WEST DES MOINES, Iowa -- As the coronavirus pandemic continues to unfold, Iowa's first responders say the state should no longer hold off on declaring Emergency Medical Services an essential service.

That status is something EMS workers in Iowa have sought long before COVID-19. Being declared "essential" would require ambulance service across the state, instead of relying on a patchwork of volunteers, agencies and providers.

Mark McCulloch, deputy chief of EMS for West Des Moines Emergency Medical Services, says he thinks the current crisis will prompt those who have resisted such a move to reconsider.

"The understanding of how important and how critical our services are, I think, is increased," he states.

McCulloch says the lack of guaranteed emergency medical services is especially a problem in rural parts of Iowa, where younger adults are moving away and reducing volunteer ranks.

Having the state approve a plan to guarantee emergency medical services would open the door to funding for EMS in these communities. But some tax revenue would also be needed, a move that some lawmakers oppose.

Stacy Frelund, government relations director for the American Heart Association of Iowa, says even though the state's budget has been battered by the economic downturn, that doesn't mean this funding should fall into a political debate.

"Being able to get them some more resources that they need throughout the state, I think is really, really important, especially now in the time of COVID -- when, you know, there's a lot of uncertainty," she stresses.

And beyond the current crisis, Frelund says rural areas need a stronger network of ambulance service for heart attacks and stroke-related calls.

Just before the pandemic, various bills were being considered in the Iowa House. Their supporters hope they see a revival as lawmakers take a long look at the state budget when they reconvene in early June.

The U.S. House is preparing to vote on the Safeguard American Voter Eligibility Act, a bill voting rights groups said would block millions from registering to vote.

The legislation requires proof of citizenship, such as a passport, military papers or an original birth certificate, documents many Georgians do not have on hand.

Lauren Groh-Wargo, CEO of the advocacy group Fair Fight Action, called it the "Voter Cancel Act," arguing it would strip voting rights from young people, women and marginalized communities.

"We shouldn't be passing bills in Congress to take away 21 million Americans' rights," Groh-Wargo contended. "In Georgia, here, not only is it about 80,000 folks we estimate don't have that documentation."

Supporters of the bill claim it would strengthen election security by ensuring only U.S. citizens can vote in federal elections. But Groh-Wargo pointed out there is no evidence of widespread noncitizen voting and warns the measure could lead to more voter roll purges, an issue which has already affected many Georgians.

She said Fair Fight Action is working to educate voters on the bill's potential impact and urging them to engage with their representatives. Groh-Wargo also noted the bill could have major consequences for online registration.

"Every year in Georgia, many Georgians get registered to vote through automatic voter registration," Groh-Wargo emphasized. "That is when you go get your license or update your license, you're automatically reregistered to vote."

Sarah Harris, director of media engagement for the nonprofit Stand Up America, said the bill would be especially burdensome for rural voters and married women, many of whom have birth certificates which do not match their current legal names. She warned similar laws in other states have already prevented people from voting.

"A lot of people do not have readily available their birth certificates or their passport," Harris stressed. "And when this was tried in other states, like Kansas, let's say, they had a similar law, 31,000 eligible American citizens in the state were actually blocked from registering to vote."

Harris called the bill a "de facto poll tax," noting getting a passport costs $130. She added Stand Up America has mobilized its members to send more than 60,000 emails urging lawmakers to reject the measure before the upcoming vote.


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Minnesota's rural health-care landscape is described as being "stressed" - and the diagnosis could become grimmer if congressional Republicans keep their sights on Medicaid when reducing spending.

Specifics need to be sorted out, but the budget framework advanced by House Republicans this week is expected to include major cuts to Medicaid, so lawmakers can adopt President Donald Trump's tax-cut plan. Health-care voices have said the government insurance program has a big presence in rural areas.

U.S. Sen. Tina Smith, D-Minn., touched on that issue in a news conference hosted by Protect Our Care when discussing how Minnesotans would feel the pain.

"Many of the patients that show up for care at rural hospitals are folks that get their insurance either through Medicaid or through Medicare," she said. "It tends to be in rural communities; an older and often sicker group of people."

Smith added that losing reimbursements would force more rural providers to make tough decisions by doing away with services such as maternal care or pain management.

House Republicans have said they're eyeing a final plan that "makes government work more effectively for all Americans." But they're already seeing backlash in their home districts.

Mark Jones, executive director of the Minnesota Rural Health Association, said the situation in this state isn't as dire compared with other parts of the country. But he said deep Medicaid cuts would still overwhelm the landscape as providers in smaller towns try to stand upright.

"We've seen providers leave, we've seen services cut," he said. "We've made our way through the pandemic, and now one more struggle - much of which we have no control over or little control over."

Jones reminded people that Medicaid coverage isn't a handout. He said recipients in rural areas - who often are working - have little choice but to turn to programs such as these.

"The wages aren't there to support commercial health care," he said, "or employers are very small and can't offer a group plan."

If congressional Republicans go big on Medicaid cuts, with more than $800 billion currently projected, Jones said, Minnesota's list of rural hospital closures could grow longer. Six have shuttered since 2005, which he said hurts local economies and makes communities less attractive.

"If you're trying to recruit a teacher at the school, or you're trying to recruit somebody at the law office or the bank downtown, when they come to town to look at your community and you don't have a hospital," he said, "that's kind of a sign that your town isn't very healthy."


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A lawsuit to halt the firing of probationary federal workers gets a hearing before a district court judge in San Francisco this afternoon, even as the Trump administration readies a new round of job cuts.

A coalition of unions and nonprofits is asking for thousands of federal workers to be able to stay on the job while the matter is litigated.

Don Neubacher, a retired former superintendent of Yosemite National Park and Point Reyes National Seashore, works with the Coalition to Protect America's National Parks. He said civil servants deserve better treatment.

"They were told they were fired because they were bad employees but the evidence so far is just the opposite," Neubacher pointed out. "They were good employees and it was just an excuse, so we believe it was an illegal firing and they didn't follow a lawful process."

Yesterday, the Trump administration doubled down, indicating it will now seek to lay off people with civil service protections in order to cut costs. A new memo from the Office of Personnel Management instructs agencies to submit a plan for a reduction in force by March 13. By mid-April, agencies must offer a plan to reorganize management and move certain jobs out of Washington, D.C.

Neubacher argued the chain saw approach is counterproductive.

"This is just chaos," Neubacher stressed. "Right now, the National Park Service probably has the lowest morale that I've ever seen in my career in the Park Service, and I worked 36 years, so it's overall just crippling."

A dozen groups are party to the lawsuit, including the American Federation of Government Employees, VoteVets, and the United Nurses Association of California.


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