LINCOLN, Neb. — Nebraska's budget debate has been consumed by the fight over Title 10 funding and abortions, and today's hearing in Lincoln is expected to be no different.

A budget provision would deny Title 10 funds to clinics that perform, counsel or refer women to abortion services. As a practicing OB-GYN in Omaha, Dr. Tifany Somer-Shely explained these dollars are designed to be used for preventive screenings, and are not allowed to be used for abortion-related services. But without the funding, she said, clinics around the state could close - which would be particularly hard-felt in rural communities.

"Some of these clinics are the only places that women have access to preventive health care or contraceptive services, sometimes in a 200-mile radius,” Somer-Shely said. “These are women that are going to lose their basic health care - they're going to lose their mammograms, their Pap smears."

According to state data, in 2016 Title 10 clinics served 28,000 clients - including about 3,000 men - and provided services including breast exams, STD screenings, Pap smears and HIV testing. It's also estimated that the same year, Title 10 services in Nebraska prevented more than 6,000 unintended pregnancies and 2,000 abortions.

Jeff Tracy, program director at the Community Action Partnership of Western Nebraska, said the preventive work that Title 10 allows clinics to provide is a significant piece of what helps keep families together.

"It's well documented that if you take away birth control, contraceptives and education around planning your family, you are going to see increased incidences of unplanned pregnancies,” Tracy said. “Those are really big events in people's lives when something like that happens."

Somer-Shely said there is also a question of medical ethics at play, as physicians take an oath to not let personal beliefs impact clinical judgment.

"If a patient comes in with an unplanned pregnancy, it is your ethical responsibility to provide them access to all of the options for their care,” Somer-Shely said, “regardless of your own personal or religious belief."

Supporters of the provision argue it would ensure Title 10 funds could still be used for family planning, and that other services offered by clinics would not be impacted. But opponents counter the language in the bill is obscure and puts all Title 10 clinics at risk.


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Since the passage of the American Rescue Plan Act in 2021, a number of cities and counties in Ohio and around the nation have used ARPA funding to retire medical debt.

Over the summer, Akron became the latest community in Ohio to adopt a plan to retire such debts.

The city council allocated $500,000 to purchase debts through the non-profit RIP Medical Debt. RIP in turn negotiates with hospitals and debt collectors to buy old debts for pennies on the dollar and then forgives them.

Akron Ward 1 City Council Representative Nancy Holland said these debts take a toll on the community.

"Medical debt is one of the leading causes of personal bankruptcy," said Holland. "It's also a leading cause of divorce, of job disruption, of inability to qualify for most major loans like home loans, it can also cause trouble in a rental application, just to rent an apartment. "

Akron joins Lucas County, Toledo, and Cleveland in using ARPA funds to eliminate medical debts. The anticipated value of retired debts from Akron's allocation is up to $50 million.

After entering into a contract with a local government, RIP Medical Debt reviews hospital debt portfolios to determine which ones will be retired.

Residents who qualify must earn less than 400% of the federal poverty level, and their medical debts must be at least 5% of their annual income.

Allison Sesso is the president and CEO of RIP, and says medical debt can be hard to avoid.

"I think medical debt is different than other kinds of debt, because of the fact that it's inherent in the system," said Sesso. "And it's sort of a trap, you can't avoid it. You can have insurance and yet you still have medical debt. You can do all the right things and you still have medical debt. You don't control the pricing. It is not transparent as a system and so it's really hard to avoid. "

Pre-pandemic research found that 23 million Americans have medical debt, with 3 million owing more than $10,000.

While these debts are accumulated in countless ways, and at different types of healthcare organizations, Sesso said RIP will negotiate with anyone to buy qualifying medical debt belonging to those most financially burdened.

"There's often been questions about whether or not we'll work with certain kinds of hospitals, that maybe are seen as bad actors," said Sesso. "And at the end of the day, we really focus on the patient. If you have debt at a bad actor hospital, you shouldn't be punished for that."

Sesso said to date, RIP has retired $10 billion of debt for 7 million people nationally.

A tight labor market with steady growth and historically low unemployment - those are the findings in the new "State of Working Pennsylvania" report.

In July, Pennsylvania's unemployment rate was 3.5%, compared with 4.3% a year ago.

Report co-author Stephen Herzenberg, an economist and executive director of the Keystone Research Center, said the strong economy should benefit workers even more looking forward. When there are more job openings than unemployed workers, he said, it gives workers greater choice and leverage in the job market.

"Because of the tight labor market, even though inflation was high, workers' wages have actually kept up," he said, "and they're beginning to see increases in real wages in their pay packets. And that should continue into the next year."

He said the tight labor market appears to be driven by continued job growth plus long-term demographic factors which are shrinking the growth rate of the working-age population.

The good news now, Herzenberg added, is that inflation is no longer high and has come down in the last 12 months.

"While inflation was coming down - from the 9% to the current 3% - workers kept up because of that tight labor market," he said. "There's some industries - low-wage industries, like restaurants and hospitality, and retail sector - where you've seen robust wage increases."

He noted that Pennsylvania has been a leader in some areas of workforce training, such as growing apprenticeship programs, and said the state should build on that strength and expand training for the kinds of apprenticeships that connect people to well-paid jobs.

The funding gap between the state's poorest and wealthiest school districts is widening, with potentially dire consequences for students and communities, according to new data from the Kentucky Center for Economic Policy.

Jason Bailey, executive director of the Kentucky Center for Economic Policy explains year after year, state budgets passed by lawmakers have eroded the amount of money that goes into the formula to help equalize school funding. He added now, the gap between rich and poor school districts has reached levels not seen since the 1980s, when the state Supreme Court declared it unconstitutional.

"We're not seeing any efforts to reverse that trend yet," he said. "In fact, there are big concerns about actually making it worse, particularly by cutting the income tax, which is the largest source of revenue for state government."

In 2022, the per-student gap between wealthy and poor districts reached more than $3,900, according to the report.

Bailey noted wealthier districts tend to levy a variety of local taxes that are out of reach for lower-income communities. Districts in metro and suburban areas also generate more local revenues from an occupational tax on wages and net profits. He said school districts that have been hit the hardest by the funding gap are also the ones seeing average teacher pay continue to shrink.

"So teachers are facing more workloads, bigger classes, but pay that is just not keeping up, it's harder to attract people to the profession, they're more likely to burn out after a few years," he explained.

The equity gap has also been widening in other areas, including the employer portion of teacher retirement and health and life insurance.