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Tag: Big Beautiful Bill

  • The Trump-Administration Change That Could Cripple Nursing

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    FAMU School of Nursing students work in the new simulation lab in Tallahassee in April 2023.
    Photo: Glenn Beil/Florida A&M University/Getty Images

    In July, President Donald Trump signed the Republican-crafted One Big Beautiful Act into law, a legislative behemoth that boasted close to $4.5 trillion in tax cuts and changes to society-safety programs that sparked the ire of fiscal hawks and Democrats alike. But deep within the massive bill was a less discussed change to the federal government’s financial-aid program with significant implications for students across a variety of fields — including nursing, the nation’s largest health-care profession.

    As part of the funding package, the U.S. Department of Education is ending the Grad PLUS loan program, which allows prospective graduate students to borrow up to the full cost of attendance. Instead, the agency will be instituting borrowing caps, making the maximum figures dependent on whether a student is pursuing a “professional degree.” Currently, the list of the graduate programs designated as professional spans a variety of fields, from medicine, dentistry, and law to more surprising inclusions like theology. One notable exemption is that of nursing.

    Under the proposed language, graduate students pursuing a “professional” degree will be allowed to borrow up to $50,000 annually with an aggregate loan limit of $200,000. But a prospective student enrolled in a graduate nursing program could seek only up to $20,500 annually with an overall limit of $100,000. The changes will officially go into effect on July 1, 2026.

    Nurses have taken to social media to voice their concerns and anger over the shift. “If you are ever sick and need to see a provider, need a referral, need an epidural, or need any form of healthcare, this should outrage you,” @amypereztxx posted on TikTok. “I heard nursing is no longer a professional degree … now I’m allowed to act as unprofessional as I can,” wrote @nurse_gibby. TikTok user @hey_yall_its_eli, who identifies as a pediatric-oncology nurse, said, “I love having a career that’s no longer considered professional by a man who can’t even say acetaminophen.”

    The loan caps will have a significant impact on aspiring nurses, who will be forced to foot a large portion of their education costs themselves or may even decide against a nursing career entirely, warned American Nurses Association president Jennifer Mensik Kennedy.

    “The average cost of attendance is about $30,000 a year for graduate and doctoral students. What you’re looking at is a $10,000 difference that needs to be made up, which is going to be very hard,” she said. “What you’re going to see is maybe people go to get private loans, but private loans are much harder to get. They have higher interest rates.”

    Mensik Kennedy noted that the use of private loans will also limit nurses’ ability to utilize the government’s public-loan-forgiveness program for those who choose to work in public health or in underserved communities. “So we’re taking additional incentives away, unintentionally, for people to serve those communities,” she said.

    The limits will have an outsize impact on advanced-practice nurses: registered nurses with advanced degrees whose responsibilities range from primary-care providers to more specialized roles such as nurse practitioners, nurse anesthetists, and nurse midwives. Mensik Kennedy said advanced-practice nurses are often the lead medical provider in smaller, more rural regions with less access to medical care, noting that she spoke to one nurse practitioner who was the only provider within 90 miles of where they practice.

    “Certified registered-nurse anesthetists oftentimes are the only anesthesia provider for rural communities. So if you need surgery or you need anesthesia, that is the only option. If those rural hospitals cannot get a CRNA, then they cannot do surgeries and you’re going to have people traveling hundreds of miles to go get care they could have gotten in their own community,” she said.

    The federal government has taken the position that placing these new loan limits will eventually help to lower costs for graduate programs over time. And the Department of Education has challenged assertions from nursing advocates that its recent moves will exacerbate the ongoing nursing shortage, issuing a fact sheet that claims that 95 percent of nursing students “borrow below the annual loan limit” and noting that undergraduate nursing programs will not be affected.

    “The definition of a ‘professional degree’ is an internal definition used by the Department to distinguish among programs that qualify for higher loan limits, not a value judgment about the importance of programs. It has no bearing on whether a program is professional in nature or not,” the agency said.

    But Mensik Kennedy fears the limits could prompt a ripple effect that risks worsening the ongoing nursing staffing crisis that was already exacerbated by high rates of retirements and burnout stemming from the pandemic.

    “We already have, on average, a 6 percent shortage of nurses. And if people aren’t going to continue and go into nursing school, that shortage is going to get worse as we have this large population of baby-boomers retiring,” she said. “People are going to see longer waits in the emergency department. They’re not going to be able to find a primary-care provider in their community.”

    The situation is not yet set in stone. The official rule defining a “professional” student still has to undergo a 30-day public-comment period, and the Education Department has not ruled out making changes to the definition in reaction to feedback.

    Professional associations like the ANA are continuing to advocate for an adjustment to the proposed wording as leaders warn that the fallout from this seemingly small rule could have ramifications for years to come if passed.

    “We’re going to have a downward effect that’s going to affect us for decades — because it’s going to take us decades to climb out of this mess if this is allowed to go through,” Mensik Kennedy said.


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    Nia Prater

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  • Gov. Polis presents budget to lawmakers, focuses on proposal that would cut Medicaid programs

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    DENVER — For the second year in a row, Colorado is staring down a daunting budget deficit — and the governor believes cuts to Medicaid are one solution to balancing the budget.

    The solution, however, feels more like a problem for many Colorado families worried about what it may mean for the future.

    Every year, the Joint Budget Committee (JBC) is tasked with preparing budget recommendations for the General Assembly. The group of Colorado lawmakers are provided with budget requests from all executive and judicial departments by November 1.

    Governor Jared Polis presented his budget proposal to the JBC on Wednesday morning.

    The presentation began by setting the stage for the situation, where Gov. Polis cited the federal government shutdown, tariffs, and H.R. 1 (One Big Beautiful Bill Act) as factors that hurt Colorado’s budget.

