By Anna Gustafson for the Pennsylvania Independent.
Broadcast version by Danielle Smith for Keystone State News Connection reporting for the Pennsylvania Independent-Public News Service Collaboration

Josie Badger doesn't know where she would be without Medicaid.

"I use a ventilator, power wheelchair," said Badger, a disability rights advocate who lives in western Pennsylvania's Lawrence County. "I have 24-hour care. I could not get out of bed every day without that care, let alone work, have a business, be a foster mom, own a home, any of that. So, without that coverage, Josie would not be here."

Badger was born with a physical disability called congenital myasthenic syndrome, which leaves an individual with weakened muscles, and she spent months on end in the hospital as a child. While she was growing up, Badger's parents repeatedly considered getting a divorce solely so they could each have their own private insurance plan that Badger could use.

"Fortunately, that didn't happen," Badger said of her parents divorcing. "Now, as an adult, I receive waiver through Medicaid home-based services, and it is my lifeline."

Now, however, Badger is fighting to keep that lifeline.

In an effort to pay for President Donald Trump's tax cuts for the wealthiest Americans, House Republicans on May 22 passed legislation, which they named the "One Big Beautiful Bill Act," that would carve about $700 billion from Medicaid, add approximately $3.3 trillion to the national debt over the next decade, and cause about 13.7 million people to lose health care coverage nationwide. The bill passed the House by a vote of 215-214, with all but five Republicans voting for it and no Democratic support. Every Republican House member from Pennsylvania supported the bill, which is now before the Senate. Trump is expected to sign the bill if it passes the Senate. If the Senate changes anything in the House bill, the two chambers must work out those differences and vote on the final legislation before sending it to the president.

In Pennsylvania, where close to one-quarter of the population is enrolled in Medicaid, the federal Medicaid cuts could strip health coverage from hundreds of thousands of residents, including people with disabilities, individuals in nursing homes, and children. About 750,000 people with disabilities use Medicaid in Pennsylvania.

"We're at a place where we need to become very public about what's going on, because I don't think enough people realize that these cuts are going to affect them," Badger said. "They don't realize that Medicaid pays for services in schools. They don't realize that the Affordable Care Act that they're buying, those services could go away."

'I become paralyzed with the fear'

For Badger, a loss of Medicaid or reduced benefits would be life-changing. Currently, she is able to afford six nurses and three home-care attendants who provide around-the-clock services through her Medicaid plan. It's this kind of care that keeps her out of a nursing home and living in her own house with her family, running her own consulting firm, which works to empower people with disabilities, and generally living a life she loves.

As Republicans push for the largest cuts to Medicaid in the program's 60-year history, Badger is trying to focus less on how her own personal life would be affected by the GOP's plan and more on galvanizing people to fight for the public health insurance program that covers about 80 million people nationally, or about 20% of the country's population.

"For me, I can't think a lot about it in terms of my own life because I become paralyzed with the fear, with the anxiety, and so I have to go and activate other folks to get involved," Badger said. "The community is really what keeps me going and realizing why it's important that there's hope. And so a lot of my work time I've been donating towards trying to elevate people's voices for a lot of issues, not just Medicaid. I'm not even sure I can process it on a personal level."

Should the House bill be signed into law, Badger said, she expects her home caregivers could lose their jobs, or leave them, because of a lack of funding. That, then, could leave older people and people with disabilities with no option but to go into a nursing home.

"Nursing homes, historically, have been last resort, even though they are one of the most expensive options, and so I think that there's going to be a come-to-Jesus moment when we start seeing millions of folks with disabilities and older adults needing care not being able to get it and ending up in nursing homes that are also underfunded," Badger said.

Losing home- and community-based services

Jennifer Garman, the president of Disability Rights Pennsylvania, is also deeply worried about cuts to home- and community-based services that are funded by Medicaid, including housing and employment support. Through those services, people with disabilities are able to live in their own homes as well as work.

