By Tess Vrbin for The Arkansas Advocate.
Broadcast version by Freda Ross for Arkansas News Service reporting for The Arkansas Advocate-Winthrop Rockefeller Foundation-Public News Service Collaboration.

Brandy Sandersfeld had been putting off a minor surgery for her 4-year-old son, Cypress, for months.

Over three weeks this spring, the Sandersfelds made four trips to Arkansas Children’s Hospital in Little Rock from their home in Big Flat. Having enough gas money for multiple five-hour, 240-mile round trips was stressful, and it wouldn’t have been an issue if the family still had the financial support of the federal child tax credit, which ended in December 2022, Sandersfeld said.

What pushed her to go forward with Cypress’ surgery was the fact that the grant funding her job at the University of Arkansas System was about to expire, she said. She and her two sons have now been without health insurance since July 1.

In 2020, Sandersfeld and her husband moved “away from the hustle” of exurban life in Eureka Springs, and they value their rural community, but they’ve taken on the difficulties of being far away from the specific health care resources their children need, she said. Jasper, their 11-year-old son, needs both physical and behavioral therapies.

“To drive three hours three times a week for physical therapy [is] just not financially doable once I lose this job,” she said in May.

The family’s struggles obtaining health care for their children are among the tough realities Arkansans face if they’re asset limited, income constrained and employed (ALICE), especially in rural areas. ALICE signifies households earning enough money to be above the federal poverty line but struggling to afford the cost of living in their area.

“I make enough money to get by, but too much money to find any programs or resources [for low-income people] and not enough money to have any sort of stretch in my budget,” Sandersfeld said.

Data from United for ALICE, a research movement led by United Way of Northern New Jersey, shows North Central Arkansas, where the Sandersfelds live, and the Delta as regions with the state’s highest percentages of ALICE and poor households.

The annual “household survival budget” for ALICE families in Arkansas varies greatly depending on each county’s cost of living and the number and ages of the people in the household, according to United for ALICE. For a single ALICE adult, the necessary annual income to get by ranges from $22,488 ($11.24 per hour) in Monroe County to $31,152 ($15.58 per hour) in Pulaski County.

For a couple with two school-aged children, that threshold rises to $57,732 ($28.87 per hour) at the low end, again in Monroe County, and $72,120 ($36.06 per hour) at the high end in Benton County.

In the Sandersfelds’ home of Searcy County, the threshold is $30.75 per hour and $61,500 per year.

Affording health care can be a struggle even for well-off Arkansas families, according to United for ALICE.

“In November 2022, nearly one in four Arkansans — both above and below the ALICE Threshold — reported that they had an unexpected major medical expense that they had to pay out of pocket for because it was not completely paid for by insurance,” the group’s 2023 ALICE report states.

Unexpected medical expenses can lead to medical debt, which is “more concentrated in the South and among residents of low-income ZIP codes,” the Urban Institute reported in 2022.

Some states provide protections from medical debt for low-income people whose insurance plans require cost-sharing, but Arkansas is not one of those states.

ALICE households struggle to be prepared for both retirement and financial hardship, according to United for ALICE data. In 2022, only 32% of households below the ALICE threshold in Arkansas, Oklahoma, Texas and Louisiana had three months’ worth of savings that could cover a medical or economic emergency, an increase from 30% in 2019. 

Additionally, Arkansans in rural areas face challenges that might not be directly related to health care or insurance but might have an impact on their ability to access both, said Craig Wilson, director of health policy at the Arkansas Center for Health Improvement and a member of United for ALICE’s state research advisory committee.

“You don’t think that something’s going to happen to you in the immediate term,” Wilson said. “When you’re thinking about the hierarchy of needs, you’re thinking about food, transportation, housing and all those other things that are very much immediate needs and not so much [about] insurance.”