    “These actions, combined with large increases in Medicaid costs, are straining the General Fund. Difficult choices are needed to address these impacts and protect the progress we have made,” Gov. Polis said in his presentation.

    A special session was held in August to address the state’s $1.2 billion budget hole, which was created by tax changes made in President Donald Trump’s One Big Beautiful Act (H.R.1). As a result, Colorado will collect less revenue than expected when lawmakers approved the state budget in May.

    Some of that $1.2 billion revenue loss was absorbed by the state education fund and the affordable housing fund. Around $300 million that the state had in surplus, which would have been refunded to taxpayers, will now be used to help fill the gap. That left lawmakers with a budget gap estimated to be around $783 million.

    Democratic legislative leaders and Polis had a three-pronged approach to address the budget gap:

    • Cut special corporate tax breaks
    • Dip into the state’s reserves
    • Make spending cuts

    During the special session, lawmakers cut corporate tax breaks by about $250 million. They left it to Polis to make the spending cuts and to determine how much to borrow from state reserves.

    Just after the special session concluded, Polis announced a total of $250 million in cuts and redirected spending in order to balance the state budget.

    The Department of Health Care Policy and Financing (HCPF), which administers Colorado’s Medicaid program, makes up roughly one third of the total General Fund appropriations for the next Fiscal Year.

    As a result, in part, HCPF will see more than $79 million in cuts. About $38 million of that will come from freezing an increase in provider reimbursement rates that kicked in on July 1.

    Then, an executive order from the end of October “initiated an additional $537 million in budget reductions to HCPF, most of which will begin this fiscal year to quickly realize savings to address the state’s current and future budget challenges,” according to the department.

    HCPF has proposed several changes within budget requests targeted at saving money and the sustainability of programs. Their proposal was guided by a certain framework created by the department that aims to “avoid draconian cuts.”

    As part of that framework, data analytics were employed to find trends in cost increases and examine why those increases were occurring.

    “Medicaid is the fastest growing part of this budget that we present, considerably faster than education spending, the other big element,” Polis told the JBC on Wednesday. “You have to dig deeper within Medicaid. There are some costs that are not increasing more than others, and there are some that are… There’s some elements of Medicaid that have remained static and are sustainable. There’s other aspects that are not. We can’t just paint Medicaid with one broad stroke.”

    Jim Waltz

    Governor Jared Polis presented his budget proposal to the Joint Budget Committee on Wednesday morning.

    According to Polis, his proposal would protect the 1.2 million eligible Coloradans who are covered by Medicaid, as well as those who qualify in the future.

    The overview of the budget requests for Fiscal Year 2026-27 reports that caseload costs within Medicaid are “growing faster than revenues will allow without crowding out other uses of the General Fund.” It continues to say that since Fiscal Year 2018-19, the General Fund appropriations for Medicaid have “grown far faster than inflation.”

    Members of the JBC had concerns about Polis’ proposal following the presentation.

    “My concern about the cuts that have already been made, and about what we’re looking at going forward, is that we are impacting our most vulnerable populations in the state,” said State Senator Judy Amabile, a Boulder Democrat. “Some of the people who have been reaching out to me have been talking about how they have a person that they care for that requires 24/7 care. They will literally not be able to survive… I just wonder what the long-term consequences are of the decisions that we’re making today that will restrict the kind of care that our most vulnerable populations are getting. And whether we are going to be driving more people into institutional settings, which are a lot more expensive than having people receive care in a less restrictive setting.”

    State Senator Barbara Kirkmeyer, a Republican who represents Larimer and Weld counties, said she did not have many questions for Polis. Instead, she had comments she wanted the committee to consider.

    “Last year, I asked you why I should think your budget was serious. This year, I definitely don’t think this budget is serious,” Kirkmeyer said. “We know where you used to balance the budget on the backs of students. Now you’re balancing the budget on the backs of people who rely on Medicaid, and you’re jeopardizing health care for everybody.”

    Kirkmeyer called on the JBC to “do the right thing” and “build a budget that works for the people of this state.”

    Denver7 asked Polis for a response to Kirkmeyer’s comments. His team sent Denver7 the statement below:

    Gov. Polis is doing everything he can to lower the cost of healthcare. Senator Kirkmeyer can’t have it both ways and has generally voted to expand the size of government — pushing the state to make unsustainable spending decisions, and ignoring the impacts of H.R. 1 and the disastrous effects it will have on Coloradans’ access to healthcare. Governor Polis submitted a responsible, balanced budget proposal that fully funds schools, funds public safety improvement and increases funding for Medicaid to ensure our most vulnerable Coloradans continue to have access to the care they need and deserve, now and in the future.

    Ally Sullivan, spokesperson for Governor Jared Polis’ Office

    Meanwhile, 3-year-old Jackson Roberts was preparing for his weekly physical therapy appointment.

    “Jackson, he cannot independently walk on his own, and so this is just kind of building that stability and the muscles that he needs in his legs to build up the endurance,” said his mother, Ciara Stewart. “Jackson has two extremely rare genetic mutations, and that has caused a multitude of brain deformities, severe developmental delays. “He is nonverbal. He is nonambulatory. But outside of all of the craziness that we endure, you know, Jackson is a smart, happy and joyful kid who’s full of potential.”

    This year alone, Stewart said her son had spinal and eye surgery.

    “It’s hard because I’m doing everything I can to give him every single opportunity to thrive and to grow and stand up, to be included in everyday activities,” Stewart said. “Being a first-time mom, this is not exactly what you dreamt of life to be, and you just have to like mold to the new reality and become the better version of the parent that your special needs child needs you to be.”

    Stewart told Denver7 Medicaid has been their lifeline.

    “If it wasn’t for Medicaid and these programs, we wouldn’t be able to afford these things for him,” Stewart said.

