WEST DES MOINES, Iowa -- As the coronavirus pandemic continues to unfold, Iowa's first responders say the state should no longer hold off on declaring Emergency Medical Services an essential service.

That status is something EMS workers in Iowa have sought long before COVID-19. Being declared "essential" would require ambulance service across the state, instead of relying on a patchwork of volunteers, agencies and providers.

Mark McCulloch, deputy chief of EMS for West Des Moines Emergency Medical Services, says he thinks the current crisis will prompt those who have resisted such a move to reconsider.

"The understanding of how important and how critical our services are, I think, is increased," he states.

McCulloch says the lack of guaranteed emergency medical services is especially a problem in rural parts of Iowa, where younger adults are moving away and reducing volunteer ranks.

Having the state approve a plan to guarantee emergency medical services would open the door to funding for EMS in these communities. But some tax revenue would also be needed, a move that some lawmakers oppose.

Stacy Frelund, government relations director for the American Heart Association of Iowa, says even though the state's budget has been battered by the economic downturn, that doesn't mean this funding should fall into a political debate.

"Being able to get them some more resources that they need throughout the state, I think is really, really important, especially now in the time of COVID -- when, you know, there's a lot of uncertainty," she stresses.

And beyond the current crisis, Frelund says rural areas need a stronger network of ambulance service for heart attacks and stroke-related calls.

Just before the pandemic, various bills were being considered in the Iowa House. Their supporters hope they see a revival as lawmakers take a long look at the state budget when they reconvene in early June.

Rural Nebraska could lose on two fronts if two of Gov. Jim Pillen's budget vetoes are allowed to stand.

Pillen struck down a second year of increases in Medicaid reimbursement rates and millions of dollars for Rural Workforce Housing.

Dr. Jed Hansen, executive director of the Nebraska Rural Health Association, called the veto a "gut punch." He said all of Nebraska's hospitals and nursing homes will feel the effects, but especially those in rural communities, where more than 60% of hospitals operated at a deficit last year.

"So, the narrative the governor had used -- that hospitals were 'better off financially coming out of the pandemic' -- just wasn't true," Hansen asserted. "And especially wasn't true for our rural hospitals."

The Legislature had approved $20 million for rural housing development over the next two years, which the governor also nixed.

Johnathan Hladik, policy director for the Center for Rural Affairs, said a lack of housing is the "number one workforce issue" in the state, noting it is a major reason jobs remain unfilled in Nebraska's smaller towns. He pointed out the higher cost of building in rural areas makes it unlikely developers would start such projects on their own.

"We're talking about standard houses for the workforce to relocate to a community," Hladik explained. "To become employed, contributing members of that community."

With his veto, the governor cited the investments the state has made in affordable housing over the last few years, but Hladik countered it came after years of no support for housing. He maintained the state is still "playing catch-up," with the housing problem far from solved.

Hladik added the program would fund grants to nonprofit development corporations to partially cover the costs of building moderately-priced, owner-occupied houses and rental housing units.

"When you talk about how we populate our rural areas, how we attract people to rural areas, how we fill the open jobs that are in rural areas, this is a narrowly targeted program that has the ability to do that," Hladik contended. "I think it's important that it has our support."

Hansen stressed it is also important to raise the Medicaid reimbursement rate, noting maternal care and behavioral health tend to be heavily Medicaid-dependent, so the services are at particular risk in Nebraska's rural hospitals.

"We feel that those have been areas -- mental health, maternal care, family care -- that have been important to him," Hladik acknowledged. "He's expressed that those are values that are important to him. And this veto, we just feel, doesn't line up with that."

A decision about overriding both vetoes is expected on Wednesday.

Over the weekend, lawmakers announced they have reached an agreement to reduce spending and address the debt limit. The deal needs a full signoff from Congress before it becomes law.

West Virginia could lose billions of dollars for programs like Medicaid and Head Start under the historic spending cuts House Republicans are proposing. An analysis by the group Americans for Tax Fairness found the GOP debt ceiling budget would reduce federal aid to the Mountain State by $518 million in 2024, and by more than $8 billion over the next decade.

David Kass, executive director of Americans for Tax Fairness, said Republican lawmakers are pushing for massive cuts in federal programs that help working families.

"Seven hundred teachers would be removed from West Virginia classrooms, 5,500 West Virginians would lose access to job-training programs, 220,000 West Virginians would lose health care coverage from Medicaid," Kass outlined. "Those are the cuts, and they'd have a really significant impact on West Virginia."

Republicans argued limiting federal spending through measures like blocking student loan relief and tightening work requirements for programs like SNAP and Medicaid -- along with temporarily increasing the debt limit -- will help the nation pay its bills.

Kass pointed out GOP lawmakers continue to support tax breaks for upper-income households who do need social services to stay afloat.

"They're proposing these cuts in really essential services for people in West Virginia, 'Because we need to cut the deficit,' they say," Kass asserted. "At the same time, they're proposing these tax cuts that will primarily benefit the wealthy."

The Biden administration has proposed restoring the top 39.6% tax rate for households with taxable annual income of more than $450,000 a year, and single earners with taxable income above $400,000, along with closing some of the tax loopholes used by the wealthy.


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The looming U.S. debt default could affect a host of programs across the country - and in New York, the list includes clean-energy investments.

Treasury Secretary Janet Yellen has said the U.S. has until June 5 before a default would occur. In the meantime, states like New York have been ramping up their clean-energy infrastructure with federal Inflation Reduction Act funds.

A Climate Power report finds the IRA created 950 clean-energy jobs in New York from more than $560 million in funding.

Zander Bischof, head of Regulatory & Government Affairs at MN8 Energy, described how a default could jeopardize the future of these investments.

"It would put pressure on clean energy investment through a few mechanisms," said Bischof. "I think, firstly, it would drive up interest rates, and therefore the financing costs of clean energy assets - which are generally pretty capital intensive. We're talking about most of the costs being to get the steel in the ground, and then very low ongoing operating - and then from there, fuel costs."

He added that a default also could devalue the U.S. dollar, leading to higher costs for these projects.

This isn't the first time the IRA has been threatened. A bill to repeal it appears to be stuck in the U.S. House.

The Joint Economic Committee estimates that repealing the IRA would lead to energy costs of up to $300 a year higher per household.

Some experts feel the alternative isn't much better. House Republicans' "Limit, Save, and Grow Act" would raise the debt ceiling, but slash clean-energy funding.

Sandra Purohit - director of Federal Advocacy at the advocacy group E2 - said she feels after so much progress, it would be a step in the wrong direction.

"If you avoid default under this plan," said Purohit, "you would do so by revoking incentives that are making a huge and positive impact on our economy."

Both President Joe Biden and House Speaker Kevin McCarthy have said they're confident a deal will be reached as negotiations continued over the weekend - although others see it as an impasse that's unlikely to be settled by the deadline.




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