Nebraska saw nine long-term care facility closures in 2022, second only to 13 in Texas.

In the past three years, Nebraska has lost a combined 29 assisted living facilities and nursing homes. Inadequate funding for Medicaid patients, workforce issues and the rising costs of goods and services have all contributed to these closures.

Two bills to be heard in the Unicameral's Appropriations Committee today would mean substantial increases in state and federal funding for both types of facilities.

Jalene Carpenter, Nebraska Health Care Association CEO, says additional funding is crucial to stem the state's long-term care crisis.

"In Nebraska, 15 counties do not have a nursing home or an assisted-living [facility], and we are really starting to see a 'care desert' be created. And that causes significant issues for Nebraska seniors, " Carpenter expressed.

LB-941 would increase the daily reimbursement rate for assisted living residents on the Medicaid Waiver program. The new daily rate of just under $79 is based on a Nebraska Department of Health and Human Services study. LB-942 would increase the nursing home Medicaid reimbursement rate by about 5% over the next year. Both bills were introduced by state Sen. Myron Dorn, R-Adams.

Carpenter says the COVID-impacted long-term care workforce is improving in the state, but she stresses Medicaid reimbursement rates play a large part.

"A large portion of the Medicaid rate -- when you look at what it covers -- it's primarily going towards labor and benefits. Nursing-facility and assisted-living care is very hands-on, and we need adequate rates to be able to attract and retain team members," she added.

Carpenter said the state, educational institutions and organizations, including the Nebraska Health Care Association, are also focused on building the long-term care workforce -- including introducing young people to careers in health care and strengthening Certified Nursing Assistant programs.

"We're trying not only to increase the rates so that our facilities can attract and retain (employees), but then also, as an association, to look at other ways to drive people into the workforce for this profession, " she said.

In 2023, Gov. Jim Pillen approved a one-year, 3% increase in the Medicaid reimbursement rate, but vetoed the Legislature's 2% increase for the second year.

House lawmakers have passed a bill advocates said will be harmful to nonprofits in New York and nationwide.

House Resolution 9495 passed with a 219-184 vote after failing to get a two-thirds majority in the chamber last week. The bill gives the Treasury Secretary power to rescind tax-exempt status for nonprofits considered "terrorist supporting organizations." On its first vote, it had strong bipartisan support.

Jeff Ordower, U.S. Lead for the group 350 Action, said President-elect Donald Trump's rhetoric about "the enemy within" makes this bill's return troubling.

"They are trying to consolidate the number of tools in their toolbox," Ordower contended. "So they can move quickly to call some people the enemy within and shut down organizations that are supporting causes that are unpopular, supporting causes that are fighting corporate power, fighting structural racism."

Voting in favor of the bill were 15 Democrats, including Rep. Tom Suozzi, D-N.Y. It could be due to its other provision giving tax breaks to Americans wrongfully imprisoned abroad or held hostage by terror groups. Ordower noted it is the result of a push by groups who want Israel and Gaza's status quo before Oct. 7 restored, which aid organizations could jeopardize.

Beyond public concern, some experts feel the bill's primary goal is helping President-elect Trump consolidate power within the Executive Branch. Ordower pointed out it is one of the many battles with the second Trump Administration about what defines a healthy and sustainable democracy.

"What we need in order to really have a good fight that defends civil society, that leads us towards and continues some of the ways that are flourishing democracy is to have lots and lots of groups that are able to push their agendas, and not just groups with particular ideologies or point of views doing that," Ordower stressed.

Ordower is surprised by lawmaker's persistence to pass this bill given wars occurring across the world, as well as ongoing economic, climate and immigration issues at home. Some 150 groups including the ACLU signed a letter to House lawmakers urging them to oppose the measure.

The Indiana Chamber of Commerce outlined six key priorities for lawmakers ahead of the legislative session in January.

Rather than releasing detailed policy positions, the Chamber emphasized broad focus areas, including workforce, education, economic growth, infrastructure, quality of place and community health.

Phil GiaQuinta, D-Fort Wayne, House Minority Leader, responded to the Chamber's priorities, highlighting the need to address child care as a factor in economic development.

"We talk about economic development with things that impact economic development here in the state. Child care is really one of those," GiaQuinta contended.

The organization stressed the critical role of affordable child care in workforce development, citing a report estimating Indiana loses $4.2 billion annually, including $1.7 billion in tax revenue due to child care challenges. High costs force some parents out of the workforce, straining the state's economy.

Statehouse leaders acknowledged the issue but differ on solutions. Democrats argued child care deserves more state investment, while Republican leaders believe the private sector should play a larger role.

Todd Huston, R-Fishers, Speaker of the House, said businesses should not expect the state to solve their child care problems entirely.

"They've done a lot of different things to try to support families and young families. We will continue to do that," Huston stated. "But I think we also have to set a level of expectations that we're not going to; the state's not going to be funding all universal pre-K."

The Chamber plans to release detailed policy proposals in January, aiming to guide lawmakers toward strategies to strengthen Indiana's economy and workforce.


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North Dakota is no stranger to public pension debates. States face pressure to keep retirement systems well-funded and new data show most Americans place great value on such benefits for both government and private-sector workers.

According to the National Institute on Retirement Security, 86% of Americans believe all workers, not just those employed by state and local governments, should have a pension. There are similar approval levels when asked how important public pensions are in recruiting teachers and public safety workers.

Dan Doonan, executive director of the institute, suggested it is not too surprising to see the results.

"Pensions, along with other benefits, are part of creating that culture of careers and not jobs," Doonan explained.

Starting in January, North Dakota will close its main public pension plan for new hires, who will instead be offered a 401(k)-style benefit. The move followed debate over whether it was the right way to address a $1.9 billion unfunded liability. Backers argued it protects benefits for existing workers and taxpayers but skeptics contended it makes it harder to attract workers to the public sector.

Doonan noted the survey results overlap with the idea maintaining an experienced public-sector workforce is a good thing for community members and not just the employee and employer.

"In general, when public services are done well, they're often invisible, right?" Doonan emphasized. "We want good roads, we want safe communities, and I think Americans understand the role of having career public servants in terms of delivering those outcomes."

The Bureau of Labor Statistics said state and local governments employ about 20 million workers, which represents about 13% of the U.S. workforce.