    Stewart fears for the future of Medicaid in Colorado, specifically when it comes to Community Connector Services, a program that supports children learning how to safely and independently access their communities.

    “What affects my son the most is Community Connector cuts that allows us to engage in the community in a safe way, and it gives us those resources that we need to be successful in an environment that’s not entirely sculpted for children like my son,” Stewart said.

    Jackson Roberts

    Jim Waltz

    Three-year-old Jackson Roberts relies on Medicaid.

    According to a funding request from the HCPF for Fiscal Year 2026-27, a solution to the budget deficit would be removing access to those Community Connector services for members who are under 6 years old.

    “This will ensure that parental responsibilities are taken into account with this service, while allowing age-appropriate members to make meaningful connections within their communities,” the document states.

    Stewart disagrees.

    “Community Connector doesn’t replace a parent responsibility. It empowers it, at the end of the day,” she said. “It is a blessing and a half to see my son be able to navigate our home and communities and his school more independently.”

    Ultimately, Stewart believes cuts to Medicaid would be felt throughout the entire Colorado community.

    “I understand that budget cuts have to happen, and I just hope that they just don’t end up being as drastic as what it’s looking like. Because it’s not just my family, it’s thousands of families, thousands of disabled children, thousands of disabled adults,” said Stewart. “It’s not just an effect on families. It ripples through the economies and our communities as well.”

    What exactly the future holds for Colorado health care programs is still uncertain, since the budget process is far from over.

    In January, state departments can request adjustments to their appropriations from the JBC for the fiscal year ahead. Such requests are called supplementals, which are bills that can be introduced into the legislative session in early February.

    Once the JBC has settled on their recommendations, the result is the Long Bill — the legislation that details the state budget. That is typically introduced into the session by late March or early April.

    Related coverage:

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    Denver7 | Your Voice: Get in touch with Colette Bordelon

    Denver7’s Colette Bordelon covers stories that have an impact in all of Colorado’s communities, but specializes in reporting on crime, justice and issues impacting our climate and environment. If you’d like to get in touch with Colette, fill out the form below to send her an email.

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    Colette Bordelon

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  • With SNAP Benefit Freeze, Clevelanders Face Question of How to Feed Themselves, and Their Pets – Cleveland Scene

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    After a little more than two decades working as a software engineer, making well into the six figures and even owning his own company, Jay found himself unemployed and out of a job in January, a byproduct of AI.

    That began an era of loss. Job applications went unanswered. His savings dwindled while trying to keep up with his and his wife’s home in Brooklyn. He lost his car insurance. He forever gave up his confidence in the White House. “I voted for Trump,” Jay, 41, told Scene. “This is my fault.”

    By August, Jay’s pride fizzled. He needed help. He applied to the government’s Supplemental Nutrition Assistance Program, casually known as food stamps, and got approved for $759 a month, to feed himself, his wife and their three-year-old daughter. (They used the funds mostly on pasta and frozen meatballs.)

    Yet, in light of the U.S. Department of Agriculture’s impending freeze on SNAP funds come Nov. 1, Jay now has another bundle of anxiety: How to feed his cat, Nebula, and his two dogs, Sandy and Jinx.

    “It costs a ton already,” Jay said in a phone call. “I can’t even say. I hunt down which of the dollar stores has the cheapest dog food and cat food. But it adds up; it’s not cheap.”

    Democrats and Republicans are currently, as of Friday, in a standstill as far what it will take to end what’s been so far the second-longest government shutdown in U.S. history, at 30 days and counting.

    Cities, counties and states are trying to make up at least some of the difference, but SNAP benefits are expensive, and more than 42 million Americans rely on them. In Cuyahoga County, there are some 190,000 reidents who need their EBT cards to keep pantries and refrigerators stocked.

    As of September, SNAP gives its receivers up to $297 a month per person, which amounts to $9 a day, or roughly $3 per meal. But throw two teenagers in the mix, maybe a border collie or two, a hamster and a goldfish, and those leaning on D.C. to keep them alive this fall are heading towards the previously unthinkable.

    “People are gonna have to make a choice, right?” Anne Konarski, a SNAP policy expert who studies hunger for a Cleveland nonprofit and owns three dogs, said. “Do you feed your kids or do you feed your pets?”

    In interviews with four local pet food pantries, all of them told Scene that they’ve strengthened their relationship with regional food banks and the Hunger Network, the largest food distributor in Cleveland, in the past year—both out of necessity and an empathy for pet owners that walk in on a routine basis.

    A routine that’s become more dire in the past week or so, as a subset of their clientele wonder how they’re going to make it to Thanksgiving while keeping their pets healthy and nourished to see December. Or, as some expressed to Scene, whether they might be forced to give them up to a local shelter, many of which are already at capacity and facing budget issues of their own, or let them loose on the street.

    Volunteers at Neighborhood Pets, a food pantry in Slavic Village, sorted out dried dog food to hand out to clientele on Thursday. Credit: Mark Oprea
    Taymar Ethington, a Slavic Village resident on SNAP, and her two boys at Neighborhood Pets. Credit: Mark Oprea

    “They can and will turn to animal shelters and say, ‘I can’t afford my pet anymore’,” Sharon Harvey, president of the Cleveland Animal Protective League, said. “Or, ‘If you can’t help me with what I need for my pet, can you take it and find it a new home?’”

    Harvey, like the others that bring in boxes of food, relies primarily on donations to bag and distribute food to pet owners. Times have gotten harder. Harvey helped dole out 17 tons of pet food last year; near the end of September, they had already sent out 20 tons in 2025.

    The same is true for Wayne Campbell, who’s been running Paws For Purpose’s pet food pantry in Lake County for the past five years.

    Donors haven’t been as reliable this year, he said. And as a result, PFP is in more need of supply (amid climbing grocery costs) and facing more demand.

