AUSTIN, Texas -- As states grapple with financial shortfalls due to the coronavirus pandemic, a new study shows just how much Texas could benefit by expanding Medicaid under the Affordable Care Act.

Study lead Laura Dague, associate professor in the Bush School of Government and Public Service at Texas A&M, said at current funding rates, Medicaid expansion in Texas could bring in $5.4 billion in new federal spending and provide health coverage to nearly 1 million Texans, with little cost to the state.

Dague said the unexpected health crisis illustrates how expanding Medicaid could help lower-income Texans.

"Medicaid is the kind of program that can make a big difference in a pandemic - especially as, going forward, where hopefully we'll develop better treatments, and thinking about how people are going to pay for those things," Dague said.

Without health insurance, people typically forgo preventive care, and head to an emergency room when they're sick, creating a financial burden for the state and taxpayers. Research for the study was compiled by the Bush School of Government and Public Service and sponsored by the Episcopal Health Foundation.

Texas is one of 12 states that hasn't expanded Medicaid since becoming eligible to do so with passage of the Affordable Care Act in 2010. As a result, Texas has the nation's highest rate and total number of uninsured individuals.

Dauge said many Texans earning minimum wage are too poor to qualify for an ACA tax credit, but earn too much to qualify for Medicaid under the state's strict eligibility criteria.

"So, we have a really big eligibility gap in Texas that a lot of people in working families can fall into," she said. "And that's one of the reasons we have a high uninsured rate relative to other states."

Dague worries when the COVID-19 vaccine is available, the cost will be out of reach for some Texans.

In 2019, a federal judge in Texas invalidated the Affordable Care Act, although the law remains in effect awaiting a U.S. Supreme Court ruling.

It's National Nurses Week, and educators and healthcare officials say there just aren't enough of them to go around. A combination of retiring baby boomers and nurses who chose to leave the field after the pandemic has left a projected shortfall of more than 5,400 nurses in Nebraska's hospitals, clinics and long-term care facilities.

Linda Hardy, Nebraska Nurses Association president, explained that the system is not training enough new nurses to fill the vacancies.

"I think across the country we have a nursing shortage," she intoned. "But the other thing we have a shortage of are nurse educators - and also, clinical sites for student nurses to be able to practice their clinical skills."

According to a Nebraska Health Care Workforce Collaborative report, 66 of the state's 93 counties have been declared medically underserved, and nine have no nurses. The report points to degraded "emotional health and well-being" as the main reason for staff shortages.

Hardy added healthcare providers and state officials are studying how to increase the investment in educational facilities and clinical sites to train new healthcare workers, and said one goal is to recruit them when they are young.

"There's a collaborative effort to try and get more healthcare workers, not just nurses but radiology techs, pharmacists, etcetera, into the pipeline from high school kids. So, that's a good thing," she insisted.

Carole Johnson, administrator of the Health Resources and Services Administration, said her mission during National Nurses Week is to highlight the vital role nurses play on the front lines, providing care, comfort and support to patients every day, but added the best way to honor them is to support them from training through retirement.

"You have to be investing in the nursing workforce. And so we're providing scholarships, loan repayment, stipends, upskilling - a whole host of training initiatives to really help ensure that we can recruit people into nursing and that when they're there, that they stay," she continued.


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Birth doulas assist new moms with the stress, uncertainty and anxiety of childbirth, while another type of doula offers similar support to those who are dying.

Death doulas, or end-of-life specialists, give spiritual and emotional support to people nearing death in a nonmedical setting. The word 'doula' comes from the Greek word 'doule,' meaning 'female helper.'

Kim Burgess, end-of-life doula and board certified adult geriatric nurse practitioner for Comforting Transitions, an elder care facility in O'Fallon, said fulfilling a dying person's wish to be in their desired setting is important.

"When I was in the home, primarily geriatric population, people wanted to stay in their home; the comfort of their home, their own surrounding, their own food, their own loved ones," Burgess explained. "I loved to being able to support people in that role."

Training to become an end-of-life doula happens in workshops, with required reading and work-study assignments. Since it is not a federally recognized field, insurance companies do not cover the services. The Illinois Department of Public Health said in 2022, Cook County alone saw nearly 46,000 deaths. Almost 20,000 were between ages 65 and 84.

Death, or what is sometimes called "the other side," can produce feelings of fear, or a sense of denial, especially if a terminal condition has been diagnosed. Burgess observed it is a 24-hour job for loved ones helping someone in their final days or weeks. She has encountered families who are unprepared for the caregiving needs.

"A lot of times, their family is saying, 'We're just overwhelmed, and we have hospice involved, but we still feel like we need some more support,'" Burgess recounted. "An end-of-life doula can be there, giving the family reassurance or making some slight suggestions on how to comfort their loved one."

Doulas can also help plan an advance directive, instructions a person can leave behind about their funeral service or cremation, what to do with a pet or help writing a loving message to family and friends.

A Des Moines-based farm co-op is taking high-tech sports-training into the country and has hired an athletic physician to do it.

The field of high-tech sports training is usually reserved for athletes and other high-level performers but the mindset is taking a dramatic turn, as the Landus Co-op in Des Moines has hired a physician.

Dr. Dehra Harris has spent much of her medical career training the Toronto Blue Jays minor-league baseball players and is bringing those skills to the Iowa countryside. Harris said she has always been drawn to helping people who have to perform physically to make a living.

"You don't have days off. You can't take it easy, right?" Harris pointed out. "It's that 'rub some dirt on it' kind of world. And to be able to take the things that we've been learning, in sports and in medicine, and apply it to this group is just an incredible opportunity."

Harris explained she will start by listening to farmers' physical needs, then developing proper nutrition and recovery programs even if it means responding to a farmer who's delivering a calf at three in the morning, and whatever else it takes to help with America's ag production backbone.

Harris noted her regimen will not stop with physical training. In fact, the Centers for Disease Control and Prevention reports suicide rates are nearly twice as high for farmers compared to the general public. The threat was most severe during the pandemic.

Harris will design wellness plans for farmers' mental health, although she noted getting the information might not be easy.

"I love it when I talk to farmers because I'm going to hear all about their family," Harris added. "I'll hear about everything to do with their farm but I'm also not going to hear a lot about what they need. So, we think that the strategies that are actually going to work best here are actually to approach this as a family, and see what the needs are for the whole unit."

Landus is among the first co-ops in the country to take the new approach.


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