BEREA, Ky. - An economic policy think tank in Kentucky finds that a plan by Congressional Republicans to reduce federal Medicaid and Medicare spending would break a long-standing American promise of basic health security for society's most vulnerable.

Jason Bailey, director of the Kentucky Center for Economic Policy in Berea, says House Republicans' plan to turn Medicare into a voucher program and give states a set amount to run Medicaid would shift more of the cost to beneficiaries or cause them to lose health benefits.

"What it would do is really change the federal role in supporting health care for seniors, for people with disabilities, for children living in poverty, in a way that would harm many Kentuckians. "

Bailey says analysis by the Congressional Budget Office shows that in 10 years, a typical 65-year-old would be paying twice as much out-of-pocket for Medicare under the GOP plan as under the traditional system. Moreover, Bailey says, shifting Medicare to the private sector would spike costs because private insurance has higher administrative costs and provider payments.

When it comes to Medicaid, Bailey underscores Kentucky's dependence on the federal-state program that serves those in poverty and with disabilities. More than 800,000 Kentuckians rely on Medicaid. Bailey believes the Republican plan to break from funding a portion of the costs and turning it into a block grant program would allow states to alter benefits and who receives them.

"Kentuckians would lose eligibility. We would throw people off the Medicaid rolls. We would cut benefits. We would cut payments to providers, which are already very low in the Medicaid program. And so fewer doctors, fewer health care providers, would accept Medicaid."

Bailey says ideas to undo Medicare and Medicaid as we know it break the country's decades-old compact to ensure basic health security for the sick, aging and impoverished.

"It would say to people, 'You're on your own.' That's a real strike against a core value we've held in this country over the last 45 years since these programs were created."

Bailey adds that the U.S. House Republicans' budget plan to eliminate the Medicaid expansion scheduled for 2014 under health care reform would deny coverage to an estimated 261,000 Kentuckians.


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Average Affordable Care Act premiums in Wisconsin would have been 56% higher this year without temporary subsidies from the federal government, and small-business advocates say a new extension is a big help when smaller firms are trying to get back on their financial feet.

The Inflation Reduction Act included a provision to extend the ACA's premium subsidies through 2025. The extra tax credits are from an earlier pandemic relief package and were set to run though this year.

David Chase, vice president for outreach at the Small Business Majority, said the extension removes a lot of headaches during a complicated time for owners of smaller operations.

"Only about half of small businesses are able to offer coverage," he said, "and we've seen that number drop even more since the pandemic, which makes the Inflation Reduction Act even more important."

Since its inception, Chase said, the Affordable Care Act has been a game-changer for small businesses but acknowledges owners still face challenges. He said health-care costs continue to rise, with one recent analysis noting marketplace insurers already were proposing premium hikes for 2023. Policy experts have said the subsidy extension will help buffer those higher expenses.

Shawn Phetteplace, the Wisconsin-based Midwest regional manager of the Main Street Alliance, said the extension is especially helpful here, because Wisconsin is still among the 12 states that have yet to expand Medicaid under the Affordable Care Act. He said that adds barriers for small business owners trying to build a staff these days.

"A lot of folks go and do jobs - that they're working for large corporations purely to get health insurance," he said. "You have folks who don't start a business because they need health insurance. You have folks that only are part-time with their business because they need health insurance."

The Inflation Reduction Act also will allow Medicare to negotiate some drug prices. Analysts have said that also could help small business owners in the future, because skyrocketing prices have made it harder to select a plan to offer to their staff.

Childhood poverty was cut nearly in half during the Covid pandemic due to expanded federal programs like the child tax credit, and stimulus payments, which also prevented some five million Americans from falling below the poverty line.

Advocates for the poor argued those gains are already being lost since the most helpful programs were not extended, and high inflation is now impacting families as well.

Joe Diamond, executive director of the Massachusetts Association for Community Action, a coalition of some 23 community action agencies, said advocates are using lessons learned during the pandemic to help improve peoples' lives.