    All while trying to keep true to PFP’s mission: keep pets out of and away from shelters.

    “I mean, we used to give out 80 bags of cat food, 80 bags of dog food with dry treats and canned food, and we’re up to about 160 now of each,” he said. “It’s just, you know, the need is getting greater and greater.”

    Ohio Gov. Mike DeWine on Thursday signed an executive order providing $25 million in emergency relief in the face of the impending food disaster, with $7 million going to food banks and $18 million going to about 63,000 Ohioans directly. But it’s a small drop in the bucket. About $34 million would be needed to fully fund just Cuyahoga County’s portion of SNAP benefits for November.

    Cleveland and Cuyahoga County officials are convening Friday morning to announce what will be their proposal to help cover the gap left by the SNAP freeze. Leaders will, a press release read, “discuss the urgency of addressing the needs of Cuyahoga County residents.”

    As for their pets?

    Over in Slavic Village on Thursday afternoon, Becca Britton helped lug in boxes of canned tuna and dried dog food, kibbles her volunteers soon scooped into Ziploc bags and handed out to the dozen or so waiting in line in the lobby. (A quarter of which were on SNAP.)

    “It’s heartbreaking, even just right now,” Britton said, as her volunteers shuffled around her, some bagging pellets or tending to clientele. “We just don’t know. But I do think—sad as it is to say—that it’s going to get to the point where people are going to have to surrender their pets.”

    Close by was Taymar Ethington and her two boys, who stopped by Neighborhood Pets on Thursday to pick up food, toys and a leash for their puppy, Prince.

    Ethington, a single mom living at a nearby apartment building, said the up-in-the-air situation with SNAP has propelled her to extend her gathering outward: to the Greater Cleveland Food Bank, to churches, to the Salvation Army. She even set up a pantry nook in her building to help out fellow SNAP receipients.

    “I’ve been stocking my pantry, filling up my deep freezer,” she told Scene, as her boys waited nearby. “Things like that. Filling up my canned goods.”

    As for Prince, Ethington said he’s going nowhere.

    “He’s just a little puppy,” she said. “He doesn’t cost too much to feed.”

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    Mark Oprea

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  • Undocumented residents’ access to Maryland health insurance marketplace delayed – WTOP News

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    Maryland Health Benefit Exchange officials say delay in Access to Care Act is needed after new Trump immigration and health policies.

    This article was republished with permission from WTOP’s news partners at Maryland Matters. Sign up for Maryland Matters’ free email subscription today.

    A plan to give undocumented immigrants access to Maryland’s state health insurance marketplace next year has been put off until 2028 by state officials, citing recent federal policies affecting immigrants as well as overall uncertainty in health care markets.

    The delay was the one of the biggest changes outlined for state lawmakers Thursday by health care and health insurance officials discussing the impact of recent Trump administration policies on Maryland’s health care system.

    The joint virtual meeting of the Senate Finance and the House Health and Government Operations committees went over policies that are expected to increase health insurance costs, create barriers to access plans and reduce federal funding to Maryland, among other effects. The briefing also laid out the ways in which Maryland might respond to those changes.

    Michele Eberle, executive director of the Maryland Health Benefit Exchange, said one of the changes she was the “most unhappy about” was a delay in the implementation of the Access to Care Act, in light of recent federal developments.

    Currently, undocumented immigrants can purchase health care plans directly from insurers. But they are barred from using the Maryland Health Benefit Exchange to compare plans and find the most appropriate insurance for their households.

    The 2024 Access to Care Act would have changed that by opening the marketplace to undocumented residents, allowing them access to the marketplace, where they could comparison-shop health plans from different providers. It was to take effect next year if the state could get a waiver from the federal government, which is got while President Joe Biden was still in office.

    The law would not have given undocumented residents access to the federal subsidies to make health care affordable for many customers. But, for those who could afford to buy individual plans without a subsidy, it would at least have given them a chance to use the online marketplace as a tool to weigh their options.

    But with the Trump administration’s antagonistic approach toward undocumented immigrants, along with significant changes to health care funding, Eberle said the exchange decided to delay opening the marketplace to undocumented residents until 2028.

    “We worked really hard under the last [Biden] administration to make sure that it was approved — and we were all set to go,” Eberle said. “We did not anticipate at that time that we would have the Marketplace Integrity Rule or HR 1 that would throw up a whole bunch of new requirements that we would have to put in place in short order.”

    The rule and the bill — also known as the One Big Beautiful Bill — overhaul parts of the Affordable Care Act and other federal health regulations, and states like Maryland are having to focus their resources on complying with those changes.

    The Marketplace Integrity Rule also revoked a Biden-era decision that classified immigrants covered by the Deferred Action for Childhood Arrivals program — for undocumented immigrants who were brought to this country as children — as “lawfully present” individuals. Being lawfully present would have given DACA recipients access to the federal subsidies that help make health care coverage affordable for many.

    Without the classification, DACA recipients lose access to the subsidies, a change that is set to affect about 300 DACA recipients in Maryland currently benefiting from those subsidies.

    But federal decisions targeting Maryland’s undocumented and immigrant populations were just part of what Insurance Commissioner Marie Grant called “gloomy but important” health care-related updates under the Trump administration.

    Grant noted the significant rise expected next year in insurance premiums — due in part to the anticipated expiration of pandemic-era federal tax credits that bring down costs of individual plans purchased through the Affordable Care Act.

    In September, the Maryland Insurance Administration approved an average premium increase of 13.4% across plans next year, less than what insurance companies initially asked for, but still a significant hit in monthly costs for many low- to middle-income families.

    Health care advocates fear people will drop their coverage because they can no longer afford their plans if those credits expire. But carriers say the rate increases are needed to offset the number of people they expect will choose to go without health insurance — due to high costs.

