DES MOINES, Iowa – Since Iowa expanded its Medicaid program in 2013, more low-income rural residents are covered by health insurance.

A new report from Georgetown University shows that coverage gaps in states where Medicaid was expanded are much smaller than in states that did not expand.

Anne Discher, executive director of the Child and Family Policy Center with the Iowa Department of Human Services, says only 15 percent of Iowa's low-income rural residents were uninsured in 2016.

That's compared with a nationwide high of 47 percent in neighboring South Dakota, which chose not to expand.

"I think that Iowa's decision to expand Medicaid to low-income adults has really paid off and it's paid off across the state, really, including folks who live in small towns and rural areas in every part of the state," Discher states.

In 2016, Iowa moved its Medicaid program away from federal and state management and hired private companies to run Medicaid programs and administer benefits paid for by the state.

Medicaid serves 685,000 low-income or disabled Iowans.

Study co-author Joan Alker, executive director of the Georgetown University Center for Children and Families, says the uninsured rate for low-income adults has dropped much faster in states that expanded Medicaid.

She notes that unlike some states where the gap between metro-area uninsured residents and rural residents is significant, Iowa is nearly equal.

"And rural areas are struggling for a lot of reasons,” she states. “They already have a higher poverty rate. Oftentimes they have higher unemployment rates. And so being uninsured is just adding another woe to these struggling communities."

Discher says Iowa is a healthier state because more residents have insurance.

"Health insurance is the key that opens the door to the health care system,” she points out. “Without insurance, you just can't get the kind of regular care that you need to be healthy, to be a productive parent and worker."

Parents make up about half of rural low-income uninsured adults, many of whom are relied on by children as parents, child care providers, teachers or other caregivers.


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By Haley Miller for Chalkbeat Indiana.
Broadcast version by Joe Ulery for Indiana News Service reporting for the Chalkbeat Indiana-Free Press Indiana-Public News Service Collaboration.

When Alma Figueroa visited the homes of Indianapolis Public Schools students who were pregnant or parenting earlier this year, she noticed hazards that put babies at risk of suffocation or strangulation — from bed-sharing to stuffed animals in the crib.

But Figueroa has a response ready for the upcoming school year.

As the case manager for the IPS Stronger Tomorrows program for pregnant and parenting students, she plans to give them the items to guard against babies sleeping at angles in car seats or swings, sharing beds with adults or pets, and sleeping with loose objects. Figueroa wants the additional resources she’ll hand out, like sleep sacks and portable cribs, not only to lower the infant mortality rate in Marion County, but also help the parents feel secure enough to stay in school and on track to graduate.

“If their babies are not OK or if something is not going well at home, then we know that’s really going to affect their success at school,” Figueroa said. “Making sure that their babies are well is essential for them to be successful in the classroom.”

The resources Figueroa will distribute are supported through a $10,000 donation from the Shepherd Community Center.

In the 2023-24 school year, IPS had around 60 students who were pregnant or parenting, according to Figueroa; in the past school year, 14 IPS students who were pregnant or parenting graduated.

She said many of the students didn’t know about safe-sleep practices, or they didn’t have the money or space to provide a secure sleeping environment.

Figueroa also hopes the increased access to safe-sleep items will help reduce Marion County’s high infant mortality rate. In 2022, the county had an estimated 8.1 deaths for every 1,000 live births, compared to the statewide rate of 7.2 and the national rate of 5.6 in the same year.

“Do you have a place for the baby to sleep is a big thing,” Figueroa said. “A lot of our students were not prepared.”

A report released last year by the Indiana Department of Health found that 528 babies died suddenly and unexpectedly from 2015 to 2019, and 99% of the deaths had at least one unsafe sleep risk factor present.

In Figueroa’s experience, providing resources like safe-sleep items for pregnant students before they give birth is key to help them feel prepared when the baby comes and stay on track to graduate.

Figueroa noted that the district created the Stronger Tomorrows program to ensure pregnant and parenting students know their rights under Title IX — a civil rights law that prohibits sex-based discrimination by schools that receive federal funding — and remove barriers to their education.

The program helps students receive accommodations from their school, like excused absences, and connects them to organizations in the community where they can access support for young parents.

The Shepherd Community Center received grant funding specifically to promote safe-sleep initiatives on the eastside of Indianapolis, said Jay Height, the group’s executive director.

“We believe IPS is doing a great job, and it’s important for our neighborhood to have strong schools,” Height said. “This is one of many ways that we support them and our students.”


Haley Miller wrote this article for Chalkbeat Indiana.


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In Pennsylvania, a unique mobile van brings reproductive resources to communities across Western Pennsylvania. A new podcast, called "(In)Accessible," explores the challenges people have in finding reproductive healthcare, including abortion, in the state.

Podcast host Rebecca Susman, communications and development director for the Keystone Progress Education Fund, said it features guests doing innovative work to address these barriers, with topics like fertility treatments and menopause care. Susman describes one of the conversations.

"I spoke with Alecia Ott from The Auto(nomous) Body Shop or the 'auto body shop,' which is an amazing mutual aid van, where she brings it all over the place, to universities, to events. And she gives out information about birth control and emergency contraception - as well as harm reduction, such as Narcan," she said.

In Pennsylvania, abortion remains legal until 24 weeks of pregnancy, and it's one of the closest locations to receive care for people living in many nearby states with abortion bans.

In the podcast, Alecia Ott explains that when she parks the van, she puts out a chalkboard inviting people to stop by for free information and contraception. The eye-catching orange van often sparks curiosity.

"You'd be surprised at how quickly somebody is telling me a story about how they accessed care, or they had to help somebody else find a place to have an abortion or emergency contraception or, you know, fertility help. People are sharing really intimate stories very quickly," Ott said.

Ott points to a few resources, like the Steel City Access Network in Pittsburgh, that provide transportation for abortion seekers, while the Western PA Fund for Choice offers financial assistance. She also envisions a collaborative network of mobile units to strengthen her advocacy.

Susman said the podcast also has covered the impact of the Dobbs decision, and the confusion people may have about their options, with ever-changing legal challenges in nearby states. She sees Pennsylvania's current abortion access as the result of strong political leadership, but acknowledges it could be under threat.

"Every single seat in the House, the Pennsylvania House, is up for grabs this fall. And we have another state Supreme Court election as well. This could all change. And these decisions happen because of who we elect into office and who they appoint, so it's very, very important that we all show up this November," Susman explained.

California has shattered heat records left and right this month and temperatures are forecast to be 10 degrees above normal this weekend, so the state wants to remind workers of their right to shade, free cold water and rest breaks.

Employers are required to train workers on how to prevent heat illness.

Charlene Gloriani, senior safety engineer for the California Division of Occupational Safety and Health, said employers must provide shade when the temperature climbs to over 80 degrees.

"When temperatures exceed 95 degrees, a buddy system should be in place and employees must be monitored for signs of heat illness," Gloriani pointed out. "Also, cool-down rest periods are required every two hours."

She added new workers must be watched for their first two weeks on the job, to make sure they are acclimatized to the heat. In June, the Occupational Safety and Health Standards Board passed new regulations regarding excessive heat in indoor workplaces, which are expected to take effect in the next few months.

Gloriani noted indoor rules come into play when it is at least 82 degrees inside.

"The indoor heat regulation requires employers to assess the indoor temperatures," Gloriani explained. "Generally, if it's above 87 degrees, cool the workplace or implement other engineering controls."

Workers who see abuses of heat policies are encouraged to file a complaint with Cal/OSHA. You can enter your ZIP code on the agency's website to find the office nearest your work site.


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