BISMARCK, N.D. – Medical professionals in North Dakota are facing pressure from all sides, feeling the pains of a growing shortage of doctors and potential changes to a visa program that helps supply doctors and wondering what will happen to health insurance at the federal level.

President Donald Trump's review of the H-1B visa program has raised anxiety for the Peace Garden State, where 4.7 percent of physicians come from the program, and the highest rate in the country.

Courtney Koebele, executive director of the North Dakota Medical Association, says the state's rural nature can make it hard to attract doctors.

"The H-1 visa program helps us recruit people that normally wouldn't consider North Dakota, and what we hope is that the people come here to work and they fall in love with North Dakota and they stay," she states.

There are around 400 foreign-born doctors working in North Dakota. In fact, the vice president of Koebele's association, Dr. Fadel Nammour, came to the United States from Lebanon through the visa program and now works as a gastroenterologist in Fargo.

Koebele says people in rural parts of the state sometimes have to drive hundreds of miles to see a specialist.

She's also worried about proposed changes to Medicare and Medicaid. Trump's recent budget proposal suggested cutting Medicaid by $800 billion over the next decade and the American Health Care Act could affect funding for Medicare.

Koebele says that could be bad news for North Dakotans looking for doctors.

"As we cut back on these low-income protections like Medicaid and Medicare, that really undercuts the whole system because if there's a shortage of doctors for Medicaid and Medicare, then there's a shortage of doctors for everybody," she stresses.

Koebele notes there also are problems with the Affordable Care Act that need fixing. The nation faces a shortage of doctors as the population ages.

According to the Association of American Medical Colleges, the country could be in need of an additional 95,000 doctors by 2025.





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Advocates for immigrants are pushing back on a bill signed by Iowa Gov. Kim Reynolds in the last few days of the legislative session, modeled on a recent, controversial Texas law.

Senate File 2340 gives local law enforcement officers and judges the authority to deport undocumented immigrants.

Erica Johnson, executive director of the Iowa Migrant Movement for Justice, argued the bill is an overreach, and said Iowa law enforcement officers are not authorized to enforce it.

"This is a pretty clear intervention into federal territory," Johnson pointed out. "U.S. immigration law is governed by federal law."

Much like the author of the Texas bill, supporters in Iowa blame the Biden administration for failing to slow illegal immigration, so the state has decided to take matters into its own hands.

Johnson contended the bill and other anti-immigrant sentiment during the just-completed legislative session target the very people Iowa, with its dwindling population, will depend on for its future workforce.

"What we need is communities that are safe, where workers have access to dignified, safe workplaces," Johnson emphasized. "The truth of what Iowa's future could be depends on immigrants and immigrant workers in our state, and unfortunately, this law could take us back, away from that possible future. "

Johnson added her organization will pursue legal ways to block the bill from taking effect in July.


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The future of Senate Bill 4 is still tangled in court challenges. It's the Texas law that would allow police to arrest people for illegally crossing the border. But groups are speaking out about the impact of "Operation Lone Star" on the youngest migrants. Governor Greg Abbott continues to bus migrant families to other states, many with young children - more than 100,000 families so far.

Robert Sanborn, CEO of Children at Risk, works to improve the quality of life for boys and girls in Texas, and contends the policy has put trauma on top of trauma.

"We never want children to be political pawns. We don't want maximum chaos on the backs of children. We want children to grow up and be assets for our community," he contended.

Sanborn points out that 2.2 million children in Texas are immigrants, and said it would be less stressful for kids if families were not bused in the middle of the night, and if they were allowed to pick their destination.

When immigrants arrive at the border, they are evaluated to determine if they're eligible for asylum.

Beatriz Zavala, clinical coordinator at El Paso-based Humanitarian Outreach for Migrant Emotional Health, or "HOME," said the children in this situation are at higher risk for mental health disorders.

"What is particularly troubling is the profound disregard for the stability and protection these families need. The impact on their mental health is undeniable. These are not just statistics. These are children, real children," she said.

As part of Operation Lone Star, families have been bused to Chicago, Denver, Los Angeles, New York City, Philadelphia and Washington D.C. The governor has said the practice is needed to keep the Texas-Mexico border safe.


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Legislation in Albany would create the first right to counsel for people in immigration court.

The Access to Representation Act would provide immigrants the right to an attorney in their New York immigration cases, ending the tendency to represent themselves if they cannot afford one.

Estimates show a backlog of more than 330,000 immigration court cases, and fewer than half have attorneys. Studies show without legal counsel, migrants are less likely to remain in the U.S.

Marlene Galaz, director of immigrant rights policy for the New York Immigration Coalition, described what the bill would do.

"It has a six-year ramp-up to start implementing and building infrastructure," Galaz outlined. "Having a pipeline between law schools for law students to go into immigration practice, and getting to nonprofits and so on."

Galaz noted most opposition centers around the $150 million to fund the program but pointed out the total expenditure is less than 1% of the state's $229 billion budget. She added anti-immigrant rhetoric has also damaged support for the bill. Currently, it is in the state Senate Finance Committee.

The New York City Comptroller's office said enacting the bill would benefit the state financially. It could keep about 53,000 people from being deported, which would result in almost $8.5 billion in local, state and federal taxes over the next 30 years.

Galaz emphasized the influx of migrants has saturated the court system, leading to what could have been an avoidable backlog.

"I firmly believe that if these investments had been made when we first asked for them, I believe, like, three years ago, then we wouldn't be struggling," Galaz contended. "We would have had the infrastructure built to address an increase in welcoming our newest neighbors."

A Vera Institute survey showed 93% of New Yorkers across party lines and regions support access to attorneys for all people, including those in immigration court, and government-funded attorneys for them.


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