    The General Assembly approved funding this year that would partially replace the soon-to-expire federal tax credits for the coming year. But those state subsidies are only temporary fixes, analysts say, and even with that assistance plenty of people will still pay more each month for coverage than they did this year.

    Congress could vote to extend those tax credits, which is at the heart to the current government shutdown debate. But Grant notes that time is running out to make that decision and have it effect 2026 health care plans.

    “We’re expecting those enhanced tax credits to expire by the end of this year, unless Congress takes action to extend them,” she said. “The clock is ticking. It is … likely we’re getting to a point where, unless this extension happened in the next couple of days, it is likely too late to have carriers refile rates for 2026.”

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    Diane Morris

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  • Nearly $1.1B to be spent on ‘Smart Wall’ at California border under ‘One Big Beautiful Bill’

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    CONCERNING HER FIRING. THE TRUMP ADMINISTRATION ANNOUNCED IT’S PLANNING TO BUILD NEW SECTIONS OF THE SOUTHERN BORDER WALL. THE NEW BARRIERS WOULD EXTEND NEARLY TEN MILES ALONG THE SAN DIEGO MEXICO BORDER. KCRA 3’S ANDREA FLORES HAS BEEN COVERING THE SOUTHERN BORDER FOR MORE THAN THREE YEARS. UNDER THE BIDEN AND TRUMP ADMINISTRATION. SHE JOINS US WITH WHAT THIS MEANS FOR BORDER SAFETY AND HOW IT’S GETTING FUNDED. SO THE NEW WALL SYSTEM IS BEING FUNDED BY THE SO-CALLED BIG BEAUTIFUL BILL ACT, AND IT GIVES CBP MORE THAN $46 BILLION THROUGH 2029 FOR CONSTRUCTION AND MAINTENANCE COSTS. SO THIS IS VIDEO FROM KCRA 3’S TIME AT THE BORDER. THIS WAS BACK IN APRIL OF THIS YEAR WHEN THOUSANDS OF MILITARY TROOPS WERE SENT TO THE AREA TO ASSIST CBP WITH SURVEILLANCE AND INFRASTRUCTURE. NOW, THE PROPOSED BARRIERS WOULD BE BUILT NEAR THE TECATE AND OTAY MESA PORTS OF ENTRY. CBP SAYS IT PLANS TO BUILD AND MAINTAIN NEARLY TEN MILES OF BORDER WALL. IT ALSO PLANS TO ADD NEARLY 52 MILES OF IMPROVED INFRASTRUCTURE ALONG EXISTING BARRIERS, INCLUDING SURVEILLANCE CAMERAS, ACCESS PATROL ROADS AND ARTIFICIAL LIGHTS. BUT IMMIGRATION ADVOCATES LIKE AMERICAN FRIENDS SERVICE COMMITTEE, WHO WE SPOKE WITH BACK IN APRIL, OPPOSES THE PLAN, SAYING THIS WOULD DIVERT MIGRATION FLOWS INTO MORE DANGEROUS AREAS WITH POTENTIALLY DANGEROUS CONSEQUENCES. U.S. CUSTOMS AND BORDER PROTECTION SAYS APPREHENSIONS ARE DOWN IN THE SAN DIEGO SECTOR. LAST MONTH, THEY RECORDED 715 ENCOUNTERS. THAT’S A 95% DECREASE FROM AUGUST OF 2024. WE DID REACH OUT TO CBP FOR AN INTERVIEW ON WHEN THE CONSTRUCTION OF THIS NEW AREA OF THE BORDER WALL WOULD BEGIN

    Nearly $1.1B to be spent on ‘Smart Wall’ at California border under ‘One Big Beautiful Bill’

    Updated: 11:19 PM PDT Oct 13, 2025

    Editorial Standards ⓘ

    The Department of Homeland Security and Customs and Border Protection have awarded $4.5 billion in new contracts under the “One Big Beautiful Bill” for Smart Wall construction along the southwest border.At least 10 new construction contracts will add 230 miles of barriers and nearly 400 miles of technology, delivering on the Trump Administration’s promise to secure the border.(Video Above: Trump administration announces plans to build new sections of southern border wall)“For years, Washington talked about border security but failed to deliver. This president changed that,” said CBP Commissioner Rodney Scott. “The Smart Wall means more miles of barriers, more technology, and more capability for our agents on the ground. This is how you take control of the border.”The Smart Wall is a border security system that combines steel barriers, waterborne barriers, patrol roads, lights, cameras, and advanced detection technology to give Border Patrol agents the best tools in the world to stop illegal traffic. The technology additions will further secure the existing wall in areas where the Biden administration’s policies canceled contracts to do so, according to a joint statement by DHS and CBP.The 10 contracts, awarded between Sept. 15 and 30, are the very first to be funded by President Trump’s One Big Beautiful Bill. They also include minimal prior year funding from fiscal year 2021 wall appropriations. That funding was on hold during the Biden administration, according to the release.To expedite the construction of the Smart Wall, Secretary of Homeland Security Kristi Noem also issued two new waivers for approximately nine miles of Smart Wall in CBP’s San Diego sector and approximately 30 miles of new Smart Wall in New Mexico within the El Paso sector.Contracts in California include:San Diego 1 Project – Awarded to BCCG Joint Venture for $483,486,600 for the construction of approximately nine miles of new Smart Wall and approximately 52 miles of system attributes in USBP’s San Diego Sector in California.El Centro 1 Project – Awarded to Fisher Sand & Gravel Co. for $574,000,000 for the construction of approximately eight miles of new primary Smart Wall and the installation of approximately 63 miles of system attributes in USBP’s El Centro and San Diego Sectors in California.See more coverage of top California stories here | Download our app | Subscribe to our morning newsletter | Find us on YouTube here and subscribe to our channel

    The Department of Homeland Security and Customs and Border Protection have awarded $4.5 billion in new contracts under the “One Big Beautiful Bill” for Smart Wall construction along the southwest border.