"We already also have a waiting list for home- and community-based services for people with intellectual disabilities," Garman said. "And so we would also be concerned that waiting lists will grow for services and that people will have to wait a longer time than they're already waiting."

"It will just be a tremendous strain on the commonwealth and really deeply impact the community and people accessing the services that they need," Garman continued.

Cutting or decreasing those services would be disastrous, said Christie Cyktor, the youth leadership and training coordinator for western Pennsylvania at the PEAL Center. The PEAL Center works with youth with disabilities and their families to help them advocate for themselves in a variety of settings, such as school or the workplace.

Cyktor, who has a congenital disability that affects her joints and has used a power wheelchair since the age of 8, explained the youth she works with want to go to college, be in the workforce and live independently. In order for them to do that, they need to have a direct-care worker who helps them with various tasks, depending on their needs, such as dressing themselves, she explained.

Cutting those services would harm people who want to contribute to their families, communities and economy, Cyktor said.

"They want to contribute to the workforce and economy and give back that way, but they're like, How am I going to afford this if I can't fund a direct-care worker?" Cyktor said.

Cyktor doesn't currently have a direct-care worker, but she did in college, and she said that support allowed her to graduate.

"There's no way that I would have been able to go live independently at college if I did not have this woman," Cyktor said. "She was the sweetest woman and would come in the morning, help me get up, get dressed for the day, get me set up, and I could go do things independently during the day. And then she'd come back at night, and, same thing, sort of helped me get ready for the night and everything. And that enabled me to go get my degree."

Support at school

Medicaid also funds school-based services, which is the only way that many school districts are able to afford means of support for students with disabilities, such as occupational therapy, nurses, mental health care, and specialized equipment such as wheelchairs.

Cuts to those services could have lifelong consequences for students, Cyktor said. In addition to working at the PEAL Center, Cyktor also provides virtual occupational therapy for students across Pennsylvania.

"So many school-based services are funded by Medicaid, and so it's already something I've sort of been thinking about for these families who I see all across Pennsylvania, in very rural areas, and really the cyber platform is maybe the only time they have access to occupational therapy, any other service," Cyktor said. "So if that gets cut, these kids are going to be losing out on these vital services and doing this really important development at such a young age."

Cyktor works with students in kindergarten through 12th grade on fine motor skills, such as handwriting and typing, as well as executive functioning skills like daily activity scheduling. Without those skills, it will be difficult to enter the workforce, she emphasized.

"If they're cut now, the future impacts are going to be huge for them," she said.


Anna Gustafson wrote this article for the Pennsylvania Independent.


get more stories like this via email

As federal Medicaid cuts loom, consumer advocates are celebrating Washington's new bill limiting hospital prices for state and public school employees.

Senate Bill 5083 caps reimbursement rates for nearly 700,000 people covered by the Public Employees Benefits Board and School Employees Benefits Board.

Sam Hatzenbeler, legislative director for the Economic Opportunity Institute, said public and school employees pay more than twice what the federal government said is a fair price for Medicare, with some hospitals charging up to four times more.

"At a time when everyone is going to be asked to tighten their belts due to federal cuts, it's more important than ever to be prudent with our health care resources," Hatzenbeler contended.

Washington hospitals pushed hard against the bill, warning it will add pressure to their already stretched budgets. Hatzenbeler pointed to a similar law passed in Oregon in 2019, which saved the state more than $100 million and cut out-of-pocket costs for patients by nearly 10%.

Adam Zarrin, director of state government affairs for the Leukemia and Lymphoma Society, said large hospitals consolidating through buying up their competitors is one of the reasons health care costs have grown out of control.

"States can and should take action to try to increase competition in this health care space," Zarrin argued. "Because we know that those market factors can help drive and keep costs down."

Public and school employee health insurance rates have risen more than 6% annually since 2021, compared to roughly 10% annually for other plans. Hatzenbeler added while the cap is a step forward for public workers, lawmakers must expand the relief statewide.

"The data tell us that there are plenty of ways to trim excessive spending," Hatzenbeler emphasized. "For example, we can look at healthcare CEO salary data. But we simply can't shift more costs onto the backs of people who are already struggling to get health care."