"We were inspired by the resilience of the people that we served, and we also were inspired by what we found to be the effectiveness of the programs that were able to run during the pandemic," Diamond remarked. "We know that our mission now also includes doing our very best to sustain those programs and to continue to work as hard as we can towards of our goal of reducing poverty."

Advocates suggested strategies could include the creation of a state-funded child tax credit, providing an adequate guaranteed income, and supporting extensive outreach to ensure every family receives the benefits they need, and to which they're entitled.

Tax reform and public benefits are not the only answer.

Nancy Wagman, research and Kids Count director at the Massachusetts Budget and Policy Center, said people need good jobs, with growing wages.

"People who are poor are largely working," Wagman pointed out. "They're just working at jobs that either don't pay enough or are unstable, unpredictable hours, those sorts of things. So the kinds of policies that help support work for workers really can make a difference."

Wagman has updated a pre-pandemic report on the challenges faced by poor people in Massachusetts due to historic underinvestment in public transit, quality child care and affordable housing; challenges only made greater by the pandemic and institutional racism.

For example, Black veterans of World War II were denied the G.I. Bill, and today, Black workers and those of Latin descent have a harder time breaking out of low-wage jobs.

Wagman contended the state can play a crucial role in ensuring barriers to opportunity are dismantled, by revising the tax code, so as not to primarily benefit those on top.

Meanwhile, the need for help remains critical for people living on the margins. The coalition is hosting its first in-person gathering since the start of the pandemic today. They say member organizations are excited to implement the lessons learned these past two years, and they are even more committed to the challenge of ending poverty.

Laura Meisenhelter, executive director of North Shore Community Action Programs, said the need for help has only increased since federal pandemic aid ended.

"We've given out more gas cards to help put gas in their car, and gift cards to grocery stores, so they can feed their families," Meisenhelter outlined. "We've done that more than we ever have."

Anti-poverty advocates are honing in on Essex County, the state's third most populous county, and focusing on the challenges there related to housing, food insecurity and job development. They hope their work will serve as a model for other counties going forward.

Beth Francis, president and CEO of the Essex County Community Foundation, explained they are one of many charitable organizations supporting such efforts.

"These community action agencies are in all across the Commonwealth, and they do vitally important work," Francis stressed. "We are proud to fund them, and they work with our most vulnerable families and I think they need to have a little light shed on them."

Advocates for expanding child care in North Dakota are responding to the governor's proposal to improve access across the state. They said it is a step in the right direction, but argued there are other solutions in need of more attention.

Yesterday, Gov. Doug Burgum announced a working plan in response to what many have described as a child care crisis in North Dakota. He noted there are more young children than available slots, making it harder for parents to stay in the workforce.

"When working parents are seeking child care in North Dakota, they're often met with long wait lists, and especially for infants and toddlers," Burgum stated.

Cost is a roadblock, with the Human Services Department reporting child care accounts for up to 40% of the average household budget in North Dakota. Burgum's plan includes expanding the eligibility pool for the Child Care Assistance Program, adding a state child care tax credit and boosting training. Advocates say the ideas provide hope, but do not focus enough on child care workers' low wages.

Erin Laverdure, a member of the North Dakota Child Care Action Alliance, said so much of the ripple effect created by the crisis is rooted in staffing shortages at day care centers. She stressed low wages play a big role.

"Child care provider wages right now are right around poverty level; the average wage across the state is about $11.19," Laverdure pointed out. "You take that wage in the face of inflation and how can you care for a family, let alone care for other people's families?"

Laverdure, who also serves as board president for a child care cooperative in Hazen, said the wage issue is definitely playing out in her setting, although the pay is a little higher than the statewide average.

"In the absence of really meaningful benefits, we're losing workers to other jobs," Laverdure observed. "I can understand that."

The Alliance is reaching out to providers and others as it crafts recommendations. The governor's office said it will update the plan as discussions continue. The proposal, which could cost up to $80 million, will be introduced to lawmakers early next year.