Scarcity of services

Sandersfeld has applied for her children to receive insurance from ARKids First, Arkansas’ Medicaid program for children, and she said she is waiting for the state Department of Human Services to process her application. Her husband, Kurtis, is a construction worker and does not have access to employer-provided coverage.

“I’m a little excited about ARKids because my insurance right now doesn’t pay enough for [therapies] to make a difference, but now I have a new issue: I’m going to have availability for these services, but I have nobody to provide these services,” Sandersfeld said.

Searcy County is one of several Arkansas counties that do not have hospitals, according to the Arkansas Department of Health. Many counties also had very few full-time primary care physicians per 10,000 residents in 2020, according to ACHI data.

The cities closest to Big Flat with any health care providers at all are Marshall and Mountain View, each more than 20 miles away on roads that twist through the Ozark Mountains and require more time and gasoline than flatter terrain.

Long-distance travel for health care is not unique to North Arkansas. Many specialized medical services are only available to Arkansans if they travel out of state or to the Little Rock or Northwest Arkansas metropolitan areas.

The nonprofit Community Health Centers of Arkansas has about 50 sites statewide that provide primary care services with a sliding scale cost system, depending on the patient’s ability to pay. Dr. Lanita White, the nonprofit’s CEO and a University of Arkansas for Medical Sciences professor, said in February that not enough Arkansans are aware of this resource, calling it “a PR issue.”

Phillips County in the Delta has two community health centers, but the number of beds at the local hospital in Helena-West Helena has shrunk to 25 when at one point it was 120, said Donna Dunlap, who has been a nurse in the county for 33 years.

Physicians from more populous areas used to regularly visit Phillips County, but the decline in population in the county and the region has led to fewer available health services, Dunlap said.

“We had surgeons, we had an orthopedic doctor that came to the area, we had cardiologists,” she said. “They may have had to travel in from another town — a lot of times they would come from Little Rock — but at least we had those services available for our patients to go locally instead of having to travel two hours to see someone.”

Barriers to care

While state officials have increased Arkansas’ minimum wage over the past several years, Medicaid income limits have not been adjusted accordingly, which has created coverage gaps, Dunlap said.

“A lot of people [are] kind of falling through the cracks on the kind of health care they can receive,” she said. “Say they’re covered at work, but they can’t afford to cover their spouse or their family.”

Melissa Cleveland of Harrison is also a nurse and said she has had this experience: she is covered by her employer’s insurance, but covering her family would reduce her paycheck by an untenable amount. Her family is already “barely making it” since her husband cannot work due to disabilities, she said, and her three children were covered by ARKids before unexpectedly losing coverage earlier this year.

“You’re paying a high deductible for a cheaper plan, but you’re still losing money and you can’t ever climb out of that,” Cleveland said. “It’s just going to keep you under, and you get denied crucial benefits just because an insurance [company] looks at you on a piece of paper and says, ‘Nope, you don’t need that, we’re not going to pay.’”

Alison Guthrie of Little Rock said she had to turn down a job offer that pays more than her current employer because the medical expenses she would have incurred after losing Medicaid coverage would have led to an overall financial loss.

Guthrie needs a wide range of specialists and medications to treat her Ehlers-Danlos syndrome, which causes chronic pain, gastrointestinal issues and a host of other problems, she said. The job she turned down had a “generous” insurance policy but still would not have covered as many copayments as Medicaid does, she said.

“Being chronically ill is a full-time job,” Guthrie said. “There are times when you can’t function and you have no control over that, and if you’re not salaried and you’re paid by the hour, you’re screwed that way too.”

While Guthrie has the benefit of living in the vicinity of the specialized care she needs, low-income people in poorer, less resourced areas such as Southeast Arkansas might not even seek primary care, said Isierene Brown, who was the nurse at Reed Elementary School in Dumas until she lost her job in the school district’s recent layoffs.

Residents of Desha County often don’t have the means or the time to go to the doctor, so they “opt out not to do it, and they just hope for the best,” Brown said.

