PORTLAND, Maine -- Some mental health and substance-use providers in Portland may need to cut down on services in the midst of the global pandemic after a ballot initiative passed in the city that requires employers to pay time-and-a-half in hazard pay during states of emergency.

Malory Shaughnessy, executive director at the Maine Alliance for Addiction and Mental Health Services, said reimbursement rates for providers through Medicaid and MaineCare have not kept pace with minimum-wage increases, and demand for mental health and substance-use services has surged since the start of the pandemic.

"Now that we're going into the winter and the holidays, we're seeing really high spikes in our overdose deaths," Shaughnessy said. "We're seeing greater need for substance-use treatment services; for mental health treatment, crisis lines are up on calls."

The Alliance joined a lawsuit to clarify the start date for hazard pay. Although the city says the ordinance doesn't go into effect until 2022, at least one lawsuit has been filed to start it immediately.

Shaughnessy said some providers can't accommodate the increase so quickly, and may have to make immediate cuts to avoid potential litigation.

She said the Alliance supports hazard pay and increases to the minimum wage, but she said along with that, the state needs to either use federal grant dollars or increase the MaineCare reimbursement rates to keep services afloat and available to Portland residents.

"It causes agencies to either close - we've seen a lot of closures in the last few years - or cut back on the services they offer," she said. "And then access is gone."

She said others may be looking to move out of the city, but Portland has public transit and other accommodations. She noted some other states have used CARES Act dollars to fund hazard pay for essential workers, and she hopes Maine might consider a similar path.

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.