According to state data, as Medicaid and the Supplemental Nutrition Assistance Program, or SNAP, face cuts, Michigan's most vulnerable stand to lose the most.

In the Great Lakes state, more than 2 million people count on Medicaid, and more than 1 million of them are kids. When it comes to putting food on the table, more than 1 million Michiganders rely on SNAP benefits, including one in four children.

Amber Bellazaire, senior policy analyst with the Michigan League for Public Policy, emphasized the ripple effects of these proposed cuts could create widespread challenges, even for those not directly enrolled in Medicaid or SNAP.

"If a rural hospital closes because they're operating on razor-thin margins and have lost a significant amount of their funding, because of Medicaid cuts, that hospital closes not just for Medicaid enrollees but for all folks in that community," she explained.

Supporters of the cuts contend that these programs place a heavy burden on the federal budget, discourage work and self-reliance, and are susceptible to fraud and abuse.

MLPP reports that Medicaid is relied on across all Michigan counties and congressional districts, especially in rural and northern areas. The state also ranks high for SNAP participation among veterans, with 41,000 enrolled.

Bellazaire noted that the proposed cuts won't make health care more efficient or affordable - and if she had a seat at the table where budget decisions are made, she'd offer a more balanced perspective.

"I think that there is opportunity to discuss the balance between fiscal responsibility and protecting and improving upon the successes that we've seen come from the Medicaid program and Medicaid expansion," she continued.

Those in favor of the cuts maintain that private markets and local solutions are more effective than government run programs - and states should have more control over program management, rather than relying on the federal government.

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.