BISMARCK, N.D. -- North Dakota's governor and health-care leaders want residents to take COVID-19 seriously to prevent the snowball effects of the latest variant surge. Community Health Centers are stepping up to help.

This week saw Gov. Doug Burgum and large health systems plead with North Dakotans to get their vaccinations and wear masks, or more hospitals will be pushed to the limit this fall.

Only 51% of residents 18 and older have received all their shots.

Lori Dumke, chief operating officer of Northland Health Centers, said with misinformation still flying around, their clinics are trying to put skeptics at ease by connecting with prominent figures in communities with low access to care.

"'Can we take a picture of you getting a vaccine?'" Dumke explained. "You know, just showing in the community that trusted leaders are for it, I think is a huge step forward."

The National Association of Community Health Centers said in the U.S., clinics have administered 15 million COVID shots. The group said during the crisis, the centers also boosted telehealth to keep reaching underserved communities, and provided COVID care in non-emergency situations.

Those still reluctant to get vaccinated cite such reasons as personal freedom or mistrust of government.

Whether it is smaller, community-driven health facilities or larger providers, their message is uniform: The vaccines are safe, and most hospitalizations involve unvaccinated patients.

Janice Hamscher, chief nursing officer of Altru Health System in Grand Forks, said on Wednesday of this week, they had 10 COVID patients, and only one had received a shot.

"That continues to be a trend that we're seeing," Hamscher reported. "Unvaccinated individuals having more severe cases of COVID that result in hospitalization."

North Dakota's rolling 14-day average positivity rate for COVID cases had fallen to 1% in early July. It has now crept up to nearly 7% going into September.

Access to reduced-price medication is a necessity for many rural Missourians with low income.

Rep. Cindy O'Laughlin, R-Shelbina, the Senate Floor Leader, said Big Pharma is trying to confuse legislators with unrelated hot-button topics such as abortion access and illegal immigration in a last-ditch effort to stop the state from joining a program to force drugmakers to sell medicines at a discount.

"Appealing to nuclear topics, which really do not apply in this situation, is a disingenuous way to try to defeat a bill that is actually good for Missouri," O'Laughlin asserted.

O'Laughlin pointed out the program is transparent, and uses the tax money saved to help low-income families deal with chronic conditions such as diabetes.

The drugmakers object to the government forcing them to give significant discounts, arguing hospitals' and for-profit pharmacies' bottom lines, particularly those owned by pharmacy benefits managers, are being exploited. Nationally, 46% of contract pharmacy agreements involve pharmacies linked to the three largest benefits managers.

Rep. Tara Peters, R-Rolla, introduced the 340B contract pharmacy access billand said the lobbying is absurd.

"Federally, 340B program does not allow for abortion drugs," Peters stressed. "Why would any legislation that we're trying to pass in the state allow for that? I mean, the thought of that even being in existence is absolutely ludicrous."

The Missouri Senate passed the bill 27-3 on Monday and it now goes to the House.


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Alabama is running out of time to tackle Medicaid expansion this legislative session.

More than 230 people gathered earlier this month with the group Alabama Arise, urging state lawmakers to prioritize the issue. Their message: Access to health care isn't just a matter of policy, it can be a matter of life and death.

Debbie Smith, Cover Alabama campaign director for Alabama Arise, said as the session winds down, the group will continue to echo the call for increased access to health coverage. She thinks it would not only save lives but revitalize communities across the state.

"Over 80% of our rural hospitals are operating in the red," Smith pointed out. "Not a great stat. About 19 rural hospitals are at immediate risk of closure, and those are the lifeblood of those communities. They're on life support."

Smith emphasized hospitals at financial risk also put their workforce at risk. Those who are against Medicaid expansion believe it is ultimately unaffordable for the state. However, Smith argued it could save the state nearly $400 million over the next six years. According to the Public Affairs Research Council of Alabama, those savings would be enough to cover the cost.

The council's study also showed Medicaid expansion would generate nearly $2 billion of economic growth. Beyond economic benefits, Smith pointed to the stark disparities in maternal and infant mortality rates in Alabama.

She stressed Medicaid expansion would do more than provide health care coverage during pregnancy or postpartum, it is about ensuring comprehensive coverage.

"We've been lucky enough to expand Medicaid coverage up to 12 months postpartum but we still need to figure out how to cover people before they even get pregnant," Smith asserted. "It's really important for people to have health coverage so they can address any kind of issues they might have, like if they have diabetes or high blood pressure that might affect their pregnancy in the future."

With limited time left in the legislative session, she noted one option could be Gov. Kay Ivey's executive authority to enact Medicaid expansion. Smith added using the power could be the simplest path forward, backed by the promise of additional funding from the American Rescue Plan.

A Connecticut bill would expand the state's paid sick leave law.

The initial 2011 law requires 40 hours of paid sick leave for workers at employers with 50 businesses or more. The new bill covers all workers regardless of their employer's size.

Janée Woods Weber, executive director of the nonprofit She Leads Justice, said the legislation can benefit workers without access to paid sick leave.

"These are people for whom taking a few hours off when their child has a cold or perhaps they need to take themselves to a doctor's appointment are the kinds of challenges that many of us don't worry about, those of us who do have access to paid sick days," Woods Weber explained.

Small businesses were concerned about how the change could affect them. To address worries, the bill has a three-year implementation cycle giving them time to adapt. It also creates a task force studying the feasibility of providing tax credits to businesses with the smallest workforces. The bill passed the House and awaits a vote in the Senate.

An estimated 11% of workers are eligible for paid sick leave under the current criteria. Though expanding the law has taken over a decade, Woods Weber argued it has always been necessary.

"Nobody should be forced to make what is often times a very difficult and sometimes impossible choice between their livelihood," Woods Weber emphasized. "Getting a paycheck and getting to take paid time off to take care of themselves or a loved one if they get sick."

She added once the bill is passed, the state can build on it by allowing people to earn additional time off, at least up to 40 hours. It stems from the pandemic, when people had to isolate for up to five days if they contracted COVID-19, which could burn through their allotted sick time.


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