Some older patients with diabetes are now getting easier access to insulin. But there is concern many younger ones are still navigating a difficult path in managing their situation, including an outspoken Wisconsin health care worker.

The average cost of insulin nearly tripled between 2002 and 2013, according to The American Diabetes Association. It prompted outrage following stories of patients being forced to ration their supply of the drug. Last year's federal Inflation Reduction Act capped monthly copays at $35 for Medicare recipients.

Saskia Hale, a registered nurse in Stevens Point, said she is relieved those individuals are less likely to need hospitalization for diabetes complications.

"Some of these complications include having limbs amputated, having sores, having chronic kidney problems, going into kidney failure," Hale said.

She said those often stem from patients not being able to cover out-of-pocket insulin costs. A new federal Health and Human Services report suggests the cap will save seniors $500 a year. But Hale, who is a diabetic herself, said non-Medicare patients still have insurance barriers, along with added expenses for supplies like needles and glucose monitors.

Hale said falling off a management plan because of skyrocketing insulin costs can result in being labeled "noncompliant" by your insurance coverage provider.

"When they're labeled that way, it makes it seem as though they are doing this simply because they don't want to take their insulin and that is usually not the case," she said. "It's usually because they cannot afford the medication."

She added being labeled noncompliant, even if it's not the patient's fault, can lead to the insurer dropping insulin coverage from the individual's plan. President Joe Biden recently called on Congress to extend the $35 cap to all Americans with diabetes. But political analysts predict it is unlikely, with a divided power structure right now. There is some bipartisan support, but some Republicans say it would be a mandate, hindering competition.

Rural Nebraska could lose on two fronts if two of Gov. Jim Pillen's budget vetoes are allowed to stand.

Pillen struck down a second year of increases in Medicaid reimbursement rates and millions of dollars for Rural Workforce Housing.

Dr. Jed Hansen, executive director of the Nebraska Rural Health Association, called the veto a "gut punch." He said all of Nebraska's hospitals and nursing homes will feel the effects, but especially those in rural communities, where more than 60% of hospitals operated at a deficit last year.

"So, the narrative the governor had used -- that hospitals were 'better off financially coming out of the pandemic' -- just wasn't true," Hansen asserted. "And especially wasn't true for our rural hospitals."

The Legislature had approved $20 million for rural housing development over the next two years, which the governor also nixed.

Johnathan Hladik, policy director for the Center for Rural Affairs, said a lack of housing is the "number one workforce issue" in the state, noting it is a major reason jobs remain unfilled in Nebraska's smaller towns. He pointed out the higher cost of building in rural areas makes it unlikely developers would start such projects on their own.

"We're talking about standard houses for the workforce to relocate to a community," Hladik explained. "To become employed, contributing members of that community."

With his veto, the governor cited the investments the state has made in affordable housing over the last few years, but Hladik countered it came after years of no support for housing. He maintained the state is still "playing catch-up," with the housing problem far from solved.

Hladik added the program would fund grants to nonprofit development corporations to partially cover the costs of building moderately-priced, owner-occupied houses and rental housing units.

"When you talk about how we populate our rural areas, how we attract people to rural areas, how we fill the open jobs that are in rural areas, this is a narrowly targeted program that has the ability to do that," Hladik contended. "I think it's important that it has our support."

Hansen stressed it is also important to raise the Medicaid reimbursement rate, noting maternal care and behavioral health tend to be heavily Medicaid-dependent, so the services are at particular risk in Nebraska's rural hospitals.

"We feel that those have been areas -- mental health, maternal care, family care -- that have been important to him," Hladik acknowledged. "He's expressed that those are values that are important to him. And this veto, we just feel, doesn't line up with that."

A decision about overriding both vetoes is expected on Wednesday.

Over the weekend, lawmakers announced they have reached an agreement to reduce spending and address the debt limit. The deal needs a full signoff from Congress before it becomes law.

West Virginia could lose billions of dollars for programs like Medicaid and Head Start under the historic spending cuts House Republicans are proposing. An analysis by the group Americans for Tax Fairness found the GOP debt ceiling budget would reduce federal aid to the Mountain State by $518 million in 2024, and by more than $8 billion over the next decade.

David Kass, executive director of Americans for Tax Fairness, said Republican lawmakers are pushing for massive cuts in federal programs that help working families.

"Seven hundred teachers would be removed from West Virginia classrooms, 5,500 West Virginians would lose access to job-training programs, 220,000 West Virginians would lose health care coverage from Medicaid," Kass outlined. "Those are the cuts, and they'd have a really significant impact on West Virginia."

Republicans argued limiting federal spending through measures like blocking student loan relief and tightening work requirements for programs like SNAP and Medicaid -- along with temporarily increasing the debt limit -- will help the nation pay its bills.

Kass pointed out GOP lawmakers continue to support tax breaks for upper-income households who do need social services to stay afloat.

"They're proposing these cuts in really essential services for people in West Virginia, 'Because we need to cut the deficit,' they say," Kass asserted. "At the same time, they're proposing these tax cuts that will primarily benefit the wealthy."

The Biden administration has proposed restoring the top 39.6% tax rate for households with taxable annual income of more than $450,000 a year, and single earners with taxable income above $400,000, along with closing some of the tax loopholes used by the wealthy.


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The looming U.S. debt default could affect a host of programs across the country - and in New York, the list includes clean-energy investments.

Treasury Secretary Janet Yellen has said the U.S. has until June 5 before a default would occur. In the meantime, states like New York have been ramping up their clean-energy infrastructure with federal Inflation Reduction Act funds.

A Climate Power report finds the IRA created 950 clean-energy jobs in New York from more than $560 million in funding.

Zander Bischof, head of Regulatory & Government Affairs at MN8 Energy, described how a default could jeopardize the future of these investments.

"It would put pressure on clean energy investment through a few mechanisms," said Bischof. "I think, firstly, it would drive up interest rates, and therefore the financing costs of clean energy assets - which are generally pretty capital intensive. We're talking about most of the costs being to get the steel in the ground, and then very low ongoing operating - and then from there, fuel costs."

He added that a default also could devalue the U.S. dollar, leading to higher costs for these projects.

This isn't the first time the IRA has been threatened. A bill to repeal it appears to be stuck in the U.S. House.

The Joint Economic Committee estimates that repealing the IRA would lead to energy costs of up to $300 a year higher per household.

Some experts feel the alternative isn't much better. House Republicans' "Limit, Save, and Grow Act" would raise the debt ceiling, but slash clean-energy funding.

Sandra Purohit - director of Federal Advocacy at the advocacy group E2 - said she feels after so much progress, it would be a step in the wrong direction.

"If you avoid default under this plan," said Purohit, "you would do so by revoking incentives that are making a huge and positive impact on our economy."

Both President Joe Biden and House Speaker Kevin McCarthy have said they're confident a deal will be reached as negotiations continued over the weekend - although others see it as an impasse that's unlikely to be settled by the deadline.




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