CLARIFICATION: An earlier version of this story noted the Children's Health Insurance Program as a component of Medicaid, before outlining Minnesota data. That version did not make clear that while under the same umbrella, there are differences. An update emphasizes Medicaid and CHIP when noting Minnesota data. (8:45 a.m. MST, Jan. 16, 2025)

In their pursuit of slashing government spending, Congressional Republicans are taking a hard look at Medicaid. But a new report shows how this public health program is preventing care access from further eroding in rural Minnesota and elsewhere.

The incoming Trump administration promises major budget cuts, and a House GOP proposal floats a nearly $2.5 trillion Medicaid reduction. But findings from Georgetown University's Center for Children and Families show people in rural areas are more likely than metro populations to receive health coverage through Medicaid.

Katy Kozhimannil, associate professor in the University of Minnesota School of Public Health, said its providers rely on it, too.

"Medicaid is an absolutely essential source of revenue for those hospitals to keep operating and to provide different types of services and additional training and support for clinicians," she said.

A key Medicaid component is the Children's Health Insurance Program. At 7%, the Georgetown report says Minnesota is among the states with the largest difference in the share of kids covered by Medicaid and CHIP when comparing smaller towns to urban centers. Some House Republicans insist these programs need reform to avoid a fiscal collapse. But skeptics say drastic changes are a way to offset a planned extension of federal tax cuts.

Joan Alker, executive director and co-founder of the Center for Children and Families at Georgetown University, called these budget proposals "horrifying," while suggesting the public might be caught off guard because the program wasn't really discussed on the campaign trail last fall.

"There was complete silence about it, despite the fact that it is the largest source of public coverage by far in the United States," she said. "It's also a very popular program with the voters of all political stripes."

Report authors stress the timing of the proposed cuts is especially bad as rural areas continue to grapple with hospital closures. 120 facilities have either closed or ceased offering inpatient services over the past decade. Many rural hospitals opt to shutter less lucrative units such as maternity wards. And the experts say Medicaid covers a majority of pregnancy care in smaller communities where these units still operate.

In a significant development for family caregivers across America, AARP is spearheading initiatives at both federal and state levels to provide tax relief for those caring for loved ones. The organization is championing the Credit for Caring Act, which proposes a $5,000 federal tax credit, while also pursuing similar legislation at the state level in Ohio.

Jenny Carlson, AARP Ohio state director, said it's a comprehensive approach to supporting the 48 million Americans who serve as family caregivers.

"We're doubling down on this initiative! We feel strongly that it's going to work on the national level. We are turning our attention to the state law, working towards (a) swift package so that family caregivers could take advantage of it for their 2026 returns," she explained.

Carlson added that Ohio is home to approximately 1.5 million family caregivers, providing an estimated $21 billion worth of unpaid care each year. She added they struggle to balance caregiving with full-time jobs, often sacrificing income and retirement savings. The proposed tax credit has received bipartisan support.

AARP has been vocal in its support for Rep. Mike Carey, R-OH, who is sponsoring the legislation in Congress. Carlson emphasized the importance of enabling caregivers to continue working while supporting their loved ones.

"It's called the Credit for Caring Act, which would provide eligible working caregivers a tax credit to help offset the costs of care that they offer. It would allow them to continue to work while caring for a loved one through illness, disability and aging in place," Carlson said.

A recent AARP backed survey found that 84% of voters across party lines support a tax credit for family caregivers. However, some experts caution that while tax relief is helpful, broader policies-such as increased Medicaid coverage for home care may be necessary to fully address the challenges caregivers face. The bill's future now rests with Congress.

Dozens of local leaders from California are in the nation's capital this week, joining about 2,800 colleagues from around the country at the National League of Cities' Congressional City Conference.

The group met with White House officials Tuesday and is set to see Sen. Alex Padilla, D-Calif., today.

David Sander, a council member and former mayor in the city of Rancho Cordova and immediate past president of the league, said local leaders want to find out how the "DOGE" cuts could impact their cities' bottom lines.

"Because there are so many changes potentially underway, we're really focused on certainty and stability," Sander explained. "Because it's hard in local government, where everything has to work, and we're held accountable."

Local officials are concerned the budget bill being prepped in Congress could eliminate the tax-free status cities now get on their municipal bonds, financing priorities like roads and schools. And in the upcoming transportation bill, local leaders want to continue the previous Trump administration practice of sending funds directly to municipalities, rather than routing them through the state.

Sanders pointed out the briefing on immigration covered the many legal issues surrounding cities' policies on cooperation with federal Immigration and Customs Enforcement.

"There's an awful lot in the hands of the courts right now," Sanders observed. "Trying to understand the role of a federal detainer versus a federal warrant, versus a local warrant; trying to understand the legalities around all those and what cities can or can't do."

California is home to multiple so-called sanctuary cities, including Berkeley, Fremont, Oakland, Los Angeles, San Francisco, Santa Ana and Watsonville. The conference wraps up today.


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It is the North Dakota Senate's turn to ramp up debate on property tax reform, a key issue of this session and lawmakers are hearing from a range of groups, including farmers, to ensure a fair plan.

Several bills to establish property tax relief have already cleared the North Dakota House. Yesterday, a Senate committee took up some of the proposals. All the measures have different language, but a consistent provision is an annual 3% cap on property tax hikes sought by local governments.

Parrell Grossman, legislative director for the North Dakota Soybean Growers Association, told lawmakers he hopes a final package will include agricultural properties.

"Some of these landowners might certainly have significant land and others might be facing huge debt because of their machinery, livestock costs, or low crop prices," Grossman pointed out.

The arguments come as farmers navigate land price issues and other market forces in an era of corporate consolidation. Advocates also acknowledged the need for balance, so small and large communities are not hamstrung in maintaining their infrastructure. Some rural leaders worry about proposed caps limiting their ability to raise enough revenue to not harm vital services.

Brenton Holper, city administrator for the City of Horace, a town of more than 3,000 people just outside Fargo, elaborated on potential service disruptions if local governments are weighed down by any property tax restrictions.

"Instead of plowing the street when there's a couple inches of snow, it might be five, six inches," Holper pointed out. "The thresholds are going to be different."

Still, Holper was among those who said they recognize many people are "fed up" with their property taxes. In a ballot question last fall, North Dakota voters rejected the idea of largely doing away with property taxes but polling has indicated they want policymakers to take meaningful action to keep their yearly bills in check.


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