Congressional Republicans are taking a hard look at Medicaid as they pursue spending cuts and a new report shows how the public health program is preventing care access from further eroding in rural North Dakota and elsewhere.

A House GOP proposal floats a nearly $2.5 trillion Medicaid reduction. Findings from Georgetown University's Center for Children and Families showed people in rural areas are more likely than metro populations to receive health coverage through Medicaid.

Katy Kozhimannil, professor of health and policy management at the University of Minnesota School of Public Health, said the program is a key contributor to pregnancy care in these settings.

"Offering obstetric care is a financial challenge for hospitals as revenues may not cover the costs of providing that care," Kozhimannil pointed out. "Medicaid covers nearly half of all births nationally and plays a substantially larger role in paying for births in rural areas."

The report said in 2022, 52% of rural hospitals no longer had maternity wards, compared with 36% of urban hospitals. There is concern the gap would widen with Medicaid cuts and North Dakota almost leads the nation for lack of rural OB/GYN services. Some House Republicans insist the programs need reform to avoid a fiscal collapse. But skeptics said drastic changes are a way to offset a planned extension of federal tax cuts.

The report also pointed out residents in rural areas have worse health outcomes.

Joan Alker, executive director of the Georgetown University Center for Children and Families, said it demonstrates why Medicaid is so important, adding it serves as a lifeline to a range of populations living in these communities.

"It is serving children. It is serving seniors in nursing homes, people with disabilities," Alker outlined.

Alker noted Medicaid helps recipients get ahead of health challenges through preventive care, as
opposed to letting conditions worsen.

"People wind up sicker and then they're in the emergency room and children can't get their asthma inhalers and they miss school," Alker explained.

Indiana lawmakers introduced a third property tax plan this week, aiming to protect local governments from funding cuts while offering minimal relief to homeowners.

The proposal, led by state Rep. Jeff Thompson, R-Lizton, would change how property taxes are calculated, including phasing out certain homestead deductions and shifting local income tax authority.

"When you raise the rate, pocketbook lost some money," he said. "You lower the rate; pocketbook gains some money - that's the right system. It won't be always smooth, but the alternative is where we're at right now, and we can continue on down the path and we'll have the same results."

Thompson's plan joins competing proposals from Gov. Mike Braun and Senate Republicans. Braun's plan, which was central to his campaign, would significantly cut property taxes but at the expense of local government funding. The Senate version proposes smaller cuts to both homeowner taxes and local budgets.

David Ober, vice president for taxation and public finance at the Indiana Chamber of Commerce, told lawmakers that changes to the business personal property tax rate were "a bit of a double-edged sword."

"It eliminates the aggregate floor," he said. "It doesn't eliminate individual pool floors. A lot of businesses' personal property is sitting at that floor - at that 30% - but if you eliminate that 30% floor, it's not like it goes down to zero."

Despite the differences, all three plans would shift tax burdens between property classes.

Critics argued that reducing business taxes could place more financial pressure on homeowners. The Ways and Means Committee is also considering separate legislation to gradually lower the state income tax rate if revenue growth meets specific targets.


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In a significant development for family caregivers across America, AARP is spearheading initiatives at both federal and state levels to provide tax relief for those caring for loved ones. The organization is championing the Credit for Caring Act, which proposes a $5,000 federal tax credit, while also pursuing similar legislation at the state level in Ohio.

Jenny Carlson, AARP Ohio state director, said it's a comprehensive approach to supporting the 48 million Americans who serve as family caregivers.

"We're doubling down on this initiative! We feel strongly that it's going to work on the national level. We are turning our attention to the state law, working towards (a) swift package so that family caregivers could take advantage of it for their 2026 returns," she explained.

Carlson added that Ohio is home to approximately 1.5 million family caregivers, providing an estimated $21 billion worth of unpaid care each year. She added they struggle to balance caregiving with full-time jobs, often sacrificing income and retirement savings. The proposed tax credit has received bipartisan support.

AARP has been vocal in its support for Rep. Mike Carey, R-OH, who is sponsoring the legislation in Congress. Carlson emphasized the importance of enabling caregivers to continue working while supporting their loved ones.

"It's called the Credit for Caring Act, which would provide eligible working caregivers a tax credit to help offset the costs of care that they offer. It would allow them to continue to work while caring for a loved one through illness, disability and aging in place," Carlson said.

A recent AARP backed survey found that 84% of voters across party lines support a tax credit for family caregivers. However, some experts caution that while tax relief is helpful, broader policies-such as increased Medicaid coverage for home care may be necessary to fully address the challenges caregivers face. The bill's future now rests with Congress.

Dozens of local leaders from California are in the nation's capital this week, joining about 2,800 colleagues from around the country at the National League of Cities' Congressional City Conference.

The group met with White House officials Tuesday and is set to see Sen. Alex Padilla, D-Calif., today.

David Sander, a council member and former mayor in the city of Rancho Cordova and immediate past president of the league, said local leaders want to find out how the "DOGE" cuts could impact their cities' bottom lines.

"Because there are so many changes potentially underway, we're really focused on certainty and stability," Sander explained. "Because it's hard in local government, where everything has to work, and we're held accountable."

Local officials are concerned the budget bill being prepped in Congress could eliminate the tax-free status cities now get on their municipal bonds, financing priorities like roads and schools. And in the upcoming transportation bill, local leaders want to continue the previous Trump administration practice of sending funds directly to municipalities, rather than routing them through the state.

Sanders pointed out the briefing on immigration covered the many legal issues surrounding cities' policies on cooperation with federal Immigration and Customs Enforcement.

"There's an awful lot in the hands of the courts right now," Sanders observed. "Trying to understand the role of a federal detainer versus a federal warrant, versus a local warrant; trying to understand the legalities around all those and what cities can or can't do."

California is home to multiple so-called sanctuary cities, including Berkeley, Fremont, Oakland, Los Angeles, San Francisco, Santa Ana and Watsonville. The conference wraps up today.


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