    At least 10 new construction contracts will add 230 miles of barriers and nearly 400 miles of technology, delivering on the Trump Administration’s promise to secure the border.

    (Video Above: Trump administration announces plans to build new sections of southern border wall)

    “For years, Washington talked about border security but failed to deliver. This president changed that,” said CBP Commissioner Rodney Scott. “The Smart Wall means more miles of barriers, more technology, and more capability for our agents on the ground. This is how you take control of the border.”

    The Smart Wall is a border security system that combines steel barriers, waterborne barriers, patrol roads, lights, cameras, and advanced detection technology to give Border Patrol agents the best tools in the world to stop illegal traffic. The technology additions will further secure the existing wall in areas where the Biden administration’s policies canceled contracts to do so, according to a joint statement by DHS and CBP.

    The 10 contracts, awarded between Sept. 15 and 30, are the very first to be funded by President Trump’s One Big Beautiful Bill. They also include minimal prior year funding from fiscal year 2021 wall appropriations. That funding was on hold during the Biden administration, according to the release.

    To expedite the construction of the Smart Wall, Secretary of Homeland Security Kristi Noem also issued two new waivers for approximately nine miles of Smart Wall in CBP’s San Diego sector and approximately 30 miles of new Smart Wall in New Mexico within the El Paso sector.

    Contracts in California include:

    • San Diego 1 Project – Awarded to BCCG Joint Venture for $483,486,600 for the construction of approximately nine miles of new Smart Wall and approximately 52 miles of system attributes in USBP’s San Diego Sector in California.
    • El Centro 1 Project – Awarded to Fisher Sand & Gravel Co. for $574,000,000 for the construction of approximately eight miles of new primary Smart Wall and the installation of approximately 63 miles of system attributes in USBP’s El Centro and San Diego Sectors in California.

    See more coverage of top California stories here | Download our app | Subscribe to our morning newsletter | Find us on YouTube here and subscribe to our channel

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  • Medicare Holds, But the Rest of Healthcare Wobbles: Shutdown Threatens Trials, Telehealth and Safety Nets

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    WASHINGTON, October 1, 2025 (Newswire.com)
    –
    Black Book Research today released an independent assessment showing that while Medicare and Medicaid continue unaffected, the shutdown is forcing sweeping furloughs and program suspensions at the FDA, CDC, NIH, CMS, and SAMHSA, creating systemic risks to patient safety, public health, and medical innovation.

    “The nation’s healthcare system isn’t shutting down overnight,” said Doug Brown, founder of Black Book Research. “But important functions that support research, oversight, and public health are being slowed or suspended. If the shutdown continues, the effects will become more visible and increasingly difficult to reverse.”

    Key Agency Impacts

    Department of Health and Human Services (HHS): Tens of thousands of staff furloughed, with only life-saving or urgent public health functions continuing. Grants, policy development, and regulatory reviews pause indefinitely.

    Centers for Medicare & Medicaid Services (CMS): Medicare and Medicaid claims continue to be paid as mandatory programs. However, audits, program integrity reviews, and innovation pilots including accountable care and bundled payment models stall, leaving oversight gaps.

    Food and Drug Administration (FDA): User-fee funded drug and device application reviews continue, but most food safety inspections, routine facility checks, and non-user-fee programs are halted. Risks include supply chain vulnerabilities and delayed enforcement actions.

    Centers for Disease Control and Prevention (CDC): Emergency outbreak response and essential disease surveillance persist, but broad public health programs, communications, and prevention initiatives are curtailed. The agency’s long-term preparedness mission is substantially weakened.

    National Institutes of Health (NIH): Patients already in clinical trials continue receiving care. However, most grant reviews, new trial starts, and research support staff are furloughed. The U.S. biomedical research pipeline stalls until funding resumes.

    Substance Abuse and Mental Health Services Administration (SAMHSA): Community program grants and state block funding are frozen, threatening the continuity of local substance use and mental health initiatives.

    Indian Health Service (IHS): Direct patient care is protected as essential, but supply chains, contracting, and administrative functions are disrupted.

    Veterans Health Administration (VA): Protected by advance appropriations, VA hospitals and clinics remain operational. Research and long-term policy projects, however, may slow due to staff furloughs.

    Cross-Cutting Risks

    Research & Innovation: With NIH and FDA research pipelines paused, thousands of grant reviews and trial starts are delayed. Innovation suffers immediate setbacks.

    Regulation & Oversight: FDA and CMS furloughs weaken safety inspections, compliance audits, and contractor oversight. Food and medical device monitoring is drastically reduced.

    Public Health: CDC’s ability to track and mitigate health threats outside of emergency outbreaks is severely hampered. Preventive health campaigns and state support programs stall.

    Vulnerable Populations: Programs such as WIC (Women, Infants, and Children) may run out of funds, threatening nutrition access for low-income families. Mental health and substance abuse treatment programs lose stability as grants freeze.

    Provider Operations: Claims payments continue, but cash-flow delays from administrative slowdowns could disproportionately harm smaller hospitals and safety-net providers.

    Duration Matters

    According to Black Book’s analysis, the severity of impact escalates with the shutdown’s length:

    First 2-3 weeks: Entitlement funding cushions core services, but backlogs and administrative slowdowns begin.

    One month or more: Research, grants, and inspections stall significantly. Telehealth waivers and hospital-at-home programs expire without congressional renewal, pulling patients back into traditional settings.

    Multi-month: Structural harm occurs – loss of innovation momentum, worsening health disparities, and rising long-term costs from deferred care and weakened oversight.

