Nebraska physicians and their patients have been dealing with the state's 12-week abortion ban since it went into effect just over a year ago.

It replaced the 2010 law which prohibited abortions past the 20th week of pregnancy and was considered one of the country's most extreme abortion laws at the time.

Dr. Emily Patel, a maternal-fetal medicine specialist, said many things can go wrong after the first trimester.

"We are really punishing women who end up having pregnancy complications or fetal anomalies or genetic conditions that are discovered after 12 weeks," Patel contended. "Saying to them, 'Well, I'm sorry, you don't have access to the same care you could have gotten if you were within that first trimester, or if you were out of our state receiving your prenatal care there.'"

When it comes to potential complications, Patel pointed out the first diagnostic test cannot be done until the 10th through the 12th week of pregnancy, and definitive genetic testing on the fetus itself cannot be done until the 16th week, well into the second trimester.

Patel noted the 12-week ban has already had short-term effects, including requiring Nebraska women to go out of state to receive their care, and she fully expects it will have long-term effects as well.

"I think it's really important that people understand that this has reduced access to care in our state," Patel asserted. "It's going to continue to further reduce access to care, especially in smaller communities, just due to the simple fact that it's going to be really hard to recruit providers."

In 2022, a March of Dimes report labeled nearly 52% of Nebraska counties "maternity care deserts," compared with around 31% of counties nationwide.

Patel admitted the current political atmosphere can make her role challenging, but she is glad she is still able to discuss patients' options with them. Some states now prohibit doctors from doing so. She emphasized the best thing she can hope for as a provider is for voters to really consider what is at stake and vote to protect the rights of patients and the doctors who care for them in November.

She stressed the current 12-week ban has implications for every woman living in Nebraska who becomes pregnant.

"Until somebody is faced with that decision, they wouldn't know that they would need access to it, or maybe even be thinking about it," Patel explained. "In a way, this can affect really anybody at any time, and we just want to be able to offer the same level of care to every patient."

Nebraska voters may have up to four abortion-related initiatives to choose from in November. Only one of them, the "Nebraska Right to Abortion Initiative," backed by the Protect Our Rights coalition, would allow abortions past the first trimester.

About 1.3 million Missourians are currently enrolled in Medicaid and nonprofits around the state have warned proposed federal cuts would be devastating.

In Missouri, children are the largest group served by Medicaid, with 61% enrolled. States could face more than $800 billion in Medicaid cuts and more than $200 billion in the Supplemental Nutrition Assistance Program, known as SNAP or food stamps.

McClain Bryant Macklin, vice president of policy and impact for the Kansas City nonprofit Health Forward Foundation, emphasized how important Medicaid is to the organization.

"From a policy perspective as well as where we tend to lend our funding support is squarely in that direction, and Medicaid access has been our primary policy issue, really since our inception," Bryant Macklin explained. "It's just our number one priority."

Supporters of the cuts argued Medicaid is inefficient because of waste and fraud, and restructuring or reducing funding could improve sustainability.

Bryant Macklin noted the Health Forward Foundation played a key role in advocating for Medicaid expansion in Missouri, contributing to policy changes which extended coverage to thousands of low-income residents. She stressed as a Medicaid expansion state, Missouri will need to find funding from other critical sources, which could result in further challenges.

"State legislators are going to be forced to -- and administrators forced to -- find those dollars elsewhere," Bryant Macklin pointed out. "That elsewhere will be from other key social services that folks are relying upon and that the state has grown accustomed to receiving that federal support."

Those in favor of the cuts said they would give states greater control over Medicaid through block grants, which are fixed amounts of federal funding states can use with more flexibility, to tailor programs to local needs and priorities.

Indiana is losing millions in public health funding as the federal government cuts grants for state and local programs.

In Marion County, officials confirmed the immediate loss of a $450,000 immunization grant, leaving employees searching for ways to continue vaccination efforts amid ongoing disease outbreaks.

Dr. Virginia Caine, director and chief medical officer for the Marion County Health Department, highlighted the cuts during a town hall hosted by Rep. André Carson, D-Ind.

"We are now seeing that they've cut all state and local health departments budgets," Caine explained. "We have to be very concerned about our ability to protect the public."

Caine noted the federal government eliminated $13.1 billion in funding for state and local health departments, part of a broader rollback of pandemic-era grants. Indiana Department of Health legislative director Rachel Swartwood recently commented the state's goal is to ensure no direct services to Hoosiers are interrupted.

State health officials estimate Indiana will lose about $40 million because of the cuts. Additionally, the U.S. Department of Health and Human Services recently announced plans to eliminate 10,000 full-time jobs. The totality of the cuts is very concerning for Caine.

"When we had this fentanyl epidemic with overdoes -- we have the bird flu taking place across this country -- we have to be concerned," Caine emphasized. "Do we have the workforce to come out and meet these demands?"

Marion County officials are evaluating how to fill the funding gap. Caine added the department has 300 positions supported by grants and expressed concern job losses and service reductions could follow if no alternative funding emerges.


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Oregon does not have enough health care workers and the need continues to grow.

Service Employees International Union Local 49 members said retention is a key cause of the shortage and they are lobbying for two bills in Salem to improve job quality across the industry. Over the next 10 years, health care and social services will need to bring in nearly 225,000 workers, according to the Oregon Employment Department.

Matt Swanson, political strategist for SEIU Local 49, said meeting the growing demand will take every possible intervention.

"I heard from many workers about how tired they are," Swanson reported. "How difficult it is to provide quality patient care when there just aren't enough people working."

One bill at the top of the union's priority list would address unchecked workplace violence, which health care workers experience at a higher rate than any other industry. Another would expand funding to allow providers to continue to work while going to school for advanced training.

Felipa Nesta, a licensed practical nurse at Kaiser Permanente, is using existing funding to get a nursing degree while working. She said Senate Bill 27 would help meet the growing demand for health care providers by increasing funding for such programs as well as providing wage replacement, child care, and transportation.

"It would help so more people can get into health care jobs without being buried in debt," Nesta emphasized.

Rachel Dennis, a certified nursing assistant at PeaceHealth Sacred Heart Medical Center, said Senate Bill 537 mandates de-escalation training as well as systems to notify providers of potentially violent patients. It also guarantees counseling and paycheck protection for injured employees. She noted nearly all her coworkers have faced verbal or physical assault on the job.

"I'm tired of seeing my coworkers leave because they're scared to go to work," Dennis stressed.

Both bills have had public hearings and are scheduled for work sessions in Salem.