The tragedy surrounding UnitedHealthcare has brought renewed focus on cost barriers within the health care system.

A group of Minnesota unions said a nonconfrontational but organized front paid off in recent talks to limit cost hikes for members.

This fall, unionized state workers in northwest Minnesota, who receive care through Essentia, were notified the provider would increase out-of-pocket expenses Jan. 1. In a tiered system, they would move from Level Two to Level Three.

Amanda Stegmaier, information technologist at Minnesota State University-Moorhead, said she was caught off guard, noting the change could have boosted co-pays by roughly $30 per visit.

"I was personally looking at supplemental health insurance," Stegmaier explained. "What could I do to stay at a lower cost level, because being a single mom and one-income household, there's only so much money that goes around."

Stegmaier, a member of the Minnesota Association of Professional Employees, urged colleagues to contact Essentia about the situation. Regional members of other unions like the American Federation of State, County and Municipal Employees did too, and the coalition convinced the provider to keep the cost hike temporary. It goes back to Level Two March 1. Stegmaier acknowledged the issue will likely resurface a year from now but a strong unified message can have an effect.

State employees have the benefit of union negotiators but those involved said voices working together, no matter where their insurance comes from, and can reasonably articulate the plight of health consumers might be able to turn some heads.

Adam Kamp, business agent for the Minnesota Association of Professional Employees, feels it is a key strategy in the current landscape.

"Health care's becoming increasingly corporate, we're seeing more mergers, more buyouts," Kamp observed. "In that instance, it took peaceful, collective action in order to pressure the provider to do the right thing."

Stegmaier stressed keeping costs in check is important in her part of the state, because it allows members to keep going to the clinics that work best for them.

"Good health care in this area is hard to come by," Stegmaier emphasized. "When you find your care team that you're happy with, you wanna stick with them."

Solving North Dakota's child-care crisis is taking another turn, with adoption of a new tax credit.

The incentive is geared for employers who make contributions toward their employee's child-care costs.

Gov. Kelly Armstrong has signed a bill that allows employers to claim a tax credit of 50%, for child-care stipends they might offer as part of a benefits package.

Bill supporters say it might convince more businesses to meet the needs of staff members with young kids.

Bill Bauman, CEO of the Missouri Valley Family YMCA in Bismarck, said he hopes it'll be effective in removing stress on the child-care system by keeping parents in the workforce.

"It's so vital to our economy," said Bauman, "our community, our workforce and our families."

The YMCAs are collectively the largest provider of child-care services in North Dakota, and Bauman said they've seen progress in closing gaps based on 2023 investments from the state.

Other organizations such as the Chamber of Commerce agree that previous steps have helped.

But officials note some solutions have limitations, pointing to age and income eligibility levels under the Working Parents Child Care Relief Program.

Bauman credited policymakers for continuing to monitor how these efforts are playing out, and whether they need to try something new.

He suggested it's going to take additional time to measure the effectiveness of new programs and incentives.

"Some are highly utilized and others maybe not as utilized," said Bauman, "so you have to be able to adjust."

According to a 2024 North Dakota business survey from the Chamber of Commerce, 69% of respondents indicated that child care was an issue for their organization.

A similar percentage indicated support for this type of incentive to help recruit and retain workers.



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Thousands are expected to rally in Harrisburg on Monday for a "Raise the Wage and Immigrant Rights Day of Action."

More than 47,000 Pennsylvania workers earn the minimum wage of $7.25 an hour or less.

Jarrett Smith, legislative director for the Service Employees International Union, said Pennsylvania hasn't raised its minimum wage in more than 15 years, while more than 30 other states and Washington, D.C., have all moved toward $15 an hour.

Smith said this makes it harder for the state to stay competitive.

"We are demanding that we raise the wage in Pennsylvania to $15 an hour," he said, and "that we include a cost-of-living adjustment so that we don't have to keep coming back, year after year."

Smith said the coalition Pennsylvania Stands Up is leading the protest, backed by labor and community groups and some lawmakers.

Two years ago, the House passed a bill to raise the state minimum wage to $15 by 2026, but the Senate hasn't acted. Smith said Gov. Josh Shapiro has pointed out it could bring in up to $60 million a year in tax revenue.

Smith said it's key to distinguish low-wage from minimum-wage workers. Nearly 1.2 million Pennsylvanians earn wages less than $15 an hour, and many are single moms. He added that these workers often support families, pushing the state to cover gaps with programs such as SNAP and Medicaid.

"When we talk about how do we actually lift workers out of poverty," he said, "one of the things that you can do is raise that floor and give families the financial independence to actually earn a wage that's going to allow them to not have to make decisions between paying a grocery bill or getting health care."

Smith noted that Pennsylvania is losing workers to neighboring states with higher minimum wages, making it hard to keep a strong workforce.

"We are one of the fastest-shrinking states in the Northeast," he said. "New Jersey, across the border, they have a $15 minimum wage to start, and they're already increasing it for certain workforces, like health care and education."

He added that SEIU represents around 80,000 service workers in the state, across industries such as government, health care and food service. The union is also negotiating its first national Starbucks contract.


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New national rankings out this week show South Dakota jumped a few spots higher in teacher pay for each state. However, there are questions about whether the shift will be temporary.

The National Education Association puts South Dakota at 46th in the U.S. for compensation offered to educators around the state. The current rank is the highest South Dakota has achieved since reporting began. Teachers in the state now earn an average salary of more than $56,000.

Loren Paul, president of the South Dakota Education Association, credits higher bumps in state aid the past few years.

"That extra effort from our state gets us out of the bottom rankings," Paul explained. "It also is supportive in recruiting teachers and also retaining teachers in the profession."

In this year's legislative session, education got a smaller funding increase of 1.25%, falling behind inflation. Paul cautioned it could mean South Dakota will slide back in future rankings. The smaller bump came as part of a "belt tightening" mood at the State Capitol this year, with uncertainty over federal funding and declines in sales tax revenue.

Educators said they understand the budget challenges facing South Dakota but Paul contended taking the foot off the accelerator only puts the state in a troubling pattern it has been trying to shake off.

"It has to be year after year," Paul stressed. "It's not a, 'Oh, we're going to address this for a year or two, and then we're going to fall back into very small increases,' or no increases, or actually going backwards."

He added when shrinking investments cause a state to tumble in rankings, public pressure goes back up because no state wants to be seen as holding the last spot.

The union noted when adjusted for inflation, teachers in many parts of the country still make less than they did a decade ago, and if they cannot afford to cover basic expenses, some will choose to leave the profession.