Groups that fight for greater access to health care are criticizing the Republican budget blueprint currently before the
U.S. House of Representatives, claiming it could lead to huge cuts to Medicaid -- known as Medi-Cal in the Golden State. Republicans can only afford to lose a couple of votes in order to use reconciliation to pass the bill on a simple majority vote.

Kiran Savage-Sangwan, executive director of the California Pan-Ethnic Health Network, is asking voters to get in touch with their local members of Congress.

"Devastating health-care cuts can still be stopped," she said. "With the slimmest of a majority in the House of Representatives, it would take less than a handful of House Republicans to vote 'no' on this plan to save health care for 15 million Californians who count on Medi-Cal."

The House version of the budget blueprint calls for $880 billion in cuts to the part of the government that funds health care for low-income families, seniors and people with disabilities. House Speaker Mike Johnson has said the savings are necessary to fund President Donald Trump's other budget priorities.

Adriana Ramos-Yamamoto, a senior policy analyst with the California Budget & Policy Center, said the administration's priorities stand to hurt average Californians.

"Republicans want to cut funding for basic health care and nutrition programs that millions of people rely on, all in order to help pay for tax cuts that disproportionately benefit the wealthy and corporations," said Ramos-Yamamoto. "These cuts would be a major hit to California, where federal dollars make up about a third of the state budget."

Amanda McAllister-Wallner, interim executive director of the nonprofit Health Access, notes that Congress will soon adjourn for a two-week break, sending lawmakers back to their districts.

"When these members are home in their district, we want to make sure that they're hearing from constituents -- and that they are accountable when they go back to D.C. and they start talking about the details of this plan," she explained.

Details of the campaign to protect Medi-Cal are online at fightforourhealth.org

A budget plan taking shape in Congress is getting attention for tax cuts and reductions for safety-net programs. Policy experts in South Dakota also track what changes would mean for state government spending.

The GOP-led proposal cleared the House this week by a slim margin, with all eyes now on the Senate for action.

Programs such as the Supplemental Nutrition Assistance Program, or SNAP, would be overhauled to offset proposed tax-cut extensions. Advocates have said new work requirements would reduce access to benefits. States would also have to absorb more program costs, and Ed Gerrish, associate professor of public administration at the University of South Dakota, said there's a key factor to consider.

"The states, of course, have a balanced-budget requirement, whereas the federal government does not," he said, "so the overall package that was passed will add trillions to the national deficit and debt. [The] federal government can do that, but states can't."

This means that if states have to contribute more to cover SNAP but don't have the money, their budgets would have to be cut elsewhere. Gerrish said it depends on the state, but he predicts South Dakota would simply reduce the scope of its SNAP program.

South Dakota just passed a budget slightly smaller than the previous spending plan due partly to dwindling sales-tax revenue.

There's also proposed Medicaid changes, and the Congressional Budget Office has said several million people could lose health coverage over time. Gerrish said if those people were to file for bankruptcy because of unpaid medical bills, the state would likely have more court expenses on its hands.

"So, that's what we saw prior to the Affordable Care Act was high levels of medical bankruptcies, and I expect we'll see a higher level of medical bankruptcies here in the next," he said. "It's not going to wind through immediately, right? But it might be three or four years."

Some provisions wouldn't take effect until at least 2026. With a sunset date looming, backers of extending and expanding tax cuts from 2017 cite urgency in generating economic activity. Gerrish said that could help with South Dakota's sales-tax collections, but noted that these moves prevent income taxes from increasing again. Provisions that would enhance tax cuts are mostly temporary.


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A guaranteed income pilot program in Oakland improved housing stability and employment among its recipients, according to a new report from the University of Pennsylvania's Center for Guaranteed Income Research.

Starting in 2021, 300 low-income families in Oakland received $500 a month in cash for 18 months.

Jesus Gerena is the CEO and president of UpTogether, a nonprofit based in Concord that administered the program alongside the group Oakland Thrives.

"The income guidelines are at or below the federal poverty line," said Gerena. "They had to have at least one child under the age of 18, and then the average age for participants was 38 years old. Eighty-four percent of them were women."

The report showed that participants often made significant gains. Participating adults were 44% less likely to experience homelessness after one year in the program.

And contrary to popular belief, the extra money did not hurt employment. Full-time employment rose 11% for those in the program, compared to a 4% increase in a control group.

Gerena said even though the pilot program is now over, he hopes its success will convince authorities that poverty is a policy choice.

"If we trust and invest directly in people and their abilities, who are facing financial hardship," said Gerena, "they're more than capable to be able to identify goals and figure out what they need to do to be able to find success in their lives."

Researchers also found that families receiving the cash also reported an increase in their children's academic performance.

The program was funded by private donations. Once it ended, many of the gains receded.






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Minnesota is in the top half of states when linking Medicaid coverage with needs for maternal care in rural areas.

That's according to a new report from the Center for Children and Families at Georgetown University.

In rural Minnesota, more than 23% of women of child-bearing age are covered by Medicaid. That's in line with the national average and 4% higher than the state's metro counties.

The University of Minnesota Professor in the School of Public Health Dr. Katy Kozhimannil is part of the broader research community looking at this issue.

She said these numbers come amid a continued decline of obstetric care in these communities.

"More than a decade into a maternal health crisis in this country," said Kozhimannil. "Fewer and fewer U.S. hospitals provide obstetrics every year with rural hospitals experiencing the greatest losses."

Researchers say this care is expensive and big Medicaid adjustments create more harm for rural providers, putting the health of mothers and babies at risk.

House Republicans are considering program reforms, including work requirements, to help pay for tax cuts.

The GOP says streamlining services keeps the program strong for vulnerable people, but the Congressional Budget Office estimates nearly 8 million people would lose coverage.

With that CBO forecast, Democrats and health advocates contend the proposed changes amount to massive cuts.

The Georgetown Center's Executive Director and Co-founder Joan Alker said the current debate over Medicaid is one of the more consequential ones she has seen in her time tracking federal policy.

"And the reality is that these cuts," said Alker, "could be extremely pernicious and dangerous for rural communities."

The report says in 2023, Medicaid covered 41% of births nationwide, but nearly half of all births in rural areas.

As for the chance of increased health risks, these researchers note that rates of infants with low-birthweight in rural counties tend to be higher than those in urban settings.