Congressional Republicans are taking a hard look at Medicaid as they pursue spending cuts and a new report shows how the public health program is preventing care access from further eroding in rural North Dakota and elsewhere.

A House GOP proposal floats a nearly $2.5 trillion Medicaid reduction. Findings from Georgetown University's Center for Children and Families showed people in rural areas are more likely than metro populations to receive health coverage through Medicaid.

Katy Kozhimannil, professor of health and policy management at the University of Minnesota School of Public Health, said the program is a key contributor to pregnancy care in these settings.

"Offering obstetric care is a financial challenge for hospitals as revenues may not cover the costs of providing that care," Kozhimannil pointed out. "Medicaid covers nearly half of all births nationally and plays a substantially larger role in paying for births in rural areas."

The report said in 2022, 52% of rural hospitals no longer had maternity wards, compared with 36% of urban hospitals. There is concern the gap would widen with Medicaid cuts and North Dakota almost leads the nation for lack of rural OB/GYN services. Some House Republicans insist the programs need reform to avoid a fiscal collapse. But skeptics said drastic changes are a way to offset a planned extension of federal tax cuts.

The report also pointed out residents in rural areas have worse health outcomes.

Joan Alker, executive director of the Georgetown University Center for Children and Families, said it demonstrates why Medicaid is so important, adding it serves as a lifeline to a range of populations living in these communities.

"It is serving children. It is serving seniors in nursing homes, people with disabilities," Alker outlined.

Alker noted Medicaid helps recipients get ahead of health challenges through preventive care, as
opposed to letting conditions worsen.

"People wind up sicker and then they're in the emergency room and children can't get their asthma inhalers and they miss school," Alker explained.

High taxes and a weak economy are the top concerns of Illinois residents according to a new poll, with nearly half of those surveyed saying they would leave the state if given the opportunity.

The poll, conducted for the Illinois Policy Institute, showed more than half of those surveyed rank the state's high taxes as their number one concern, with the overall economy coming in second. Half of voters surveyed said they would move out of the state, regardless of whether they can afford it.

Dylan Sharkey, assistant editor for the Illinois Policy Institute, said the group started conducting surveys to shed light on tax issues.

"It's impossible for lawmakers to deny that these are the issues that people care about," Sharkey contended. "Because when you have a survey or a statewide poll, it's hard to deny those voices."

Illinois residents have the highest combined state and local tax burden in the nation, accounting for nearly 17% of their paychecks, and the second-highest property taxes in the country, according to the financial website WalletHub.

Since 2020, it is estimated Illinois has lost close to 500,000 residents. Sharkey argued the poll helps to dispel the myth people are leaving the state due to the weather. He added states of similar size and climate, such as Ohio, Pennsylvania and Michigan, are also losing residents but at a much slower rate.

"This might seem obvious to some people, but of course, high taxes are number one," Sharkey emphasized. "Part of the reason we do this polling is because there are lawmakers and groups out there who look at our state and think, 'Well, we just need more money to fix the problem.' And the reality is, if you take more money from people, they're just going to find a new home."

Sharkey added he hopes the poll will serve as guidance for Illinois lawmakers as they consider new legislation which could add to the tax burden residents already carry.

"Even if lawmakers aren't in consensus over new taxes, their constituents are," Sharkey asserted. "The bottom line should be that taxes should not be a first resort. The first resort should be to do more with money they already have."


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Groups fighting hunger in Oregon are urging residents to speak up if they are concerned about the cuts Congress could make to food, health care and housing assistance programs.

Congress is considering proposals to reduce SNAP benefits and free school meals for students, along with cuts to health care and rental assistance programs. About one in six Oregonians receives SNAP benefits and about a quarter use Medicaid.

Alejandro Queral, executive director of the Oregon Center for Public Policy, said the proposals are not really about cutting waste and fraud, as the Trump administration contended. Instead, Queral argued they are about tax cuts.

"Extending those tax cuts from 2017 to the very rich will add to the deficit and will have a direct impact on people's lives," Queral asserted.

Research shows policies implemented during the pandemic, like the Child Tax Credit, led to a record drop in poverty across the country in 2021. When the policies were revoked, the nation saw a record increase in poverty the following year.

One proposal on the table would reduce SNAP benefits for more than 700,000 Oregonians by changing how the benefits are calculated. Another would end free school meals for 12 million children across the country, as well as the Summer Food Service Program.

Queral believes funding such programs is the responsibility of the federal government.

"What the Trump administration and Republicans in Congress are proposing is, in essence, playing a budget 'trick' by shifting those costs to the state," Queral emphasized.

Congressional Republicans also aim to add more paperwork and work requirements to receive SNAP and Medicaid benefits. Queral noted creating more barriers often means fewer people get the services. He stressed it is essentially a way to indirectly cut popular programs many children and lower-income Oregonians depend on.

"Lack of nutrition early in life, lack of access to health care early in life, have repercussions for future generations," Queral underscored. "We have to really think about the long-term consequences of the choices that we're making today."


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Minnesota lawmakers have a few weeks left to wrap up their legislative session on time. A new state budget tops the list of remaining tasks, with observers wondering if both chambers have just enough bipartisanship in them to get it done.

Minnesota still has a surplus for the next two years but elected officials from both parties are trying to get ahead of a projected deficit for 2028 and 2029 by looking at spending cuts. Gov. Tim Walz and fellow Democrats have also eyed raising certain taxes and fees to keep a negative balance at bay.

Kevin Parsneau, professor of political science and Minnesota State University-Mankato, said after a rocky start, things have been relatively cordial.

"They've gotten a lot done, a lot faster than you might've expected," Parsneau observed. "Although there are some very big issues that have to be resolved within the next few weeks."

The start of the session was mostly delayed because of a power-sharing dispute between House Republicans and Democrats set off by the need for a special election. The chamber is now in a tie and while they have to work together, Parsneau acknowledged the scenario has the potential to derail progress. He echoed others by noting large federal funding cuts led by the Trump administration make things hard for states to plan spending.

While the White House has been aggressive in recent months to cut aid, the next federal budget is not scheduled to be finalized until later this year. With Congressional Republicans in control, Parsneau pointed out states could lose even more assistance. Because Minnesota's budget has to be in the books beforehand, he wondered if lawmakers will have to come back later this year.

"I assume they're hoping to avoid a special session," Parsneau added. "But it seems like it's gonna be difficult to do that."

He suggested it is a tough situation because voters might view a special session as another example of political drama. Parsneau emphasized voters are locked into a mindset of wanting decisive action from their representatives. Beyond a budget, a bonding bill for infrastructure projects has been debated. As for cuts, education and health programs are getting heavy focus.


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