The budget reconciliation bill being considered by the U.S. Senate proposes $863 billion in Medicaid reductions over a decade, with 10.9 million Americans projected to lose coverage by 2034, according to a June 4 Congressional Budget Office report.

In Florida, where 760,000 Medicaid enrollees rely on community health centers, advocates say the cuts would destabilize preventive care and overwhelm hospitals.

Austin Helton, CEO of Brevard Health Alliance, said the cuts would dismantle primary-care access, rupturing what he called Florida's "health-care ecosystem."

"If you cut spending on Medicaid and ACA, which primarily pays for access to primary-care health services at community health centers, that access is gone," he said. "The patients are still going to need that care. They're just going to end up sicker and they're going to end up going to more costly and more complex environments like the emergency room at the hospital."

Helton said the cuts would hit hardest at health-care facilities such as those under Brevard, where 60% to 70% of patients use Medicaid or ACA plans.

While the Florida Policy Institute warns of clinic closures and reduced hours, supporters say the changes target inefficiencies, with House leaders claiming they'll reduce wasteful spending while protecting vulnerable patients.

Florida's community health centers, which serve one in eight Medicaid patients statewide, face what advocates call an impossible math problem: more patients but fewer resources.

"As the population in Florida increases, the number of our patients increase, the number of Medicaid enrollees decreases," said Jonathan Chapman, CEO of the Florida Association of Community Health Centers. "Therefore, by process of elimination, you're going to see more uninsured people on our doorstep."

The Congressional Budget Office projects Florida would lose $7.3 billion in federal Medicaid funds by 2030 under the House plan, with rural counties such as Gadsden and DeSoto facing severe strain. The bill remains stalled in the Senate, where Republicans are divided over many issues, including rural hospital protections.

After the Department of Government Efficiency cut AmeriCorps funding earlier this year, a federal judge last week granted a temporary halt to the cuts on behalf of a group of states that filed a lawsuit against the move. Montana is not on the list.

AmeriCorps is a national service program which has been running for three decades. In the year before the cuts, about 2,800 members, called VISTAs, served at 300 Montana host sites including food banks, schools, youth centers and more.

Rochelle Hesford, executive director of Southwest Montana Youth Partners, relied on AmeriCorps service in the group's five-year plan. But its VISTA member was on board for less than four months before funding was cut.

"We're in kind of that early critical stage where we really need to get that public support and get our name out there and build capacity for the organization," Hesford observed. "We're losing, like, a year's worth of work, I would say."

Two dozen states plus Washington, D.C., filed a lawsuit against the Trump administration arguing it did not provide sufficient notice or comment period according to law but because Montana was not a plaintiff, its AmeriCorps funding remains cut.

Groups hosting VISTA members pay about one-third of their income and AmeriCorps funding covers the rest.

Erin Switalski, senior program director for the Headwaters Foundation, which provides grants for groups across the state, said it is a big leg up for many Montana groups.

"We're a resource-scarce state in many ways, and AmeriCorps VISTAs can really come in and help organizations build new systems and find efficiencies," Switalski explained. "Losing that support is really critical."

Montana's population is one of the least dense in the country but it has the most nonprofits per capita, nearly 10 per every 1,000 residents, according to the Tax Foundation.

Switalski noted she worries cuts to AmeriCorps signal something bigger.

"It's tied to this broader trend that we're seeing in really just a gutting of civic infrastructure that helps hold our communities together in Montana," Switalski added.

The federal budget proposal now being hashed out in Congress would significantly reduce funding for programs aiming to prevent domestic violence and assault, and help support survivors.

Ohio groups are raising concerns about how the cuts could affect services across the state. The budget reconciliation bill now in the U.S. Senate includes a $200 million cut to grant programs under the Violence Against Women Act.

Maria York, policy director for the Ohio Domestic Violence Network, said the funding supports core services, such as legal assistance and victim advocacy.

"It eliminates millions of dollars in crime victim services funding," York pointed out. "The biggest grants that we were looking at is the Violence Against Women grants; a reduction in the VAWA grant funding means that these services would be cut from the shelters in Ohio."

The proposed budget also calls for consolidating the Office on Violence Against Women into the Office of Justice Programs, a move some advocates said conflicts with current federal law and could affect grant administration.

York noted Ohio reports higher rates of victimization than many other states. She pointed to a recent study estimating the economic cost of domestic violence in Ohio at $1.2 billion annually.

"When we're using these federal dollars it's actually, in the long run, saving money for Ohioans," York contended.