Nearly 1,000 New Mexicans have already accessed a new online portal which provides transparency about how much the cost of prescriptions and medical procedures vary from one location to another.

Introduced in 2024, the state service now has been updated to include costs in Spanish for the first time.

Ervin Garcia, health systems epidemiology program manager for the New Mexico Department of Health, said in addition to prescriptions, the portal shows the average costs for doctor visits and medical procedures.

"They can compare how much it would cost in one city versus the other because when you search you can put in your ZIP code and it tells you the closest around you," Garcia explained.

Research suggests health care quality is enhanced when people know what they will pay ahead of time. It also shows most people take at least one prescription drug, and lower prices help people better maintain overall health and wellness.

Garcia noted the online service could be a lifesaver for folks prescribed medicines or procedures who do not feel comfortable revealing their financial or insurance status to medical professionals.

"This kind of helps ease the health care procedures that way, so that they can kind of get a familiarity on how much it would cost," Garcia added.

Americans do not necessarily take more medications than people in other wealthy countries but federal government data from 2022 show U.S. prices across all drugs including generics were three times as high as prices in comparable countries.


get more stories like this via email

By Marilyn Odendahl for The Indiana Citizen.
Broadcast version by Joe Ulery for Indiana News Service reporting for the Indiana Citizen-Free Press Indiana-Public News Service Collaboration.

In a move applauded by advocates and lawmakers alike, the Indiana General Assembly will be taking a closer look at the estimated $2.2 billion in medical debt that is saddling many Hoosiers and often causing a devastating impact beyond the household budget.

“We all want to be able to care for ourselves and our loved ones, but medical debt poses undue financial hardship that prevents this from being a reality for countless Hoosiers,” Zia Saylor, researcher at the Indiana Community Action Poverty Institute, said in a press release. “It is important that lawmakers recognize the medical debt crisis we have and the urgent need for policies to address it.”

The Legislative Council included medical debt among the 22 topics that it assigned for further examination by the interim study committee process this summer and fall. On Wednesday, the council members unanimously passed a resolution that divided the topics between more than a dozen interim committees.

Initially, the Legislative Council began with 100 proposals for study topics this summer, plus 300 agency reports that presented more topics for possible review, according to George Angelone, executive director of the Legislative Services Agency. Through a “bipartisan process,” the list was whittled down to less than two dozen.

Other subjects scheduled for study include the economic value of Indiana’s public land for recreation, barriers to entering licensed professions, teaching water safety as part of the K-12 curriculum, salaries for K-12 administrators, the usage and cost of long-term-care insurance, and pollution caused by improperly discarded cables. Also, the Government Reform Task Force has been charged with reviewing the “efficiency and effectiveness” of various state boards, commissions and councils, and the Artificial Intelligence Task Force, established by state statute in 2024, will continue to examine the use of AI technology and the potential effects on Indiana residents’ constitutional rights, employment and economic welfare.

After the council hearing, Senate President Pro Tempore Rod Bray, R-Martinsville, said the work of the interim study committees are an important part of the legislative process. It allows state representatives and senators to dive into the topics and enables the public to provide input as well, which is helpful, he said. Bray and House Speaker Todd Huston, R-Fishers, serve as chair and vice chair, respectively, of the Legislative Council, which is comprised of eight members of the Indiana Senate and eight members of the House.

“Maybe it doesn’t end up in a proposed bill for the next legislative session, but people are always going to walk away with more facts and more information about that particular subject,” Bray said.

Democratic lawmakers were upbeat about the assignments to the committees. Senate Minority Leader Shelli Yoder, D-Bloomington, said the Democrats pushed topics that focused on improving Hoosiers’ lives. Many families, she said, are struggling to raise their children, care for their aging parents and stretch their wages to cover rising costs.

“That why our caucus fought very hard to make sure that this year’s study committee didn’t just check a box (but) that they had something meaningful to offer to Hoosiers,” Yoder said after the hearing. “We pushed hard for real topics, real impact and we have many successes to point to.”

