips and AP courses that help prepare them for their next step in life," Carter outlined.

New York City advocates are excited yet concerned about the 2025 budget.

In recent weeks, funding was restored to certain education programs such as shelter-based community coordinators. They helped more than 40,000 city students living in temporary housing. Funding for school psychologists and social workers was also restored.

Randi Levine, policy director at Advocates for Children of New York, said other programs need to be saved.

"Funding is running out for the Mental Health Continuum, which is a program that provides students in 50 schools with access to expedited mental health care, and is very important especially when we have a youth mental health crisis," Levine asserted.

Other programs facing cuts include restorative-justice practices which help schools reduce suspension. The budget's feedback has been mixed considering many programs will stay, although some could still be cut. Although the programs began using short-term funding, Levine feels their lasting effects in a post-pandemic world make them a permanent necessity.

Immigrant education programs are on the chopping block too. Promise NYC provides child care for kids regardless of their immigration status, and the immigrant family communication and outreach initiative helps parents who do not speak English learn about their kids' school.

Murad Awawdeh, president and CEO of the New York Immigration Coalition, said it would be a mistake to cut funds for things such as the language access program.

"That program, which would expand language access across the city of New York, which would build an interpreter bank as well as build translation cooperatives across the city and could save the city millions of dollars, was defunded and not restored," Awawdeh pointed out.

He added the recently passed state budget does give New York City enough funding to restore certain initiatives, but not enough to bolster others. Awawdeh argued with housing unaffordability continuing and people struggling to make ends meet, the city has to step up to aid everyday New Yorkers.


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It might not be surprising that North Dakota ranks low for electric vehicle adoption, but existing owners say they are frustrated elected officials here resist the movement, making it hard for this consumer activity to flourish in a rural state.

Gov. Doug Burgum and the state's two U.S. senators have recently spoken out against regional and federal efforts to aid in the transition to EVs.

Shannon Mohn, a member of the North Dakota EV Owners group and automotive instructor at Minnesota State Community and Technical College, said there is too much politics surrounding the issue, leaving states such as his behind in adding fast charging stations. He wants officials to know there are people in the region not worried about being left in the cold by EVs.

"I don't worry about driving anywhere with my electric car, I really don't," Mohn emphasized. "I can make it there and back without a problem."

He noted a big factor is that he can charge it at home and park it in his garage on cold nights. Mohn acknowledged it takes additional planning to cross North Dakota, given the current infrastructure landscape. North Dakota is using federal money awarded to states to enhance its charging network, but Sen. Kevin Cramer, R-N.D., has contended incentives are a waste, arguing there is not a strong market.

Mohn pointed out while EVs might see their range affected by the cold, gas-powered cars are less efficient in the winter, too. He feels dotting the state with more charging stations will naturally attract more EV owners. He also contended there is an economic benefit for rural areas because tourists are likely to make a pit stop in smaller towns if they can charge up.

"I won't go and visit a town that doesn't have a charger if I'm traveling," Mohn explained. "I will bypass their towns and go to a town that does have a charger."

The Bureau of Labor Statistics said even with political forces and other factors at play, many forecasts still expect a strong acceleration in EV adoption. Mohn is glad the Biden administration has been aggressive in gaining momentum but feels some mandates invite opponents to ramp up attacks deemed political. He recommends more outreach for the public to learn about the cars as the industry monitors growth trends.


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