DES MOINES, Iowa - While the country waits for the Congressional Budget Office's report on the Republican health-reform bill, research released Tuesday shows rural states such as Iowa stand to lose the most.

According to the Center on Budget and Policy Priorities, provisions in the American Health Care Act to restructure Medicaid and essentially end its expansion would undermine coverage in rural areas.

Jesse Cross-Call, a senior policy analyst in the center's health-policy division, said there are long-standing reasons Medicaid is particularly important to rural America.

"People who live in rural areas have lower incomes, do more contract work and are less likely to have an offer of employer coverage than people who live in nonrural areas," he said. "The Medicaid expansion has given these individuals a pathway to health coverage where, before the Affordable Care Act, one often did not exist."

The report also noted that under the Republican plan, tax credits for the purchase of health care through the insurance market do not adjust for geographic variations, which could hurt people in rural areas who typically pay higher health-care costs. In Iowa, 44 percent of Medicaid expansion enrollees live in rural areas.

Mary Wakefield, who served as acting deputy secretary of the U.S. Department of Health and Human Services, contended that the GOP plan will reverse the progress made under the Affordable Care Act, such as the substantial drop in the rate of uninsured rural, non-elderly individuals.

"From 17 percent insured in 2013 to 12 percent uninsured in 2015," she said, "and while those numbers may seem abstract, they have tangible impacts on access to care, on health and on financial security."

The American Medical Association, the American Nurses Association and the American Hospital Association are among groups that oppose the American Health Care Act. Wakefield noted that those groups did not have the opportunity to weigh in on the measure.

"As both a health-care professional and a former agency head," she said, "I was genuinely shocked to see the House develop, debate and pass legislation upending our health-care system without holding a single hearing to hear from these groups about their bill."

The CBO report on the American Health Care Act is expected to be released Monday. Its analysis of the earlier version estimated 24 million people nationwide would lose coverage.

The report is online at cbpp.org.


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After more than 50 years of use, some Michigan lawmakers say naloxone may not be the best choice in an overdose situation.

Naloxone is sometimes called the "Lazarus drug" because of its powerful ability to seemingly resurrect people after a drug overdose.

Sen. Kevin Hertel, D-St. Clair Shores, and some of his colleagues have introduced a bill which would open the door for what they say are more costly, but more powerful, antidotes.

"Given the prevalence of fentanyl in our communities, and how much stronger some of these drugs that we're now seeing are, we believe -- and in talking with others -- that there should be other tools to respond to an overdose," Hertel explained. "To make sure we're doing everything we can to save somebody's life."

Not everyone is on board with the proposed legislation, Senate Bill 542. Opponents argued the more expensive naloxone alternatives are not necessary, and using them would only increase profits for the pharmaceutical industry.

Jonathan Stoltman, director of the Opioid Policy Institute in Grand Rapids, said while the naloxone alternatives do help in overdose situations, they can also cause nasty side effects.

"The newer approaches, they put people into more severe withdrawal," Stoltman pointed out. "That's a pretty profound negative side effect. The one approach is very inexpensive and works great; the other approach is far more expensive and has this strong negative side effect."

Sponsors of the bill say they're hoping to give Michigan residents a chance to chime in on the issue in a public hearing sometime in June. Michigan saw more than 3,000 opioid overdose deaths in 2021.


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New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.

Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.

"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained

Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.

Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.

"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.

Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.

New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.

The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.

"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.

Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.

Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."

"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.

Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.