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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CORRECTION: This web-version of the story initially listed Rep. Dusty Johnson as "Rep. Dusty Johnson, R-N.D." It has since been corrected to reflect that he represents South Dakota. (10:35 a.m. CT, April 23, 2025)

A bus tour will zip through eastern South Dakota Thursday, where local leaders, health care providers and farm voices want to connect the dots between stable federal aid and their ability to plan, after recent actions have put them in a tough spot.

Thursday's events are part of the rural community tours organized by United Today, Stronger Tomorrow, a coalition that contends heavy budget cuts and grant freezes carried out by the Trump administration are the opposite of creating efficiencies.

Thursday's tour will stop in Madison, which is part of a new, largely federally funded tristate pipeline to improve water quality and economic development.

Roy Lindsay, mayor of Madison, said his city of about 7,000 cannot build a stronger future without the help of federal programs.

"It seems like whoever's pushing the buttons are looking at numbers more than (the) reality of what those departments actually mean," Lindsay observed.

Local officials echoed demands from voters who have shown up at town halls asking their members of Congress to push back against cuts. In an emailed statement, Rep. Dusty Johnson, R-S.D., said he understands the concerns but cited the federal debt as a need to, in his words, "right-size our government."

Farming communities said they are stuck in a holding pattern due to downsizing within the U.S. Department of Agriculture, including conservation grants.

Travis Entenman, executive director of the Northern Prairies Land Trust, which works with private landowners on projects, said in a "red" state, it is already hard to convince people to try out federal programs and he fears the funding dilemma will hinder progress.

"The uncertainty of it all, and the back and forth, and no one really knows what's going on, makes it extra frustrating," Entenman explained.

Entenman acknowledged not every farmer who applies for the grants gets one but added those who do have come to expect reliability in receiving funds as they work to make their farmland healthier and economically viable.

A federal judge ordered the Trump administration to "unfreeze" affected conservation grants, but Entenman and other South Dakota groups said they have yet to see evidence of money flowing again.

Dozens of mine safety field offices in Kentucky and across the country would close under a proposal by the federal Department of Government Efficiency.

According to an analysis by the nonprofit Appalachian Citizens' Law Center, offices in Barbourville and Harlan are on a list of seven in Kentucky slated for closure.

Brendan Muckian-Bates, policy and advocacy associate at the law center, said closing the offices could turn a 30-minute drive to inspect a rural coal mine into a 3- to 4-hour round trip.

"With the proposed consolidations in Kentucky, some of these offices that would be left would essentially make it near impossible for an MSHA field inspector to conduct the mandatory 4-times-a-year underground mine safety inspections," Muckian-Bates contended.

News outlets first reported last month the Department of Government Efficiency had listed the leases of dozens of Mine Safety and Health Administration field offices across the country for cancellation. Trump administration officials and adviser Elon Musk said lease terminations are part of cost-cutting efforts to eliminate waste, fraud and abuse.

Thousands of coal-mining jobs have been lost in recent decades but inspectors remain busy. More than 16,000 inspections were conducted last year, accounting for more than 234,000 hours on site at mines.

Muckian-Bates added proposed cuts to the National Institute for Occupational Safety and Health would make inspections more challenging.


"Every day that these layoffs remain in effect, that NIOSH offices are closed, more miners will become sick and potentially die," Muckian-Bates argued.

Congress created the federal mine safety agency as part of the Mine Safety Act of 1977, after the deaths of 26 miners in two underground explosions at the Scotia Mine in Letcher County the year prior.

This story is based on original reporting by Liam Niemeyer for the Kentucky Lantern.


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A bipartisan group of lawmakers in Congress is joining advocates for energy assistance across the country to warn a dangerous situation is brewing for low-income households.

Federal staffing cuts have stalled the distribution of key funding. The Trump administration's layoffs of 10,000 Health and Human Services workers include the entire office overseeing the Low Income Energy Assistance Program, which gives eligible households a break on their monthly bills to avoid utility shutoffs.

Mark Wolfe, executive director of the National Energy Assistance Directors Association, which works with states on the issue, said the layoffs have blocked the latest round of aid from getting to them.

"Many states have told us that they've either run out of money or they're very close to it," Wolfe reported. "They need these additional funds to help families pay off the remaining winter heating bills or get ready for summer cooling programs, or both."

Minnesota is among the states to report an imminent "zero balance" if action is not taken soon. It has been more than two weeks since the layoffs were announced and Wolfe noted there is no word on funding status. Congress had authorized $378 million to round out the current cycle.

Thirteen U.S. senators have signed a letter asking the administration to get LIHEAP staff back in place and the money moving again.

Wolfe stressed keeping energy bills current is about more than staying cool when the temperature spikes. He noted utility shutoffs can produce dire consequences for some households.

"The loss of access to refrigeration, for example, you can't keep your food safe, or some medications need to be refrigerated," Wolfe outlined.

There was added pressure this past winter on some state programs where there were much colder temperatures. Each year, LIHEAP helps more than 6 million low-income households and seniors on fixed incomes across the country cover their energy bills.


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