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.

Congressional Republicans are taking a hard look at Medicaid as they pursue spending cuts and a new report shows how the public health program is preventing care access from further eroding in rural North Dakota and elsewhere.

A House GOP proposal floats a nearly $2.5 trillion Medicaid reduction. Findings from Georgetown University's Center for Children and Families showed people in rural areas are more likely than metro populations to receive health coverage through Medicaid.

Katy Kozhimannil, professor of health and policy management at the University of Minnesota School of Public Health, said the program is a key contributor to pregnancy care in these settings.

"Offering obstetric care is a financial challenge for hospitals as revenues may not cover the costs of providing that care," Kozhimannil pointed out. "Medicaid covers nearly half of all births nationally and plays a substantially larger role in paying for births in rural areas."

The report said in 2022, 52% of rural hospitals no longer had maternity wards, compared with 36% of urban hospitals. There is concern the gap would widen with Medicaid cuts and North Dakota almost leads the nation for lack of rural OB/GYN services. Some House Republicans insist the programs need reform to avoid a fiscal collapse. But skeptics said drastic changes are a way to offset a planned extension of federal tax cuts.

The report also pointed out residents in rural areas have worse health outcomes.

Joan Alker, executive director of the Georgetown University Center for Children and Families, said it demonstrates why Medicaid is so important, adding it serves as a lifeline to a range of populations living in these communities.

"It is serving children. It is serving seniors in nursing homes, people with disabilities," Alker outlined.

Alker noted Medicaid helps recipients get ahead of health challenges through preventive care, as
opposed to letting conditions worsen.

"People wind up sicker and then they're in the emergency room and children can't get their asthma inhalers and they miss school," Alker explained.

CLARIFICATION: An earlier version of this story noted the Children's Health Insurance Program as a component of Medicaid, before outlining Minnesota data. That version did not make clear that while under the same umbrella, there are differences. An update emphasizes Medicaid and CHIP when noting Minnesota data. (8:45 a.m. MST, Jan. 16, 2025)

In their pursuit of slashing government spending, Congressional Republicans are taking a hard look at Medicaid. But a new report shows how this public health program is preventing care access from further eroding in rural Minnesota and elsewhere.

The incoming Trump administration promises major budget cuts, and a House GOP proposal floats a nearly $2.5 trillion Medicaid reduction. But findings from Georgetown University's Center for Children and Families show people in rural areas are more likely than metro populations to receive health coverage through Medicaid.

Katy Kozhimannil, associate professor in the University of Minnesota School of Public Health, said its providers rely on it, too.

"Medicaid is an absolutely essential source of revenue for those hospitals to keep operating and to provide different types of services and additional training and support for clinicians," she said.

A key Medicaid component is the Children's Health Insurance Program. At 7%, the Georgetown report says Minnesota is among the states with the largest difference in the share of kids covered by Medicaid and CHIP when comparing smaller towns to urban centers. Some House Republicans insist these programs need reform to avoid a fiscal collapse. But skeptics say drastic changes are a way to offset a planned extension of federal tax cuts.

Joan Alker, executive director and co-founder of the Center for Children and Families at Georgetown University, called these budget proposals "horrifying," while suggesting the public might be caught off guard because the program wasn't really discussed on the campaign trail last fall.

"There was complete silence about it, despite the fact that it is the largest source of public coverage by far in the United States," she said. "It's also a very popular program with the voters of all political stripes."

Report authors stress the timing of the proposed cuts is especially bad as rural areas continue to grapple with hospital closures. 120 facilities have either closed or ceased offering inpatient services over the past decade. Many rural hospitals opt to shutter less lucrative units such as maternity wards. And the experts say Medicaid covers a majority of pregnancy care in smaller communities where these units still operate.

One topic expected to make a big splash during Wyoming's general legislative session is property taxes at many levels.

First on the agenda for the Freedom Caucus, Wyoming's House majority faction, is a 25% property tax cut on homes up to $2 million in value, passed by both chambers in 2024. Gov. Mark Gordon vetoed it, calling the fix "temporary and very expensive," as the state would have to pay the backfill.

Hank Hoversland, executive director of the Wyoming Taxpayers Association, said another piece at play is a state constitutional amendment voters passed in November.

"That provides the legislature a vehicle to make a separate class for property taxation purposes, that is, residential real property," Hoversland explained. "Then, it also allows there to be a subclass for owner-occupied, single-family residences."

Though the amendment passed, Hoversland pointed out legislators need to take action this session in order to give the change legs.

At the industry level, Wyoming law includes a property tax exemption for "property used to eliminate, control or prevent air, water or land pollution." Senate File 61, sponsored by Sen. Cale Case, R-Lander, would clarify carbon dioxide shouldn't count as pollution so the state can tax incoming carbon capture projects.

Hoversland stressed energy companies pay a large portion of taxes in the state.

"Just this past tax year, minerals paid about 46% of property taxes, while the all-other category -- including industrial, commercial, residential and ag -- paid 54% total," Hoversland outlined.

Earlier this month, the state also certified the first Wyoming citizen's ballot initiative in 30 years, slated to appear on ballots in 2026. It proposes cutting residential property taxes by 50% for homeowners who have lived in Wyoming for at least one year.


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