Ohio advocates are encouraging residents to contact members of Congress ahead of a National Day of Action on June 10, urging them to maintain and strengthen funding for victim services.

By Laura Aka for WorkingNation.
Broadcast version by Danielle Smith for Keystone State News Connection reporting for the WorkingNation-Public News Service Collaboration

Manufacturing has been a key part of Allentown, Pennsylvania's history with textiles, furniture, and gristmills having significant roles in the 19^th century. More recently, Allentown was a hub for steel and truck manufacturing, but the region experienced a decline in these sectors in the 1980s and 1990s.

Allentown - located in the eastern part of the state - is one of three main cities that make up the Lehigh Valley. The others being Bethlehem and Easton.

In April, Mack Lehigh Valley Operations announced the layoffs of between 250-350 workers due to market uncertainty, possible regulatory changes, and the impact of tariffs.

But according to Lehigh Valley Economic Development, these days, "advanced manufacturing companies are building the economy of tomorrow alongside iconic brands like Crayola and Martin Guitar that have been the region's economic cornerstone for generations.

"The Lehigh Valley is home to more than 700 manufacturers...and produces 16% - or $9 billion - of the region's GDP."

Mayor Matt Tuerk of Allentown says investing in neighborhood-scale manufacturing sites will attract small business owners and create access to employment for area residents. "I think this has a potentially powerful impact of showing people what work looks like.

"One of the things that becomes really challenging about engaging people in communities is that there's a disconnect from the work - that somebody works somewhere in another town or somebody works somewhere up in a tall building - and they're not in the neighborhood and you don't see them. And when you see people working, it helps you understand as a young person what your future might look like."

He adds, "We're encouraging people to build buildings between 40- and 100,000-square feet that can host these smaller manufacturers."

Allentown has a population of just under 125,000. Tuerk acknowledges Allentown's majority minority population - which is 53.8% Hispanic or Latino - by referring to himself as 'el alcade' or 'the mayor.' Just over 42% of Allentown residents identify as white alone, while 13% identify as Black alone, according to the U.S. Census Bureau.

Addressing Barriers to Opportunity

Regarding a $20 million grant from the U.S. Economic Development Administration's Recompete Pilot Program, Tuerk says, "This is an opportunity for us to identify the barriers that prevent people from accessing good jobs. We know that there's lots of jobs in the area, but sometimes people just can't get to them for one reason or another.

"Our Recompete Plan is focused on making sure that the credentials are present in folks in our community that are available for these manufacturing jobs. We looked specifically at making sure that people were aware of the needs of health care and manufacturing to get them into those high-demand occupations."

Tuerk says lack of access to transportation and childcare are often barriers that keep residents from joining the local workforce - and needs to be addressed.

Manuela Guevara, the recompete program manager at the Allentown Economic Development Corporation (AEDC) adds, "This money is aiming to get people closer to jobs and jobs closer to people... and reduce the prime-age employment gap, the unemployed sector between 25- and 54-year-old people.

"Formally, the goal is to create around 650 jobs to reduce that prime-age employment gap and actually get Allentown out of that economically distressed tag."

According to Guevara, stakeholders are working on the first of two phases - strategy development. The second phase will focus on implementation of the plan.

She says, "I am excited to get this recompete initiative kicking off because it's definitely something that's doable. It's just being consistent and being able to keep that consensus and motivation, because everybody's doing their part."

Before his role as mayor, Tuerk spent 12 years working in economic development. "I, early on in that career, realized that things were changing in economic development. It really became evident to me that this was about making sure that we were investing in folks now to make sure that they're able to access the jobs that are either here now or the jobs of the future."

He also points to other AEDC work, "The Allentown Economic Development Corporation has a manufacturing incubator, so they have small manufacturers operating in a former Mack Trucks building. We love to see [manufacturers] graduate out and occupy sites in neighborhoods."

The incubator - the Bridgeworks Enterprise Center - was established in 1989, according to Brittany Butkowski, AEDC program manager. Bridgeworks has supported more than 70 companies - with 37 graduating from the program.

Of the incubator community, Butkowski says, "The best part is that they get the intangible piece of being in one space together. They can work with each other and bounce ideas off each other. I think that's something they wouldn't get if they were on their own in their own building somewhere.

"They'd have to do a little more reach out, a little more networking, where in this building they can all walk down the hall and share experiences - which is huge for small startups."

The incubator focuses on manufacturing companies that are within three years of founding and, typically, provides leases of 4-7 years, according to Butkowski.

