INDIANAPOLIS - Indiana is yet to decide if it will develop a health-insurance "exchange" as part of requirements outlined by the Affordable Care Act, or allow the federal government to handle the implementation.

A recent Indiana Health Exchange Symposium, sponsored by AARP, brought folks from all sides together to consider options. So far, says Seema Verma, health-care reform lead for the state of Indiana, there are more questions than answers from the feds.

"They've really put out almost no information about what a federal exchange would look like, so there's nothing for us to compare to at this point."

Indiana has not committed to creating its own exchange, Verma says, but is involved in planning and research if it's decided that is the best option. Indiana is one of the 28 states challenging the federal health-care law. The U.S. Supreme Court is expected to rule on challenges to the law by mid-2012.

Benjamin Domenech, managing editor of Health Care News and a research fellow at The Heartland Institute, is urging the state to wait.

"There's so many things that have to come out from Washington in terms of regulations, in terms of controls, in terms of requirements put on the state. I think that it's important for Indiana to essentially see that play out before they just go ahead with everything."

Rep. Charlie Brown, D-Gary, favors the health-care reform law and wants to see it implemented so that more Hoosiers have coverage - but he's concerned about meeting the required deadlines...

"It's going to be very, very difficult to get there by 2013 - maybe impossible."

As a legislator, Brown says he'd like to be involved in the process of developing an exchange - but he says so far that hasn't happened.


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As the federal government nears a shutdown over a budget impasse in Congress, Wisconsin offices that help low-income individuals worry they'll have to stretch their programs. They hope the public sees the importance of their assistance.

Public policy analysts say safety-net aid, such as the Supplemental Nutrition Program for Women, Infants and Children (WIC) would feel the budget squeeze sooner rather than later.

Brett White is executive director of the Southwestern Wisconsin Community Action Program, which helps clients access WIC benefits. His office is nonpartisan, but he feels the work they do tends to get overlooked in public debates over government funding.

"We are the transportation program for this neck of the woods, and take people to dialysis treatments," he said. "I mean, we're big on that."

He said they've been preparing to try to keep services running, but noted that some programs would eventually have to pause in a prolonged shutdown. Hard-right House Republicans have insisted on a federal budget that includes deep cuts for social assistance. The group Opportunity Wisconsin has called out certain GOP members of the state's congressional delegation for not opposing that plan.

Freedom Caucus members have said their demands for big cuts should be considered because they didn't make it into the debt-ceiling agreement earlier this year. Meanwhile, White said that as a lot of households still struggle with higher consumer prices, these programs are increasingly becoming a lifeline for those turning to them for the first time.

"We will see spikes, we've actually already begun to see inquiries," he said. "We see spikes in our food pantry programs."

The government shutdown threat and the potential for big spending reductions follow new data from the U.S. Census Bureau showing increases in poverty rates. That includes the nation's child poverty rate more than doubling, to 12%.

New Yorkers are preparing for an impending government shutdown.

State officials are worried about how it could impact the work state agencies have been doing for migrants. Meanwhile, residents are concerned about how a shutdown could affect federal benefits they receive.

Make the Road Action held a press conference this week urging U.S. Rep. Anthony D'Esposito - R-Island Park - to stand up to hard-right Republicans taking budget negotiations hostage.

Angel Reyes Rivas, Long Island organizing coordinator with Make the Road Action, said a shutdown would be financially disruptive for New Yorkers.

"For Social Security and Medicare, the checks are sent out, but benefit verification as well as card issuance would cease," said Reyes Rivas. "Also, SNAP, that many low-income families use on Long Island also would, the ability to send out food stamp benefits could be affected by the shutdown."

The Center on Budget Policy and Priorities finds almost 3 million New Yorkers received SNAP benefits in 2022.

Earlier this week, Gov. Kathy Hochul implored members of Congress to avert a shutdown - noting that among the many other problems it would pose, New York's 51,000 federal employees would be out of work.

The Senate passed a measure to fund the government until November 17, though House Speaker Kevin McCarthy has said he will not take the measure up as it is.

Reyes Rivas said any kind of budget must be bipartisan and based on what constituents want.

"A solution would be for the people, being Democrat or being Republican, that really care about these communities and understanding the importance of these benefits to pass something, right?" said Reyes Rivas. "There's a government shutdown, it's unacceptable."

The Senate's budget bill would have provided around $6 billion for Ukraine war efforts and another $6 billion for disaster relief in the wake of recent floods, and wildfires in the U.S.

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.