Potential remedies

In her 25 years as a school nurse, Brown saw students consistently develop respiratory illnesses such as the flu, strep throat and COVID-19 as a result of a lack of preventative health care, she said. She added that many children in the Dumas School District aren’t vaccinated against these illnesses because their parents are vaccine-resistant due to insufficient education.

“We definitely need more clinics and more doctors, but when you don’t have a lot to offer people — I mean, we don’t even have a Walmart — people don’t want to relocate to our area of the state,” Brown said.

Most physicians practice in the same state where they complete their residencies, and the University of Arkansas for Medical Sciences sponsors roughly 80% of residencies statewide. Medical school graduates have outpaced available residency slots throughout Arkansas the past few years, according to ACHI data.

Republican U.S. Sen. John Boozman, an optometrist from Rogers, has been sponsoring multiple bipartisan bills to create more residency slots nationwide and retain the doctors that train in those positions, particularly in rural areas. One proposal would allow medical and dental school graduates to pause student loan payments during their residencies, and another would give areas where a hospital has recently closed — often in rural communities — a greater chance of receiving new residents.

Meanwhile, President Joe Biden’s federal fiscal year 2025 budget proposal calls on Congress to revive the child tax credit and expand it “from $2,000 per child to $3,000 per child for children six years old and above, and to $3,600 per child for children under six.” The new federal fiscal year begins Oct. 1.

A $78 billion tax package moving through Congress would fulfill the request, but it stalled in the U.S. Senate in March after Republicans compared the child tax credit to welfare programs.

In May, Sanderfeld was one of five mothers from across the country invited to the White House to advocate for the return of federal aid for families with children.

Sandersfeld said she and her husband could afford preventative health care for their children, including the cost of travel, when the child tax credit gave them “a little bit of surplus” financially.

“We didn’t have to worry about unexpected health expenses or these copays at the children’s hospital,” she said. “…When you give people enough money to make good decisions for their family, they will.”


Tess Vrbin wrote this article for The Arkansas Advocate.


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A new report commissioned by faith leaders outlines the high moral stakes at play as the Trump administration pushes to cut federal programs to pay for extending tax cuts passed in 2017.

Karen Dolan, criminalization of poverty project director at the Institute for Policy Studies and the report's co-author, said the budget resolution recently passed by the U.S. House would eviscerate Medicaid, the single largest source of health coverage in the U.S., by cutting $880 billion.

"The proposal could result in a loss of coverage for 36 million people," Dolan pointed out. "In Colorado alone, there's over a million enrollees in Medicaid."

Republicans have long argued tax cuts boost the economy and allow people to keep more of the money they earn. They also say their budget resolution does not include the word Medicaid a single time. But according to a nonpartisan watchdog group, it would be virtually impossible for the Energy and Commerce Committee to meet its $880 billion without cutting Medicaid.

Extending tax cuts would amount to less than a dollar per day in savings for the bottom half of U.S. families. But the richest one-tenth of a percent of Americans would receive more than $314,000. Corporations promised to use windfalls from tax cuts in 2017 to raise wages, but Dolan noted the bottom 90% of workers have seen no benefits at all.

"When corporations get huge windfalls, in the form of tax breaks and tax loopholes, that money does not trickle down to worker's wages or to the economy," Dolan emphasized. "All it does is enrich that corporation."

The report outlined how mass deportations will raise consumer prices and harm immigrant families, including those with U.S. citizen children. The GOP also plans to cut food assistance by $230 billion and increase work requirements. Dolan stressed the majority of people who receive assistance are already working and many who work multiple jobs still need assistance because the minimum wage is so low.

"Ninety-two percent of people who receive Medicaid work either full-time or half-time, or have disabilities, are over age 65, are taking care of children or elderly adults, or are attending school."


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By Wesley Brown for the Arkansas Delta Informer.
Broadcast version by Freda Ross for Arkansas News Service reporting for The Arkansas Delta Informer-Winthrop Rockefeller Foundation-Public News Service Collaboration.

