Community health centers are calling on state and federal lawmakers for added protections against drug manufactures for drastically cutting them out of a federal drug discount program.

The 340B Drug Pricing program allows health centers to purchase outpatient medication at reduced costs, so they can then provide it to a greater reach of patients while drug companies get reimbursed. But in the past two years, drug producers and third-party prescription drug benefit managers have been restricting centers, threatening their financial stability.

A survey by the National Association of Community Health Centers shows more than half their patients would go without needed medications, including insulin for diabetes patients and inhalers for children with asthma, if they are cut out of the program.

Ben Browning, vice president and CEO of the Florida Association of Community Health Centers, explained the importance of the program.

"These contract arrangements are really the lifeblood," Browning contended. "They are the lifeline for a lot of the patients that may not otherwise have access to these reduced-cost, reduced-price medications."

But the Pharmaceutical Research and Manufacturers of America, the lobbying arm of the drug-manufacturing industry, countered the program needs to change, claiming there is little to no evidence patients are benefiting. They also are calling for centers to share data in an effort to tamp down on potential fraud and abuse in the system.

Browning argued the centers continue to fill a critical need because many health care providers do not have the financial resources to support an in-house pharmacy. The survey showed 86% of health centers utilize contract pharmacies, allowing them to serve hundreds of ZIP codes.

"Put some protections in law, in regulations, in statute, that said the 340B program is a vital component of the health care system," Browning urged. "This is a vital component of maintaining and securing the safety net."

It is estimated enrolled hospitals and other covered entities in 340B can achieve average savings of 25% to 50% in pharmaceutical purchases. The issue is also playing out in courts with conflicting rulings across the country.

A Minnesota House committee heard testimony Thursday about the governor's proposed spending plan for education. As these talks unfold, public polling indicates voters want to see more dollars go toward improving public schools.

Gov. Tim Walz's plan calls for boosting the general education funding formula over the next two years and tying it to inflation, while adding more staff such as counselors and social workers.

State Education Commissioner Willie Jett touted the overall proposal during the committee meeting.

"We must never lose sight of the fact that a well-supported educator workforce is fundamental and critical to the survival of our schools, and the well-being and academic success of our students," he said.

Nationally, a new American Federation of Teachers poll found 66% of voters think the government spends too little on education, and nearly 70% want to see more funding. The governor's plan closely aligns with education priorities among legislative Democrats. Republicans, who are in the minority this session, have voiced concerns that too much surplus money would go to underperforming schools.

Minnesota is also looking at boosting unemployment insurance aid to include hourly school workers when they struggle to stay employed over the summer. Rep. Emma Greenman, DFL-Minneapolis, said it's encouraging to see more conversation about helping support staff.

"If your district is like my district," she said, "you're hearing a lot about the staffing shortages, about the need for 'paras' - I hear a lot about that from parents and teachers - about the bus driver shortage."

By "paras," she meant paraprofessionals who help in clasrrooms.

In the AFT poll, teacher shortages and unsafe campus environments were listed as among the most serious problems at schools. The survey was conducted in late December and included input from 1,500 registered voters nationwide.

Gov. Greg Gianforte delivered his State of the State address to the Montana Legislature Wednesday night, discussing his plans for the state's hefty budget surplus.

Lawmakers are looking at a surplus of $2.5 billion. Republican Gianforte's top priority for the money is tax cuts.

Rose Bender, director of research for the Montana Budget and Policy Center, said the governor's proposal disproportionately benefits wealthy Montanans.

"The governor's income-tax cut proposal gives the wealthiest 1% of Montanans, on average, $6,000 each year in tax cuts, while middle-income families or those near the median income receive on average $50," Bender explained.

Bender noted most of the other tax cuts proposed, such as a property tax rebate, also would skew toward higher-income Montanans. However, she said a child tax credit the governor touted in his speech would be helpful for people with more modest incomes. The proposal would provide $1,200 to families with children age six and under, similar to a federal Child Tax Credit, which expired at the end of 2021.

Bender argued the Montana Legislature should do more this session to make health care costs more affordable and invest in child care, which is costly for families. She added other issues need addressing, as well.

"Montana's experiencing a serious housing crisis, and investing some direct state dollars into long-term housing solutions for families living on lower incomes should be another priority," Bender contended.

In his speech, Gianforte also asked lawmakers to focus on education reforms this year, including what he's calling more "parental rights." The session is scheduled to adjourn April 25.

Humanitarian groups, including one based in Minnesota, pointed out global conflicts have been pervasive in recent years. And in those trouble spots, there is a need for unarmed civilian protection.

Groups working on the issue noted there is a bright spot in their funding. The omnibus bill signed in late December by President Joe Biden included language about the importance of organizations trying to bolster nonviolent protection in communities experiencing, or at risk of, conflict.

Calista Burpee, advocacy consultant for the group Nonviolent Peaceforce, said the recognition is not just about dollars and cents; it can serve as a catalyst to foster similar work.

"It's so that more organizations will start to practice unarmed civilian protection," Burpee explained. "More governments will start to see it as an alternative to violent intervention."

Groups like hers rely on strategies like relationship-building to help establish sustainable peace. Many examples can be found in nations dealing with turmoil. But Nonviolent Peaceforce also is on the ground in places like Minneapolis, where it helps student advisory groups with de-escalation efforts within schools.

Over the past year, the war in Ukraine has resulted in images of civilians fighting back against Russian forces.

Claire Guinta, external relations manager for Nonviolent Peaceforce, noted there is another dynamic at work, addressing protection gaps in the country: humanitarian groups helping with evacuations for Ukrainians who want to escape the violence but aren't sure what to do.

"There's a lack of information," Guinta emphasized. "It's connecting people to the different resources and information that they need along the way to get them to where they want to be going."

She added such guidance is crucial when people face a long journey to safety. As for future federal funding, advocacy groups are petitioning for $25 million in the fiscal year 2024 spending plan, arguing it is an effective use of a fraction of the defense budget.