FRANKFORT, Ky. - Children's advocates in Kentucky are worried that a measure now in Congress would drive up the number of children without health insurance.

The State Flexibility Act would repeal protections put in place for states to maintain current eligibility and enrollment requirements for Medicaid and the Children's Health Insurance Program known in Kentucky as K-CHIP, according to Lacey McNary, deputy director of Kentucky Youth Advocates.. She says these efforts have eased the burden on families to get and stay enrolled.

"Children who in Kentucky are up to 200 percent of the poverty level can enroll, and they're eligible for K-CHIP. In order to save some money, the state could say, 'We're only going to cover kids up to 150 percent of poverty' - thus, covering less children and saving money."

McNary calls the measure a shortsighted tactic which will yield short-term savings.

"Kids are still going to be sick. Kids are still going to need coverage. So, it's not like that's going to change. They just won't have the benefit of having health coverage paid for."

Nearly half of Kentucky's children rely on government-supported health insurance. By recent estimates, McNary says, the average monthly enrollment in K-CHIP is 60,000 and for Medicaid more than 386,000.

"It's been proven that K-CHIP is a very successful program to get kids covered. This bill basically is a permission slip for governors to reduce coverage for kids, to balance the budget."

Research shows that, nationwide, the Children's Health Insurance Program has reduced the number of uninsured children by almost a third, providing coverage to more than 7 million low-income children. McNary shudders at the possible outcomes of retreat.

"By scaling this back and rolling back the successes, you're going to be transferring the cost to families, to hospitals, to other people who are going to have to cover that cost. You're shifting the burden: state budget to families."

If the federal government relaxes eligibility provisions, an estimated 14 million children nationwide now covered by either Medicaid or CHIP could be at risk of losing health coverage. Supporters of the measure say states need more control in managing those programs as they grapple with growing budget shortfalls driven heavily by Medicaid spending.


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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.