Child care advocates say there is a big hole in the reconciliation package being considered by the U.S. Senate.

Support for the child care industry is not yet part of negotiations on a bill known as the Inflation Reduction Act, which does include provisions to address climate change and the cost of health care.

Gabriela Quintana, senior policy associate for the Seattle-based think tank Economic Opportunity Institute, said the industry is in dire straits.

"It's really disheartening that once again we have to beg for some attention to these really important issues that are so closely correlated to our economy and our recovery from COVID and other things going on," Quintana observed.

Earlier versions of President Joe Biden's Build Back Better framework, which has been scaled back significantly in the Inflation Reduction Act, included provisions to support families and child care workers. Washington state has lost child care providers since 2017, despite an increase in the number of children, according to Child Care Aware of Washington.

Quintana argued one area policymakers should zero in on is pay for people in the industry, who often make poverty wages.

"Given how fragile the system is, I think we really need to focus on child care teacher wages to ensure that they are sticking to the profession that they love and that they want to do," Quintana asserted. "They're just not able to earn the wages and so a lot of them are leaving the industry to go get other jobs."

Quintana noted some child care teachers leave for jobs in public school instead. The Inflation Reduction Act could get a vote as soon as this week.

More officials from South Dakota's health care community are speaking out in support of Medicaid expansion. Voters will decide this fall whether to expand Medicaid to close insurance gaps around the state.

This week, the South Dakota Emergency Medical Services Association and South Dakota Firefighters Association publicly endorsed the campaign.

Maynard Konechne, a member of the South Dakota EMS Association, said expansion would provide greater assurances first responders would be at least partially reimbursed for all their calls. He explained not having expenses covered in certain situations hurts an EMS operation's budget, including maintenance.

"You can't upgrade certain pieces of equipment, that you use daily, if they break down," Konechne pointed out. "I mean, you struggle to try and have a fundraiser and stuff."

He added volunteers for those fundraisers are getting older, and not enough people are filling their shoes.

It is estimated roughly 40,000 state residents would receive coverage if Medicaid expansion moves forward. Opponents, including Gov. Kristi Noem, cited cost concerns, but a nonpartisan state report said most expansion costs would be covered by the federal government.

Sandy Frentz, a retired public health manager for the City of Sioux Falls, applauded the new endorsements. She said the delivery of health care is a united front, and emphasized first responders are crucial in a rural state like South Dakota.

"If we lose our rural ambulance services, for example, then who takes care of that rural patient that needs to be transferred to a larger, tertiary health care system?" Frentz stressed.

Frentz, who also co-chairs the American Heart Association's South Dakota cabinet for Medicaid expansion, argued the plan can strengthen the state's economy by keeping more people in the workforce. This fall's Amendment D is supported by South Dakotans Decide Healthcare, a broad, nonpartisan coalition of organizations, including the Heart Association.

President Joe Biden will sign the CHIPS and Science Act Tuesday, a landmark measure lawmakers say could create thousands of jobs here in the Buckeye State.

Supporters of the $280 billion package say it will encourage domestic semiconductor manufacturing and strengthen supply chains. And it could mean an even bigger investment from Intel, which is already spending $20 billion on a new computer-chip facility near Columbus.

Christina Muryn, mayor of Findlay, predicts it will have a ripple effect on the entire state.

"We also have a lot of manufacturing, which requires microchips and semiconductors, with a lot of automotive suppliers nearby," Muryn pointed out. "One key area is supporting the industries that are already here and helping ensure that there's stability within their market."

The Intel facility is expected to create 20,000 jobs, and the company has hinted even greater investments are possible with passage of the CHIPS and Science Act. Despite the technology being created in the U.S., about 90% of current manufacturing is overseas. Not all Republicans voted for the bill, however, citing concerns about its focus on increasing diversity in research and STEM fields.

The legislation includes funding for training, research and workforce development. Muryn emphasized Ohio needs to ensure it creates an environment to attract young professionals interested in going into technology and manufacturing fields, and supporting educational opportunities.

"Whether that means looking at educational programs in K-12 or in higher ed, and partnering with apprenticeship programs," Muryn suggested. "Continuing to ensure that we're supporting not only front-line manufacturing but also, higher-tech positions and professional degrees is going to be really critical."

Other measures in the bill could help level the playing field by including more underrepresented groups and companies in CHIPS-funded projects, and diversifying STEM research capacity at minority-serving institutions. It will also promote clean-energy innovation in diverse geographic areas and provide block grants for economic development in underserved communities.

Support for this reporting was provided by Lumina Foundation.

Democrats say they have reached an agreement on the Inflation Reduction Act, which includes measures aimed at lowering prescription-drug prices.

Senate lawmakers could begin considering its passage this week.

Donna Christensen, board member of Consumers for Quality Care and former Congressional Representative from the US Virgin Islands, said if passed into law, the changes would primarily affect Americans relying on Medicare.

"Medicare Part D, there'll be a cap on out-of-pocket costs to the beneficiaries," Christensen explained. "I think that's a very good thing. We wish that it would be extended to the privately insured as well, though, because they are facing increasing out-of-pocket costs."

Major drug companies and other opponents argued the legislation will stifle innovation and reduce the number of new medications available to consumers.

A recent survey from Consumers for Quality Care found 80% of voters feel their health care costs, including deductibles, out-of-pocket expenses and unpaid medical bills continue to increase each year.

Christensen pointed out research has shown Affordable Care Act caps on out-of-pocket costs -- which can stretch into the thousands of dollars depending on the medication -- have proved too high for most individuals to utilize.

"It's causing people to delay or skip health care because of it," Christensen observed. "Because they're afraid of incurring medical debt."

According to a Kaiser Family Foundation poll released earlier this year, 6 in 10 working-age adults with health-insurance coverage have gone into debt getting medical care in the past five years.

Advocates are calling on lawmakers to set affordable out-of-pocket caps and $35-a-month copay caps on insulin for those covered by Medicare and private insurers.