As ALICE families in Arkansas prepare for the 2025 tax season with the anticipation of healthy refunds, a federal tax proposal that offers substantial financial relief is currently at risk for low-and middle-income wage earners.

In Washington, D.C., Congressional Republicans may soon release a budget resolution that will set the terms of the national tax debate, including the expected extension of President Trump's signature 2017 Tax Cut and Jobs Cut law, including its changes to the Child Tax Credit (CTC). If Congress funds President Trump's ambitious budget bill, American taxpayers could also be on the hook for $5 trillion, several experts told the Arkansas Delta Informer.

And despite Vice President J.D. Vance's statements during the November election that he would like to see the federal CTC expanded to $5,000 per year, uncertainty still looms as Congress discusses whether to continue, alter, or end its provisions.

According to the Institute on Taxation and Economic Policy, that ongoing debate will significantly impact ALICE (Asset Limited, Income Constrained, Employed) households earning above the federal poverty level but less than what's needed to survive in the current economy.

Peter Gess, economic policy analyst at Arkansas Advocates for Families and Children (AAFC), agrees. He said that with the impact of rising inflation, ALICE households will be worse off if Congress decides not to expand or extend the 8-year-old tax policy.

"And so, if nothing happens, then that tax credit reverts to $1,000. And, you know, I did a quick look at inflation, and that's like 25% less value from where it was before the tax cuts in 2017," he said. "So, without keeping up with inflation, just being reverting to $1000 it'll be a lot less for families even than what it was before."

As noted, in his first term, the President pushed Congress to pass the $1.8 trillion Tax Cuts and Jobs Act (TCJA) in 2017, which made substantial permanent cuts to corporate and business taxes. That tax policy-changing law also raised the federal child tax credit from $1,000 to $2,000 and made it available to families earning up to $400,000 instead of $110,000.

When President Biden took office in 2021, he significantly expanded the child tax credit under the $1.9 trillion American Rescue Plan. Under that law, families received a $3,000 annual benefit per child ages six to 17 and $3,600 per child under six as a monthly payment for the 2021 tax year.

According to the U.S. Census Bureau, the payments ranged from $250 to $300, expanding the child tax credit to nearly 35 million U.S. families. However, those payments expired in January 2022 after Congress failed to renew the Biden-era program.

Likewise, unless Congress renews or expands the program under the Tax Cuts and Jobs Act, the federal CTC will revert to $1,000 per qualifying child in 2026. Additionally, the age limit for eligible children would decrease to 16.

ALICE families nervous about possible CTC changes

Athea Townsend of Little Rock hopes Congress will expand the tax credit closer to the $3600 maximum paid to families during the pandemic. However, she says letting it expire would be far worse for families struggling with inflation, high grocery bills, and childcare expenses.

Townsend says the expanded tax credit in 2021 helped her with expenses when she had only one child, Zen, a bright and energetic eight-year-old in the third grade. "You know, he is a growing boy, so it did help with essential things like clothes and food and help with the bills," said Townsend.

Today, however, Zen has a one-year-old brother, Zi, and the CTC has since reverted to 2017 levels of $2,000 per child annually. If Congress lets the CTC expire at the end of the year, it will impact thousands of ALICE households like hers, predicted Townsend, a marketing and graphic design professional.

"For working (single parents) and others like me, it is very much needed," she said.

In October 2014, new data from the ALICE in the Crosscurrents: An Update on Financial Hardship in Arkansas report showed that nearly 11,000 more Arkansas households like Townsend were still struggling to make ends meet in 2022 compared to the previous year.

That brings the total number of households living paycheck to paycheck across Arkansas to 562,879, representing 47% of the state's population, according to the latest update from ALICE in Arkansas, in partnership with United For ALICE.

