Minnesota's rural health-care landscape is described as being "stressed" - and the diagnosis could become grimmer if congressional Republicans keep their sights on Medicaid when reducing spending.

Specifics need to be sorted out, but the budget framework advanced by House Republicans this week is expected to include major cuts to Medicaid, so lawmakers can adopt President Donald Trump's tax-cut plan. Health-care voices have said the government insurance program has a big presence in rural areas.

U.S. Sen. Tina Smith, D-Minn., touched on that issue in a news conference hosted by Protect Our Care when discussing how Minnesotans would feel the pain.

"Many of the patients that show up for care at rural hospitals are folks that get their insurance either through Medicaid or through Medicare," she said. "It tends to be in rural communities; an older and often sicker group of people."

Smith added that losing reimbursements would force more rural providers to make tough decisions by doing away with services such as maternal care or pain management.

House Republicans have said they're eyeing a final plan that "makes government work more effectively for all Americans." But they're already seeing backlash in their home districts.

Mark Jones, executive director of the Minnesota Rural Health Association, said the situation in this state isn't as dire compared with other parts of the country. But he said deep Medicaid cuts would still overwhelm the landscape as providers in smaller towns try to stand upright.

"We've seen providers leave, we've seen services cut," he said. "We've made our way through the pandemic, and now one more struggle - much of which we have no control over or little control over."

Jones reminded people that Medicaid coverage isn't a handout. He said recipients in rural areas - who often are working - have little choice but to turn to programs such as these.

"The wages aren't there to support commercial health care," he said, "or employers are very small and can't offer a group plan."

If congressional Republicans go big on Medicaid cuts, with more than $800 billion currently projected, Jones said, Minnesota's list of rural hospital closures could grow longer. Six have shuttered since 2005, which he said hurts local economies and makes communities less attractive.

"If you're trying to recruit a teacher at the school, or you're trying to recruit somebody at the law office or the bank downtown, when they come to town to look at your community and you don't have a hospital," he said, "that's kind of a sign that your town isn't very healthy."


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South Dakota farmers leading the "locally grown" movement have visions of a dynamic regional food production system but some of it is in doubt with looming federal cuts.

The U.S. Department of Agriculture is swept up in the Trump administration's downsizing of federal agencies, including cancellation of the Local Food Purchase Assistance Cooperative Agreement Program for food banks to buy local produce at a market rate. Grants from the Regional Food Business Center program are also in limbo.

Stephanie Peterson, a funding recipient who operates a small egg-producing farm called Fruit of the Coop near Sioux Falls, said she is unsure she will get the rest of her money to scale up.

"The pandemic showed us the fragility of our industrial ag system, and how important it is to build up and focus on these regional and local systems," Peterson contended.

But after pouring her heart and soul into this seven-acre farm, Peterson wonders if the dream will slip out of her hands. It would mean local restaurants would have one less option for buying eggs at a time when avian flu is disrupting supply chains. The USDA has resumed funding for some initiatives but the department's top official has categorized certain local food programs as "nonessential."

The group Dakota Rural Action said ending the purchasing program for food banks affects nearly 30 farmers around the state.

Kjersten Oudman, owner of Blue Sky Vegetable Company, makes produce deliveries on behalf of a regional food hub. She said she is sad her local food shelf will lose out on some fresh and healthier options.

"We were one of the few deliveries that was giving it potatoes, cabbage, carrots or microgreens," Oudman explained. "I am most upset that people who need good, healthy, nutrient-dense food may not be able to get it."

On the business side of things, Oudman worries specialty farmers in South Dakota will lose ground in attracting new customers and markets for their products.

"We're pretty behind a lot of our other states in our infrastructure," Oudman pointed out. "There's just a lot of uncertainty and a lot of questioning of (if) grant programs do not come through, what do our businesses need to do in order to continue pushing for development?"

Postmaster General Louis DeJoy is joining forces with the so-called Department of Government Efficiency to cut costs at the Postal Service, this week announcing plans to cut 10,000 workers, amid other reforms.

Kentucky has lost postal service offices at higher rates than other states, especially in rural and Appalachian counties.

Mark Dimondstein, president of the American Postal Workers Union, said older adults, veterans and others depend on the service's commitment to deliver mail to everyone, regardless of where they live, noting the Postal Service delivers to every address in the country, 169 million addresses and 318 million pieces of mail, every day. Local unions in Kentucky are participating in a National Day of Action on Thursday.

"Part of the effort on Thursday is to make the postal customers around the country fully aware of this threat to what belongs to them," Dimondstein explained.

In a letter to Congress, DeJoy said the agency needs help with lease renewals on its retail centers and tackling the issue of counterfeit postage. The Trump administration has also floated the idea of privatizing the post office. Supporters argued the change would make the Postal Service run more efficiently and save money.

Polling from the Pew Research Center finds 72% of Americans have a favorable view of the Postal Service.

Dimondstein pointed out more than five decades ago, postal workers won collective bargaining rights. He stressed the union is prepared to fight back on any attempt to weaken union rights or target worker protections and working conditions.

"It's also very important, I think, for the public to be reminded that good living-wage jobs help our communities," Dimondstein added. "They help make them stronger. That's good jobs, turnover in the community to restaurants to small retail stores to housing."

According to the union, privatization would eliminate more than 600,000 living-wage union jobs, including more than 70,000 military veterans. As of last November, the Postal Service employed more than 7,000 Kentucky workers.

Indiana lawmakers introduced a third property tax plan this week, aiming to protect local governments from funding cuts while offering minimal relief to homeowners.

The proposal, led by state Rep. Jeff Thompson, R-Lizton, would change how property taxes are calculated, including phasing out certain homestead deductions and shifting local income tax authority.

"When you raise the rate, pocketbook lost some money," he said. "You lower the rate; pocketbook gains some money - that's the right system. It won't be always smooth, but the alternative is where we're at right now, and we can continue on down the path and we'll have the same results."

Thompson's plan joins competing proposals from Gov. Mike Braun and Senate Republicans. Braun's plan, which was central to his campaign, would significantly cut property taxes but at the expense of local government funding. The Senate version proposes smaller cuts to both homeowner taxes and local budgets.

David Ober, vice president for taxation and public finance at the Indiana Chamber of Commerce, told lawmakers that changes to the business personal property tax rate were "a bit of a double-edged sword."

"It eliminates the aggregate floor," he said. "It doesn't eliminate individual pool floors. A lot of businesses' personal property is sitting at that floor - at that 30% - but if you eliminate that 30% floor, it's not like it goes down to zero."

Despite the differences, all three plans would shift tax burdens between property classes.

Critics argued that reducing business taxes could place more financial pressure on homeowners. The Ways and Means Committee is also considering separate legislation to gradually lower the state income tax rate if revenue growth meets specific targets.


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