‘Medical debt is no-fault debt’

For Democrats, the legislature’s decision to study medical debt is a win.

The interim study committee on the courts and the judiciary has been tasked with examining medical debt, the only topic on its agenda. As part of its study, the committee will look at financial protections for individuals through caps on monthly payments for such debt and limitations on collections or liens on property, along with restrictions on garnishment of wages. Also, the committee will focus on nonprofit and county hospitals by reviewing the definition for charitable care and the requirement to offer payment plans in addition to notices about medical bills to patients.

Speaker Huston and Sen. Fady Qaddoura, D-Indianapolis, both suggested the medical debt topic.

Huston said the topic was spurred by the many different constituents who reached out, telling their stories of the immense financial burden that overdue medical bills can be.

“We will at least take a look at it and understand it, particularly for low-income folks or people that have had some kind of… large, expensive medical procedures,” Huston said of medical debt. “How do you help them get out from behind the eight ball? We’ll take a look at that and see what the options are.”

During the 2025 legislative session, Qaddoura introduced Senate Bill 317 which sought to address medical debt by offering protections similar to those that will be studied by the committee. The measure died after it was narrowly defeated in a 26-to-23 vote in the Senate.

“We should stop penalizing people for getting sick,” Qaddoura said in a statement. “Medical debt is often unavoidable and disproportionately affects those already struggling. Our goal should be to create a path forward that lifts people up, not holds them back.”

Indiana residents are some of the most burdened with medical debt in the country. A 2022 study by the Indiana Community Action Poverty Institute, Grassroots Maternal and Child Health Initiative, and Prosperity Indiana, found that residents of the Hoosier state had the 11^th highest share of medical debt in collections nationwide, which equals $2.2 billion outstanding and was the highest among the state’s Midwestern neighbors.

Delinquent or high medical debt contributes to a number of harmful consequences, according to the report. More than negatively impacting the financial health of a household, medical debt can degrade an individual’s physical and mental health. Also, unpaid medical bills can create barriers to credit and housing and can lead to garnishment of wages, property liens and reduced access to health care services.

“Medical debt is no-fault debt,” Dave Almeida, director of state government affairs for the Leukemia & Lymphoma Society, said in a press release. “It’s different from other debt because no one chooses to become sick, which means that no one should have to choose between putting food on the table, paying the rent, putting the kids through college, or engaging in life-saving treatment.”

Council bypasses some committees

Six study committee created by statute were not assigned any topics, including the elections body.

The interim study committee on elections has not met since 2017. However, bills that mostly restrict voting and elections have been introduced each legislative session, culminating in a flood of legislation this year that one voting-rights advocate described as “an assault on democracy.”

Bray did not express any concern about not giving any topics to elections and other committees, including education, public policy and public safety, and military affairs.

“We had a lot of legislation in those areas this last session and sometimes you’ve got to let some of those issues bake a little while … before you have a new issue that you really have to grapple with,” Bray said.

Yoder said she was disappointed that the Child Welfare Task Force was not assigned any topics. Passed this session with strong bipartisan support, House Enrolled Act 1273, authored by Rep. Dale DeVon, R-Granger, created the 22-member task force to study child welfare topics. The law requires the task force to submit two reports in October 2026 and October 2027, but does not specify any areas or subjects that should be studied.

Sen. Andrea Hunley, D-Indianapolis, was hopeful the study committees’ examination of the issues most concerning to families, such as clean water, maternal health and medical debt, would yield some legislation addressing key concerns in the 2026 General Assembly session.

 “We also know that a single study in the interim isn’t going to fix everything,” Hunley said. “But we also know that it can spark the change that is necessary. It can be the momentum builder that we need to make sure that we’ve got the momentum going into session, so that we can have the bipartisan support necessary to pass important legislation that this is the time where that happens.”


Marilyn Odendahl wrote this article for The Indiana Citizen.


get more stories like this via email