This includes 195,972 Arkansas households in poverty and another 366,907 defined as ALICE (Asset Limited, Income Constrained, Employed), earning above the federal poverty level but less than what's needed to survive in the current economy. ALICE households include individuals and families working low-wage jobs with little or no savings and one emergency from poverty.

However, a recent report by the U.S. Census Bureau shows that the enhanced federal child tax credit during the pandemic pulled 2.9 million children across the U.S. out of poverty. This underscores the potential positive impact of the tax credit on struggling families.

New CTC proposal part of Trump budget talks

And that President Trump has ascended to the White House a second time with Republicans in control of both chambers of Congress, one of the incoming President's key economic goals is to lock in or extend parts of the law they couldn't in 2017 due to the Senate's budget reconciliation rules.

Next year, nearly all of the individual provisions of the 2017 Tax Cuts and Jobs Act (TCJA) will expire unless Congress acts. The Congressional Budget Office has estimated that fully extending the TCJA would cost $4.6 trillion over ten years. With interest

Gess and other federal CTC proponents hope that Congress will expand the popular tax provision and tweak the law to make the credit work for more families below the federal poverty line.

According to the Center on Budget and Policy Priorities (CBPP) analysis, a bipartisan and more modest expansion of the federal CTC could be a ray of hope. This proposal, developed by Senate Finance Committee Chair Ron Wyden and former House Ways and Means Committee Chair Jason Smith, aims to assist approximately 19 million children who currently receive partial credit or none due to their families' low incomes. The bill would increase the refundable tax credit to a maximum of $2,500, offering a brighter future for these families.

That bill would also make families with low or no earnings eligible for the full credit, tie benefits to the number of children in a family, adjust the credit amount annually with inflation to ensure that it does not erode over time, and provide the credit in monthly installments.

"The last thing families need is to see Washington slashing their child tax credit in half," Smith said in a Jan. 16 committee hearing, which repeatedly addressed the expiring tax break.

In a CPBB research note of Feb. 5, Kris Cox, deputy director of the progressive Washington, D.C.-based think tank, said fixing flaws in the 2017 law would deliver a more meaningful tax benefit to single parents and working-class families.

"This should mean delivering a meaningful income boost to children in families who are struggling economically, even if any extension of the 2017 tax law would, as a whole, be costly and skewed to the wealthy," said Cox.

According to Gess, suppose the Wyden Smith bill passes in its current form. In that case, ADCF estimates that 191,000 children in Arkansas, or one out of every four currently left out of the full $2,000 credit, would benefit in the first year. "The credit would especially help children in Arkansas who are Black, Indigenous and Other People of Color (BIPOC), whose parents are more likely to hold low-paying jobs, due to historical and ongoing discrimination and barriers to prosperity," he said

"So, you're getting people who make lots of money the full credit, and you're getting people that don't make very much money, who really need it, aren't getting the full credit," Gess concluded.

And despite support from the House Ways and Means Committee and the vice president, many believe that expanding or keeping the CTC from expiring will be challenging, even with bipartisan backing.

ITEP Senior Policy Analyst Joe Hughes told the Arkansas Delta Informer that upbeat statements made by Vance and others during the election season are not part of ongoing budget talks. Also, the current proposal congressional Republicans are debating to extend the Trump-era tax cuts comes with a hefty price tag of up to $5.5 trillion over the next decade, based on a Jan. 10 report by the U.S. Treasury Department,

Hughes predicts that if the new proposal keeps most of the business provisions, including the slashing of the corporate tax cuts from 39% to 21%, most benefits will flow to wealthy individuals and businesses. He said that would leave everyone else with a token tax cut and saddle the nation with a massive national debt increase.

"Last year, we found that extending the 2017 law would direct more than two-thirds of the benefits to the richest 20% of households. A family making $20,000 a year would see a modest tax cut of a hundred dollars, while a millionaire would receive tens of thousands," Hughes said in a Feb. 5 research note. "This approach is designed to offer small tax cuts to working families as political cover while delivering massive benefits to the wealthiest Americans - at the cost of a ballooning federal deficit."

