As South Dakota continues to implement a Medicaid expansion approved by voters in 2022, controversy has emerged with some lawmakers seeking approval for work requirements.

The state Senate recently advanced a bill to put the issue on the November ballot. Voters would be asked whether some Medicaid recipients should have to prove they are employed as a stipulation for receiving the expanded health coverage. The provision would not apply to those with a physical or mental disability.

Jill Franken, retired director of Sioux Falls Health Department, said such a move would create undue burdens for those who just found out they qualified.

"This is just going to be another way of it becoming very confusing to people that already have very stressful lives and are trying to make ends meet," Franken contended.

Franken argued the requirement would keep more people out of the workforce because they could not get coverage to manage a chronic health issue. AARP South Dakota also opposes the idea, saying there are too many unknowns, including whether there would be exemptions for family caregivers. Republican supporters have raised several arguments, including the need to incentivize people to work.

But Franken, who also is a volunteer for AARP, said many people on Medicaid do work, with some having their employment occasionally disrupted by health problems. She pointed out if approved, the added provision would be especially hard on older adults still in the workforce.

"They're kind of the forgotten people, I think sometimes that we just don't pay attention to," Franken asserted. "A lot of them can be in that 50 to 64 age range; individuals who are trying to be productive but it's not always an option for them to be regularly employable."

Franken stressed lawmakers still need to allow implementation to run its course. Prior to winning approval in 2022, it was estimated the expansion would cover an additional 42,000 South Dakotans. State officials recently testified so far, nearly 18,000 people have become new enrollees. Federal incentives are covering much of the expansion costs, and the state would also need federal approval to add the requirement.

Medical debt has long been a burden for many Americans, with millions struggling to pay off their healthcare bills. In the Buckeye State, however, a new program is offering relief to some residents.

Alexandria Delikat-Hinze, an Ohioan, recently experienced the impact firsthand when her medical debt was unexpectedly cleared.

"This program can be absolutely life-changing," she said, "and having your medical debt cleared can truly have a domino effect in your life and change so many things."

Delikat-Hinze, who accumulated $25,000 in medical debt during graduate school, benefited from a partnership between RIP Medical Debt and local governments in Lucas County and Toledo. Using $800,000 in federal COVID relief funds, the program canceled millions of Ohio residents' medical debt.

Critics, however, have raised concerns about its sustainability, relying heavily on federal funding and not addressing the root causes of high medical costs.

While the program has garnered praise, it isn't available statewide, leaving many Ohioans still struggling with their medical bills. Delikat-Hinze noted that such initiatives could potentially benefit more people if expanded to other counties and states.

"The one thing that makes me sad, though, is knowing that it's not happening statewide," she said. "I was just so lucky to be in the right place at the right time to be able to qualify for this that everyone should be able to qualify for."

As talks about medical debt relief grow, Vice President Kamala Harris has proposed a plan to erase debt for millions, reflecting increased attention to the issue.

Research shows 15 million Americans have medical debt impacting their credit scores. Programs such as the one in Lucas County help some but leave many others in Ohio still in need.


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The election is less than six weeks away and Washingtonians will be deciding on a slate of initiatives, including one measure affecting funding in support of children.

If passed, Initiative 2109 would repeal a 7% tax on capital gains for assets worth more than $262,000. The repeal has support from hedge fund manager Brian Heywood, who said it is a slippery slope toward a state income tax, which the state does not have.

Gabriela Quintana, senior policy associate for the Economic Opportunity Institute, said fewer than 4,000 people in the state pay the tax.

"It's a very privileged move to be able to fund these initiatives for your own needs and to not think about the impact this will have on a huge majority in Washington state," Quintana contended.

Last year, the tax pulled in about $786 million. The first $500 million collected from it goes toward schools, early learning and child care. Any additional money collected goes toward school construction.

Justin Fox-Bailey, president of the Snohomish Education Association, said the vast majority of Washingtonians who do not pay the capital gains tax will be affected if Initiative 2109 passes, especially kids.

"They're going to feel it in their communities when we give a tax cut to these millionaires and billionaires and you don't have the same access to child care, your kid's school isn't getting updated, public services are being cut or reduced," Fox-Bailey pointed out.

Washington has historically had one of the most regressive tax systems in the country and a recent report found the lowest-income 20% pay more than three times as much of their income as the top 1%.

Quintana argued the capital gains tax is vital for the state.

"We all need to play a role, including the wealthy individuals," Quintana asserted. "Repealing it will only really hurt families and children."

Ballots start going out on Oct. 18.

Congress has one week from today to reauthorize a sweeping policy playing a big role in shaping the nation's food production system, and Wisconsin agricultural voices are paying close attention.

The Farm Bill is supposed to be renegotiated every five years. A temporary extension was approved one year ago, amid big differences about where to prioritize aid, including subsidies typically helping industrial-level farms.

Chuck Anderas, associate policy director at the Wisconsin-based Michael Fields Agricultural Institute, said as the issues get sorted out, organizations like his hope lawmakers do not lose sight of the need to adequately fund conservation programs to benefit small farms.

"To neglect that is basically just picking winners and losers within the agricultural economy," Anderas contended.

Advocates are concerned about proposed language which would essentially spread conservation funding to "climate-smart" practices skeptics say only benefit big farms. The Farm Bill also covers the Supplemental Nutrition Assistance Program. House Republicans have proposed formula changes hunger-relief advocates say would amount to a $30 billion cut. GOP leaders dispute the claim, saying they would lower costs without cutting anyone's benefits.

According to the National Centers for Environmental Information, Wisconsin has seen more than 20 weather-related disasters -- each resulting in at least one-billion dollars in damage -- in the past five years, four times the totals from the 1980s and 90s.

Anderas argued stronger and effective climate resiliency aid in the Farm Bill means participating producers can mitigate some of the damage.

"Even if you are skeptical about climate change, these practices infiltrate more water and hold more water in the soil and make a huge difference on the amount of water coming off of farm fields," Anderas outlined.

He added it protects natural resources, as well as infrastructure in farming communities, with local governments not having to spend as much on fixing washed-out roads and bridges.

With the current focus on the November election, analysts said it is likely Congress will approve another temporary extension of the current Farm Bill, rather than agree on a new one.