    Black Book warns that while core entitlements remain funded, the broader healthcare scaffolding is fragile. A protracted shutdown risks long-term harm to research, regulation, and safety nets, weakening U.S. preparedness for future crises.

    About Black Book Research

    Black Book Research is the healthcare industry’s leading source for unbiased, crowdsourced client experience data, benchmarking, and market intelligence. Since 2011, Black Book has surveyed more than 3.5 million healthcare professionals to provide independent evaluations across 36 key performance indicators for over 5,000 health IT and services vendors. Gratis industry research reports can be downloaded at www.blackbookmarketresearch.com.

    Contact Information

    Press Office
    research@blackbookmarketresearch.com
    8008637590

    Source: Black Book Research

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  • Is Trump’s Big Beautiful Bill the biggest tax cut ever?

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    Vice President JD Vance hit the road Aug. 21 to promote President Donald Trump’s legislative accomplishment, the One Big Beautiful Bill Act tax and spending bill.

    The law permanently extended tax cuts from a 2017 law Trump signed, which would have expired at the end of 2025 had Congress not reauthorized them. The law also included some new tax cuts, including for tips, overtime and Americans 65 and older.

    Speaking in Peachtree City near Atlanta, Vance said, “We had the biggest tax cut for families that this country has ever seen.”

    The tax cuts were significant, but they weren’t the biggest in U.S. history — which was a phrase Trump has often used to inaccurately describe his 2017 tax cut law. The 2025 tax cuts rank either third-biggest since 1980 or tied for seventh, depending on the yardstick.

    At the same time, many Americans could see relatively modest changes to the taxes they owe starting in 2026, because the 2025 law mostly extended existing tax cuts.

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    The White House did not provide a response before publication.

    Comparing historical tax cut laws

    We examined the tax revenue decreases from major laws passed since 1980. (On balance, most tax laws prior to 1980 either raised taxes or cut them modestly.)

    Tax bill dollar amounts tend to rise over time because of inflation, so we looked at tax cuts as a percentage of gross domestic product, which evens out the differences over time. And because some early laws have tax cut data available only for the first five or six years of the law’s life, we compared laws by looking at the cumulative tax savings during a law’s first five years in effect.

    We found that the law with the biggest tax savings was 1981 legislation passed by the Democratic Congress and signed by President Ronald Reagan, who won office promising large tax cuts. That law cut taxes by 3.5% of the nation’s cumulative five-year GDP.

    A 2012 bill passed by the Republican Congress and signed by President Barack Obama ranked second. That bill, which cut taxes by 1.7% of GDP, extended the tax cuts passed in 2003 under President George W. Bush.

    Based on current projections, Trump’s 2025 law ranks third at 1.4% of GDP when factoring in Trump’s 2017 cuts. 

    Trump’s 2017 law ranks fourth at 1%, tied with a 2010 law Obama signed that extended Bush’s 2001 tax cuts. Bush’s 2001 and 2003 tax cuts ranked sixth and seventh, with 0.7% and 0.5, respectively. 

    If considering only new tax cuts and not the reupped 2017 tax cuts, then Trump’s 2025 law would tie for seventh at 0.5% of GDP.

     

    Joseph Rosenberg, a senior fellow at the Urban Institute-Brookings Institution Tax Policy Center, told PolitiFact that it’s legitimate to measure the scale of the cuts in the 2025 tax law either way. 

    What will ordinary Americans see in their taxes starting in 2026?

    There could be a disconnect between the historical scale of Trump’s 2025 bill and the impact that ordinary Americans will notice when filing 2026 taxes.

    Because Americans are already paying the lower rates that began in 2017 and that the 2025 law extended, they won’t necessarily notice a sizable reduction in taxes owed. 

    “For most families, they are going to see a child tax credit that increases by a maximum of $200 per child — from $2,000 to $2,200,” said Margot Crandall-Hollick, principal research associate at the Tax Policy Center. “Some are going to pay a little less because of the tips and overtime provisions and a slightly higher standard deduction.” 

    The law preserves a more generous standard deduction that had been set to expire and increases it slightly to $15,750 for single filers and $31,500 for joint filers in 2025, to be indexed to inflation annually.

    At the same time, Crandall-Hollick said, some families, especially those with lower incomes, will  pay higher taxes because of the expiration of health insurance premium tax credits, which were not extended by the Big Beautiful Bill.

    Our ruling

    Vance said, “We had the biggest tax cut for families that this country has ever seen.”

    When factoring in the One Big Beautiful Bill’s extension of 2017 tax cuts, then the tax savings from Trump’s 2025 law rank third among tax cut laws since 1980, following bills signed in 1981 by Reagan in 1981 and in 2012 by Obama.

    However, the bottom-line impact on Americans’ tax liability starting in 2026 won’t be as dramatic as the historical tables suggest. Americans are already paying the lower tax rates that began in 2017 and the 2025 law saved from expiration.

    The primary reductions taxpayers will see from the 2025 law will be from new, more limited tax breaks, such as for income from tips and overtime and for Americans 65 and older.

    The statement contains an element of truth but ignores critical facts that would give a different impression. We rate it Mostly False.

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  • Planned Parenthood of Greater Ohio Employees Want Leadership to Take Pay Cuts to Avoid Layoffs, Staff Salary Reductions

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    click to enlarge

    Mark Oprea

    A sign posted on the former Planned Parenthood in Midtown blamed the Trump administration for its closure in June.

    A union representing Planned Parenthood of Greater Ohio employees is pushing back against layoffs proposed earlier this month meant to keep the reproductive care mainstay afloat after cuts in President Trump’s Big, Beautiful Bill.

    Workers backed by the local arm of the Office and Professional Employees International Union want nine C-suite executives at Ohio’s Planned Parenthood branch to cut their own pay by a quarter, the union said in a press release on Thursday, to save other jobs.

