Rural Californians would be hurt the most by huge proposed cuts to Medicaid, known in California as Medi-Cal, according to a new report from Georgetown University.

In rural parts of the state, 49% of children get their health care through Medi-Cal, and 41% in urban areas.

Faith Colburn, health care advocacy director for The Children's Partnership, said the cuts would be widely felt.

"5.3 million children in California are on Medi-Cal," Colburn reported. "Fifty-three percent of California's children and 40% of births are covered by Medi-Cal. And three-fourths are children of color. "

Congressional Republicans have suggested ways to reduce Medicaid spending, in order to extend tax cuts enacted by President Donald Trump in 2017, which some say mainly benefited the wealthy. The cuts could take the form of block grants which put a ceiling on how much states would be reimbursed, regardless of need or eligibility. It would force the state to either make up the difference through tax revenue or cut funding to health centers, thus limiting care for low-income families.

Joan Alker, executive director of the Georgetown University Center for Children and Families, said the cuts would make preventive care like checkups harder to access.

"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 pointed out.

Katy Kozhimannil, professor of health and policy management at the University of Minnesota School of Public Health, said the cuts could cause more rural hospitals to cut maternity care services, leaving expectant mothers no local option to give birth.

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

The report found in 2022, 52% of rural hospitals no longer had maternity wards, compared to 36% of urban hospitals.

February is American Heart Month and some Minnesota families are sharing their experiences with a sometimes overlooked disease among newborns: congenital heart defects.

Studies show congenital heart defects are the most common birth defect in the U.S., affecting nearly 40,000 babies each year. The American Heart Association said thanks to progress in the world of research and treatments, outcomes have improved. But families still find themselves in delicate situations.

Stephanie Johnson is a Minnesota mother whose son Henry was born with a syndrome restricting oxygen supplies to the body. Henry endured several surgeries and now lives a mostly normal life like kids his age but the worry is not over.

"We also know that the honeymoon period doesn't last forever," Johnson acknowledged. "At some point his heart's gonna get tired and he'll be looking at likely a heart transplant at that point."

Johnson hopes for additional medical breakthroughs but she and health experts noted congenital heart defect research is grossly underfunded. Another complication is government spending cuts sought by the Trump administration and the potential impact on agencies such as the National Institutes of Health. Policy experts say the research arm has already been dealing with flat funding levels.

In the absence of government support, current research heavily relies on awareness campaigns involving families navigating health scares. Johnson is among those trying to get the issue on the public's radar.

"We need to move science forward," Johnson urged. "Creating awareness for this is just incredibly important because awareness leads to funding, and funding leads to hope, and we're hoping for a cure."

Studies indicate congenital heart defects are underdiagnosed because milder symptoms are not always caught at birth. It means the disease is detected later in childhood or when the person becomes an adult.

Minnesota's Mayo Clinic and its HeartWorks program, as well as the Heart Association, are part of a network of health entities pushing for research advancements.

For Pennsylvanians with disabilities, there may be unexpected side effects to ending so-called Diversity, Equity, Inclusion, and Accessibility policies.

President Donald Trump has opted to eliminate DEIA initiatives in federal agencies and federally funded programs.

His executive order signed in January characterizes DEIA policies as "discriminatory."

But in Pennsylvania, Mallory Hudson - the director of the disability justice program at the Keystone Progress Education Fund - said a memo went out ordering the Justice Department's Civil Rights Division to not file any new complaints, motions to intervene, agreed upon remands, amicus briefs, or statements of interest.

"That means that the Department of Justice Civil Rights Division has been instructed not to file any new civil rights cases, right?" said Hudson. "And that includes ADA complaints. So, those are - that is one of the few ways that disabled people can even protect their civil rights."

She adds the Americans with Disabilities Act was first passed in 1990 under President George H.W. Bush, and its legal precedent was based on the Civil Rights Act of 1964.

Hudson said another potential concern is the future of the Inflation Reduction Act under the new administration.

She noted that the IRA has allowed the Centers for Medicare and Medicaid Services to negotiate drug prices - and many are benefiting from its progress, like a $35 co-pay for insulin.

"Older adults and some folks with disabilities have been able to do that $35 copay, and for folks on disability, that's still a pretty big chunk of change," said Hudson. "But it was better than before - and then, that meant taxpayers were paying the difference."

Lower prices have been negotiated for 10 medications so far, cutting costs for patients and saving taxpayers billions.

It's estimated that if the IRA had been enacted in 2023, it would have slashed prescription drug spending by 22% - or roughly $6 billion.

As health insurance premiums keep rising, Colorado lawmakers are advancing a bill to look at a universal Medicare for All option.

A 2020 report in the Annals of Internal Medicine finds administrative costs for private insurance, and the time doctors spend on billing paperwork, make up over one-third of all healthcare costs in the U.S.

Nathan Wilkes is a board member of with Health Care for All Colorado.

He said he believes the study called for in the bill will confirm previous research showing there is enough money to cover all Coloradans, by removing the middle-man.

"All of the public costs that we are paying, a lot of which are going to insurance subsidies and things like that," said Wilkes, "are more than enough to cover a system where there's a single pipeline."

Insurance industry executives say they've worked to lower administrative costs, and some politicians have argued private companies have better incentives to be more efficient than government services.

But administrative costs for private insurers in the U.S. are nearly six times the costs of Canada's single payer system.

Private insurers also argue they help keep overall costs down, in part by denying claims for procedures they see as unnecessary.

Wilkes said because of the industry's lobbying influence, voters will need to convince lawmakers to ensure all Coloradans can access health care.

"I think people recognize that there's a lot of profit extraction going on by companies that are not delivering any sort of healthcare services at all," said Wilkes, "while their family and friends are having to start 'Go Fund Me's' to pay for their cancer."

According to the Colorado Health Institute, some 265,000 Coloradans had no health insurance last year.

Wilkeds pointed out that Medicare's original aim was to eventually extend coverage to all Americans, not just seniors.

"Truth is that universal healthcare is as American as apple pie," said Wilkes. "Guaranteeing healthcare aligns with our nation's core values of life, liberty and the pursuit of happiness for everybody."




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