Congressional leaders are considering what some are calling "highly consequential decisions" about the future of Medicaid - and advocates are weighing in. The Medicaid budget cuts proposed by U.S. House Republicans approach $2.5 trillion, and a new report from the Georgetown University Center for Children and Families says they'd affect adults and children in rural Nevada, who rely more heavily on Medicaid for health coverage than people in cities.
Joan Alker, executive director of the Georgetown University Center for Children and Families and the report lead author, said the proposed cuts are "horrifying," and suggests Nevadans might be caught off guard because the program wasn't heavily 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. It's also a very popular program with the voters of all political stripes," she said.
The report finds there is about a 5% difference among adults in the Silver State who have Medicaid in metro areas versus rural areas. Alker added that if the cuts are enacted, the impacts will be felt across communities, businesses and healthcare systems. States would be forced to raise new revenues, or eliminate coverage for some people and cover fewer health services.
Alker said that Medicaid helps people get ahead of health challenges through preventive care - that many couldn't afford otherwise.
"People wind up sicker and then, they're in the emergency room, and children can't get their asthma inhalers and they miss school," she continued.
With the data her team compiled, Alker says it's clear rural America would feel the most harm as smaller towns and cities struggle to keep robust healthcare systems in place. Nevada's health care system already ranks among the lowest in the country, plagued with disparities across racial and ethnic groups as well.
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As Alabama's legislative session kicks off, one advocacy group is calling for urgent action to protect children's health and safety.
VOICES for Alabama's Children has outlined 10 key policy priorities for 2025, with a focus on reducing preventable deaths and expanding access to health care. The group's data show more children are losing their lives to car accidents and firearms.
Apreill Hartsfield, policy and data analyst and director of Alabama Kids Count for Voices for Alabama Children, said lawmakers could strengthen child passenger safety laws and implement firearm safety measures to help save lives.
"Hopefully, a child does not come across a firearm but if they do, that there are devices on those firearms that will keep them from being accidentally discharged," Hartsfield urged. "Because this is a reason why children in our state are dying."
Lawmakers have already prefiled about a dozen firearm-related bills. Among them is House Bill 26, which would ban pistols modified to function as machine guns, and House Bill 103, which would require secure firearm storage, making it a crime if a minor gains access due to negligence, with some exceptions.
Hartsfield thinks expanding health care access should also be at the top of lawmakers' agenda. While most Alabama children are covered by Medicaid or ALL Kids, nearly 200,000 working adults remain uninsured, creating challenges for families trying to stay healthy. She stressed when parents have health coverage, their children also reap the benefits.
"The children are more likely to be covered by insurance and are more likely to get regular medical care, to do those 'well baby checks' and just to try to stay ahead of any kind of illness, or any kind of developmental delay," Hartsfield explained.
She added other priorities include expanding mental health services, strengthening tobacco and vaping laws to reduce underage use, and increasing funding for nutrition programs like Summer EBT. The group also wants to see stronger data-driven juvenile justice reforms and updates to the state's public school funding formula to better meet students' needs.
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Tennessee's "State of the Child" 2024 report shows some progress, but also highlights ongoing concerns.
The report from the Tennessee Commission on Children and Youth examines kids' health and mental health, education, family economics, and childcare.
It also looks at the state's child welfare and youth justice data.
Kylie Graves is the director of policy and legislative affairs at the Tennessee Commission on Children and Youth.
She said a key indicator they look at most frequently is the percentage of children living in poverty. She noted that the percentage of children living in poverty in Tennessee did go up slightly between 2022 and 2023.
"So in 2023 we had 19.7% of our children under 18 living below the federal poverty line," said Graves. "For our kids under five, it was 20% - just a little bit above that. That did stay consistent between '22 and '23, so we saw no change in the under five poverty rate."
Graves noted that the annual report provides a comprehensive overview of child well-being in the state.
She said it tracks progress, comparing it with previous years and other states, and highlights areas for growth.
Graves said the report consistently reveals the high cost of infant center-based child care for families in Tennessee.
"The average market rate is $13,126, and so it's very expensive for a lot of families," said Graves. "That does make it more expensive than in state tuition for all but one of our state universities."
Graves pointed out that Tennessee's education system is showing progress, with T-CAP scores rebounding post-pandemic - though most students are still only "approaching" expectations.
She said teen mental health is still a serious concern, with nearly one in four high school students reporting thoughts of suicide.
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New child labor laws went into effect in Virginia at the start of the year, but some advocates say more can be done.
House Bill 100 took effect in January, raising the maximum financial penalty to $25,000 -- up from $10,000 -- if a child dies or is seriously injured while working in violation of labor law. Cases that do not involve injury or death will have stiffer penalties, too, with maximum fines set at $2,500.
Nina Mast, a policy and economic analyst for the Economic Policy Institute, said it is just the start of combatting illegal child labor in the Commonwealth.
"This was a really important first step in the overall goal of strengthening child labor standards in Virginia," she said, "but the penalty amounts are really only as effective as the enforcement can be in the state."
Mast added that the legislation also created a group made up of youth-serving organizations and young people to explore the creation of workers' rights education for high school students.
Going forward, Mast said new laws must keep young people from working in dangerous or hazardous work environments, including staffing agencies that are often used to fill meatpacking and construction jobs. That keeps the main company from being held liable.
Mast said state labor agencies need more employees to hold companies accountable.
"Employers know this. They know that they will largely get away with violating the law and no one will ever enforce those violations," she said. "Adding capacity is really important to signaling to employers that the law will actually be enforced when violations are found."
Before the law went into effect, there was no minimum financial penalty for business owners who broke child labor laws.
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