A new report found women of childbearing age in rural areas rely more on Medicaid for health care coverage than their urban counterparts and cuts to Medicaid could threaten services.

The report by the Georgetown University Center for Children and Families found nearly a quarter of Virginia women in small towns and rural areas get health care through Medicaid. Republicans lawmakers are now considering a $625 billion cut to Medicaid, which many believe will eliminate health care for thousands in the Commonwealth. Virginia expanded Medicaid coverage in 2019 but any decrease in Medicaid funds automatically triggers the expansion to end.

Joan Alker, executive director of the center, said cuts would threaten rural communities.

"Rural communities tend to have lower income than metro areas," Alker pointed out. "Medicaid, as important as it is for moms and babies nationwide, is even more important in rural areas and small towns."

Republican lawmakers have proposed the Medicaid cuts to redirect $4.5 trillion to other programs and tax cuts. Rep. Mike Johnson, R-La., the Speaker of the House said Congress is addressing government waste and abuse.

Cuts to Medicaid could affect rural women not on Medicaid, too. One study showed rural hospitals are at least 60% more likely to remain open in states that have expanded Medicaid. In Virginia, only eight rural hospitals have labor and delivery units.

Victoria Richardson, staff attorney for the Virginia Poverty Law Center, said rural hospitals depend on Medicaid coverage to keep their doors open.

"It's important to keep those hospitals open, not just for women covered under Medicaid but also for pregnant women in general," Richardson contended. "If a hospital closes, that affects everybody in the community, no matter what source of coverage you have."

A poll by The Associated Press and NORC Center for Public Affairs Research found 55% of U.S. adults believe the government is spending too little on Medicaid, compared to 15% who believe it is spending too much.

California's law legalizing medical aid in dying could be made permanent, if lawmakers approve a bill currently before the State Assembly.

Senate Bill 403 would eliminate the sunset clause in the 2015 End of Life Options Act.

The law allows mentally capable, terminally ill patients with less than six months to live to get a prescription to end their life.

Advocate Dan Diaz says his wife, Brittany Maynard, moved Oregon in 2014 to make use of the state's Death With Dignity Act.

"Brittany is gone, so now I'm fighting for all terminally ill individuals that might find themselves in Brittany's predicament," said Diaz, 'so that they don't have to do what she did, of leaving their home state, after being told you have six months to live."

The End of Life Options Act is currently set to expire in five years. Medical aid in dying is legal in 11 states plus Washington D.C. - but California is the only jurisdiction with a sunset provision.

Leslie Chinchilla, California state manager with Compassion & Choices Action Network, said over the past decade, there hasn't been a single substantiated case of abuse involving medical aid in dying statewide.

"The California Department of Health does a yearly report on medical aid in dying," said Chinchilla. "There has been no instance of coercion or abuse, and really the law is working as intended."

In 2023, more than 1,200 terminally ill Californians obtained prescriptions for medical aid in dying and 69% took the medication.

Patients with end-stage renal disease have two treatment options: dialysis or a kidney transplant but because donor kidneys are scarce and wait times are long, most will need to start dialysis while they remain on the transplant list.

Research from Arizona State University aims to better understand the differences in the decision-making process among clinicians about whether to accept or reject a donor kidney.

Ellen Green, associate professor of health solutions at Arizona State University, the study's principal investigator, said candidates are matched with an organ donor through the nonprofit United Network for Organ Sharing and once matches are made, they are sent out to clinics where patients with end-stage renal disease are on waiting lists.

Green and her co-investigators want to determine if an individual clinician's willingness plays a role in accepting or rejecting a kidney donation.

"In this initial study, we don't know whether or not this is a good thing or a bad thing," Green observed. "It could be that the variability is demonstrating that some clinicians are pushing the envelope while other clinicians are learning and have resources to deal with certain types of transplants that maybe are higher risk."

There are about 90,000 people in the U.S. that are waiting for a kidney transplant, and 11 people die every day in that wait, according to UNOS. Studies show while many kidney donations are deemed viable, almost 30% are declined for transplantation despite strong demand. In Arizona, 730 kidney transplants were completed in 2024, according to the Organ Procurement and Transplantation Network.

As an economist, Green noted it is a challenge to understand how a system which is not driven by price operates. She acknowledged while their study looks to learn more about clinicians' willingness, she understands other variables can affect the decision-making process.

She hopes her work will help increase the availability of donated kidneys.

"What we want to better understand is, from a clinician-to-clinician perspective, is there something that we can do or better understand about this decision-making process that we can leverage to increase those chances," Green emphasized.

Green pointed out understanding individual decision-making is something flying under the radar and argued it needs to be incorporated into current models, otherwise opportunities to have successful kidney transplants could be negatively affected.

As Congress reviews budget slashes to health care in President Donald Trump's "One Big Beautiful Bill Act," a new evaluation from the nonpartisan Congressional Budget Office projects 16 million Americans, including 1.8 million Medicaid and Healthy Indiana Plan recipients, would go without health insurance.

If the bill passes as is, said Josh Bivens, chief economist at the Economic Policy Institute, a nonpartisan think tank, health providers would see a sharp increase in what is known as uncompensated care, when people without coverage get sick but are unable to pay.

"And it means hospitals and doctors no longer receive that income stream from Medicaid payments," he said. "And lots of them are going to be forced out of business, and there's going to be closures of hospitals, especially in rural counties."

Republicans question the Congressional Budget Office projections, believing that cutting $715 billion from Medicaid eliminates fraud. They want to add specific work mandates for healthy working-age adults. The GOP bill aims to fund Trump administration priorities, including more immigration raids and border wall construction, and extending tax cuts passed in 2017.

According to the research site KFF, nearly 569,000 Hoosiers are enrolled through the Affordable Care Act's Medicaid expansion.

Bivens said he fears that if the bill becomes law, he sees the measure as a transfer of income from vulnerable families to already wealthy Americans. He noted that the average cuts to Medicaid, which would take effect after the 2026 midterm elections, would be more than $70 billion per year.

"And then if you look at the tax cuts that will be received by just people making over $1 million per year, those are $70 billion as well," he said. "We're going to take $70 billion away from poor families on Medicaid, and we're going to give it to families who are making more than $1 million per year."

Six Nobel laureate economists have signed an open letter opposing cuts to safety-net programs in the budget reconciliation bill, warning the measure would add $5 trillion to the national debt.


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