    The request comes after the union met for a third time on Wednesday with PPGOH to try and handle fallout from about $10 million in federal funding cuts affecting 12 Ohio locations.

    In June, Planned Parenthood’s clinic in Midtown shut its doors due to those funding freezes. And a month later, in July, two more Ohio clinics, in Springfield and Hamilton, closed as well.

    More somber news followed. Planned Parenthood of Greater Ohio would be forced to, the organization said, reduce their workforce through layoffs due to Trump. Other staffers would be forced to take salary cuts.

    The union asked, in the aftermath, why leadership didn’t take their own salary cuts.

    Leadership told Scene the math doesn’t work out.

    “The impacts of a total $10 million funding loss unfortunately cannot be solved entirely through cutting executive compensation,” Erica Wilson-Domer, president of PPGOH, told Scene in a statement.

    “Even with the reduction in force, PPGOH will continue to offer all of the services it currently does at our health centers,” she said. “This reduction does not include any health center closures.”

    Though it’s unclear exactly how many employees will be cut from the dozen remaining clinics and surgical centers, the pay drop for clinic workers that decide to stay could lead an overall drop in quality.

    Bee Grubbs, a patient navigator who helps with patient intake in one of Planned Parenthood’s Columbus clinics, worries that her own drop in salary—from $52,600 a year to $37,800—will lead to a kind of demotion of trained care in a line of work that’s already sensitive.

    As proposed to her, and others, in bargaining talks this month, Grubbs’ role in patient navigation would blend with two other departments, customer contact and centralized followup, into a newly-created Patient Access and Support Department, where new hires would make about $18 an hour.

    Not exactly what she feels her bachelor’s degree amounts to.

    “I in good faith don’t expect someone to stay and take a $15,000 pay cut,” Grubbs, 23, told Scene. “I mean, a 20-percent pay cut means I can’t pay my mortgage. For them? I don’t know.”

    Brian Pearson, the head of North Shore branch of the American Federation of Labor and Congress of Industrial Organizations, told Scene it’s “disappointing” to have to witness a back-and-forth fight over pay cuts and layoffs, specifically for an organization rife with employees passionate about reproductive rights in general.

    Pearson, whose organization oversees the Office and Professional Employees International Union Local 98, which is bargaining on PPGOH employees’ behalf, frames the current impasse between PPGOH and its unionized workers as part of a growing trend.

    “It’s this common theme of workers, even those that are unionized, not having a seat at the table,” Pearson said. “And I’m definitely fed up about it.”

    No Planned Parenthood leaders, including Wilson-Domer, have agreed to take any pay cuts as of Thursday. Wilson-Domer’s predecessor made roughly $318,000 a year, according to a 2023 tax filing.

    About $2 million in “director-level and above” spending was however cut, PPGOH said in a statement, “in an effort to reduce overall costs” concerning patient care.

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    Mark Oprea

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  • Urban Hospitals Warn of Medicaid Crisis as Senate Advances Rural-Only Relief – Black Book Flash Poll

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    Senate’s rural hospital protections leave urban safety-net providers facing financial fallout and potential care cutbacks, new poll results reveal.


    WASHINGTON, June 29, 2025 (Newswire.com)
    –
    As the Senate advances the amended “One Big Beautiful Bill,” granting critical Medicaid relief exclusively to rural hospitals, urban safety-net hospitals are left facing significant financial peril, according to a flash poll by independent research firm Black Book Research. The survey, conducted June 25-28, 2025, gathered urgent perspectives from twelve senior executives at major urban hospitals averaging 440 beds and a Medicaid payer mix of 67%. Respondents included leaders in finance, clinical operations, and health IT.

    Key findings signal unanimous concern among urban safety-net executives:

    All respondents anticipate serious financial harm from pending Medicaid funding cuts. Additonally, every executive reported that their state has no viable contingency plan to address the shortfall from reduced federal Medicaid matching funds.

    Seven of twelve foresee major operational consequences: significant reductions in healthcare services, layoffs, or deferral of essential investments in cybersecurity and technology infrastructure. The average projected uncompensated care expenses exceed $10 million per facility annually.

    Two executives warn of even more severe outcomes: the potential for closure or bankruptcy of their health systems within three years without legislative intervention.

    Independent assessments echo these concerns, finding that the current bill could impose severe financial burdens on urban hospitals due to Medicaid provider tax reductions. Leaders caution that the lack of urban protections may undermine care for millions of vulnerable urban residents and destabilize existing safety nets.

    “While rural hospitals rightly received critical protections, urban safety-net hospitals have clearly been overlooked. Without comparable safeguards, vital healthcare services for millions of Medicaid-dependent urban residents are at risk, ” commented Doug Brown, Founder of Black Book Research. “Our flash poll highlights the urgent need for equity in the final bill negotiations. Congressional leaders must recognize the indispensable role urban safety-net hospitals play in delivering care to the nation’s most underserved populations.”

    Urban hospital administrators urge lawmakers to ensure balanced, equitable emergency protections in ongoing legislative negotiations, calling for relief that supports the essential needs of both rural and urban hospitals.

    How to Advocate: Hospital administrators and stakeholders are encouraged to contact their senators and representatives directly via www.congress.gov/members.

    About Black Book Research

    Black Book Research is an independent research firm specializing in healthcare market trends, vendor rankings, and provider insights. Employing impartial, data-driven methodologies and comprehensive surveys, Black Book tracks healthcare technology adoption and policy impacts while amplifying provider perspectives and identifying industry gaps.

    Black Book’s rapid flash polling utilizes expert panels from both in-house and outsourced partners, ensuring timely, actionable intelligence on market and policy shifts. Access complimentary industry reports at www.blackbookmarketresearch.com or contact research@blackbookmarketresearch.com.

    Source: Black Book Research

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