Incubator participants must commit to a certain amount of job creation before graduating from the program. She says, "One of the reasons why AEDC tries to keep manufacturing within the city is because a resident who gets a job can raise their median household income significantly just by getting an entry-level manufacturing job."

Additionally, the AEDC provides post-incubator support for its graduating clients. "Urban Sites is redeveloping properties - so [repurposing] old buildings back into manufacturing use, which is how my graduates would then be able to find another space," explains Butkowski.

Urban Made focuses on business retention and expansion - and includes a loan program for manufacturers and connections to other resources that support small business.

'I never intended to be a manufacturer'

Tyson Daniels, president and CEO of Polymer Contours, Inc., did not set out to own a manufacturing company.

He was running area restaurants when he decided to take business classes at the AEDC. "I always intended to have my own thing. I was out trying to invest in my own company."

In 2014, he learned that Polymer Contours - which was part of the incubator program - was for sale. "It was small. It was just an older guy in his seventies. One customer and two machines. So, it was more of a hobby business, nothing like it is today.

"I never intended to be a manufacturer. I never intended to be in injection molding."

Daniels says, "Fast forward to today - we're in year 10. I own my building and we're close to 40 customers. We've got 12 machines and molding for big names. Really doing some pretty awesome stuff."

He bought his business property in 2022 and after readying the building, moved in May 2023.

Polymer Contours employs 10 people. And Daniels says the company has a 100% retention rate. "Nobody comes and nobody goes. I don't struggle with the areas that most of my counterparts do. My industry's number one challenge is culture, and that's my number one strength. I get that through taking care of my people."

He calls his hiring strategy "unorthodox." None of the Polymer Contours employees come from industry. "Every single person is trained from the bottom up. I have terminated every person that I've hired that comes with either experience or degree in what we do."

Daniels says his Bridgeworks experience was helpful in a couple ways. "The incubator is very heavily ingrained in the community. There were a lot of key moments where they would do a newsletter, for example. They would send out that newsletter and that would have tremendous reach.

"The second part of that is the camaraderie. We're all from different worlds, but we'd have programs in there. There was a peer-to-peer group meeting once a month. The amount of amazing conversations you have just in the hallway there...it is really wonderful."

Daniels strives to have impact on his employees' lives, as well as their kids' lives, "I'm in the human business."

Lifelong Learning in the Health Care Sector

In addition to manufacturing, Tuerk notes that Allentown has a strong health care sector - with two large hospital networks in the area. He says the city has "become a destination for health care professionals."

The AEDC's Guevara says, "The landscape for health care is huge. Lots of opportunities are out there. Also, the health care networks are thinking about this. They're very community-engaged."

"We are struggling with a workforce shortage across the board," says Annmarie Chavarria, chief nursing executive, Lehigh Valley Health Network - part of Jefferson Health (LVHN). "I would say our greatest challenges are definitely in nursing, respiratory therapy, imaging, and in our rural areas - we struggle with physician recruitment."

Kerri Green, Ed.D., MS, director of health care career development with the Department of Education at LVHN, adds, "I think you've got a lot of tech roles to a lot of foundation roles - opportunities that people can get right out of high school or as a change of career are, oftentimes, very high-needed positions. But I think RNs are top need."

The health network engages in workforce development in numerous ways, including a three-level nursing externship. Chavarria says, "They can start that program before they even technically take any of their nursing classes - as long as they're enrolled in a nursing program. And then they can progress through these different levels.

"When they graduate, we have a 90% retention rate of those nursing students working here and being very, very successful because they're ingrained in the culture."

There is also a nurse residency program to support the new nurses as they progress through their first year of practice.

Additionally, the Healthcare Academy, Green says "was designed as basically a one-stop shop - a resource for students of all types.

"It's to engage students that are in local school districts and our career and technical education schools with opportunities - to get them enthusiastic about a career in health care."

Green says it's important to introduce local students to the "environments where they can see, smell, hear, and do as much as they possibly can." Groups are given the opportunity to observe in different clinical spaces that require health care staff with all levels of education.

She says it also involves working with those who are doing clinical rotations - whether they be in nursing, physical therapy, or occupational therapy.

Educational opportunities are also available to LVHN colleagues that want to advance their careers within the network system. Chavarria notes, "There are many, many ways that our colleagues can try to see what they like about health care and then we can guide them through the right career path."

Green adds health care is always evolving, "Typically, every three to five years your job has changed. You've moved up through the organization, other opportunities have opened up for you.

"The world of work has changed. What we do know about health care is that you are a lifelong learner."

