Nearly 30 states provide direct funding to community health centers, and there's a push to add North Dakota to the list. Supporters say the extra boost would help maintain care in medically underserved areas.

Community health centers are non-profit providers that address barriers to certain types of care - including primary, preventive, dental and behavioral. They see all patients regardless of insurance status or ability to pay.

Shelly Ten Napel - CEO of the Community Healthcare Association of the Dakotas - said they're asking for approval of a bill that for the first time, would lend state support to North Dakota facilities as they navigate current headwinds.

"It's a tough time across the health-care system," said Ten Napel. "There's been pretty significantly rising wages - just a lot of workforce shortages after the pandemic."

These centers rely on federal funding, insurance billing, and a sliding fee scale. The state Senate approved a bipartisan bill providing $1 million in the next budget after an initial request of $2 million.

Ten Napel acknowledged that they're competing with other needs, but hopes the House is receptive to their plan.

Neutral testimony noted that state funding might clash with private competition.

Ten Napel said beyond maintaining current services, they want to expand their reach for certain care.

She noted that there's a significant challenge right now when it comes to some North Dakotans accessing dental care.

"We'd love to commit more resources to even a mobile unit," said Ten Napel, "that can bring access to dental care into a larger number of communities."

She said the state funding could enhance work some community health centers are doing with local schools to address behavioral health needs among students.

Other organizations have testified in support of the plan, including Community Action Partnership of North Dakota, which says community health centers play a key role in establishing better health outcomes for those experiencing poverty.

Nearly 36,000 North Dakotans receive care from 21 sites around the state.

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.