New state-level CTC bill introduced to Arkansas legislature

While Congress discusses the future of the Trump-era CTC policy, state legislatures are expanding child tax credits. According to ITEP, states with fully refundable Child Tax Credits in 2024 are California, Colorado, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New Mexico, New York, Oregon, and Vermont. Idaho, Oklahoma, and Utah.

Arkansas does not offer state-level CTC going into the 2025 legislation session, but Rep. Denise Garner, D-Little Rock, has filed a bill that would provide a $300 refundable income tax credit for qualifying taxpayers who provide support to certain dependents.

Under House Bill 1015, the credit would be available for an individual taxpayer with net income up to $100,000 or taxpayers filing jointly with net income up to $200,000. Married taxpayers who meet the income thresholds for the credit and file separately on the same return may each claim a $150 credit against the tax due on the return of each spouse.

The bill, originally filed in November, also requires the Department of Finance and Administration (DFA) to make an annual cost-of-living adjustment to the credit amount. A DFA fiscal impact study estimates that general revenues would decrease by $238 million in fiscal 2026 and $245 million in fiscal 2027.

The DFA study shows that in tax year 2022, 618,000 taxpayers with 793,000 dependents would qualify for the credit. Approximately 370,000 Arkansas taxpayers would realize an overall reduction in tax liability at a cost of $134 million, and some 250,000 taxpayers would receive a refundable credit totaling $83 million.

Nationally, AACF data shows that 90% of Arkansas families, or 661,000 children, received monthly payments of $250 to $300 under the expanded CTC program during the pandemic. Gess said the proposed new expansion of the federal CTC before Congress would boost the family finances of around 191,000 Arkansas children at tax time this year.

An updated version of HB 1015 was submitted to the House Tax and Revenue on Jan. 15, but no hearing for the bill is on the panel's calendar. That amendment added Little Rock lawmakers, Reps. Andrew Collins and Joy Springs, as co-sponsors of the bill.


Wesley Brown wrote this article for the Arkansas Delta Informer.


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Recent federal executive orders have left many organizations in Ohio navigating uncertainty, particularly when it comes to funding for essential services.

Food banks, which serve as a critical safety net for families in need, are feeling the strain.

Joree Novotny, executive director of the Ohio Association of Foodbanks, said demand has been surging across the state as economic pressures grow, leaving local organizations struggling to keep up.

"We can do a lot with a little, but we can't do it all," Novotny pointed out. "We do rely and count on our partners in local, state and federal government to be another leg on the stool of what it takes to make sure that when people are in need and facing crisis, they can turn to us for basic help with food."

The strain comes as Gov. Mike DeWine's newly proposed state budget would reduce food bank funding by 23%, cutting it from $32 million in the last cycle to $24.5 million.

While the previous budget included a one-time $7.5 million boost, Novotny warned the reduction comes at a time when food banks are experiencing record-high demand.

Beyond government funding, food banks also face challenges in managing supply and demand. With more Ohio families turning to assistance programs, organizations are being forced to stretch resources even further.

"I just talked to someone yesterday who had a distribution in one of their local communities," Novotny noted. "They generally see 175 to 200 families come to that particular distribution for help. They had 300 families come that they were able to serve and then they had to turn another 65 away."

While organizations like the Ohio Association of Foodbanks remain committed to their mission, they are calling on policymakers to provide clarity on future funding.

Federal programs like Emergency Food Assistance Program, the Commodity Supplemental Food Program, and the Local Food Purchase Assistance Program provide about 25% of the food banks' resources, while state-funded programs like The Ohio Agricultural Clearance Program and the Ohio Food Program contribute another 20%.

Nearly half of the food distributed across Ohio's 88 counties comes from state and federal support, highlighting how crucial government funding is to hunger relief efforts.