LVHN employs about 20,000 people in the Lehigh Valley region.

Seeking Opportunity Through Construction Contracts

The Watson-Batts School of Construction (WBSC) was created to "unlock your potential in the construction industry." The program runs two tracks - one for youth, ages 18 to 28. The other focuses on small construction business owners who have not managed to work in the area's large commercial projects.

Hasshan Batts, Ph.D., WBSC co-founder, says about the large construction projects in Allentown, "You see these towers going up. You see new schools going up. You see new museums and no one of color on those jobs."

Regarding the WBSC cohort members, Batts says, "We're not teaching technical skills. We have plumbers, we have painters, we have electricians, we have people that can lay flooring, HVAC, all of that."

He says the intent is to pave access for small business owners - "qualifying them to get onto larger [construction] jobs, primarily meds and eds." Meds and eds - meaning health care and education projects.

Batts adds, "When a school is being built or a college campus is being built, we want to make sure that the minority participation goals are met."

Tuerk says, "What the Watson-Batts School is intending to do is make sure that people who understand construction have all the other skills to successfully start a business that can reasonably bid on those larger construction projects. You might have a paintbrush, but that doesn't necessarily put you in a position to bid on a painting contract.

"There are huge wealth building opportunities that have not been available. It's lowering a barrier that has prevented people from being able to access those opportunities."

Batts is hopeful about potential participation in large, commercial projects. "We're encouraged by the arrival of Jefferson Health in the Lehigh Valley."

In addition, he says there is active collaboration involving other local projects including the City of Allentown and the Allentown School District, among others.

Batts notes that WBSC is working to expand its model beyond the Lehigh Valley region through partnerships in New Haven, Memphis, Nashville, Pittsburgh, Philadelphia, and Harrisburg.

About Tuerk, he says, "The mayor has a relationship with us. He has a desire and is putting forth his support and his persistence. So, we will break through those barriers."

Growth in Transportation and Warehousing

Tuerk notes that Allentown's proximity to Philadelphia and New York have resulted in "robust transportation and warehousing industries.

"This is an incredibly attractive place for people who want to ship goods to the largest consumer markets in the United States. We've seen a proliferation of those jobs and then the associated local services associated with that."

He says these sectors have driven job opportunities for people without credentials in higher education.

However, for those seeking a related bachelor's degree, Muhlenberg College offers a 22-month, accelerated business administration degree with a concentration in supply chain management. The college's accelerated programming is aimed at working adults.

"The accelerator programs are normally for a 25-year-old and above who is out there working in a field and can bring that work experience to the classroom. What we're looking to do is to have their work experience expanded upon and help them get to that next-level promotion that they're looking for," says Michael Miller, the school's dean of continuing studies.

As a capstone project, the students are required to work with an outside organization to help solve a real-world problem. Miller says, "They take the knowledge that they've gained over the previous 22 months and put together a very in-depth case study, a paper, a presentation, a video presentation...including the solution they think will best serve this problem."

Upon completion of the program, Miller says students can coordinate the transportation of products globally. "They understand the role of warehouses and distribution centers, and they understand distribution productivity measures. They use software applications to improve business and logistics processes."

Noting the region's employers, he says, "We have these large distribution areas, logistic areas, and they're filled with thousands of workers.

"It just makes sense to have this supply chain program for anybody who doesn't want to be an order filler shipper, whatever you'd like to call it, for the rest of their lives. And not that there's anything wrong with those roles, but some people want to move ahead and get into that managerial leadership aspect."

'It's about changing beliefs about who you can be'

"I think it's paramount that we balance the schooling experience with the application of real-world opportunities. I think that students have so much talent and gifts that go untapped," says Carol D. Birks, Ed.D., superintendent and CEO of the Allentown School District (ASD).

As a middle school student in Bridgeport, Connecticut, Birks was hired to work in the mailroom of a local business. Recounting the skills she learned at the time, Birks says, "I think about how that experience changed my life. It's about changing beliefs about who you can be and the gifts that you have."

She has earned educational and professional success despite growing up in a poor household. "Every research on earth would say that would not happen because of my mother's educational attainment. My 'why' is very personal because there are great teachers who believed in me.

"I want to really empower our children and their families, despite where you've come from or what they said about you. 'You can do it. You can make it.'"

The Importance of Hands-On Experience

During the 2022-2023 academic year, Birks convened a student advisory council and based on the feedback, the Youth Interns Corps was developed. The ASD explains, "Through this initiative, students are matched with positions within the district and with local businesses and organizations where they gain hands-on experience, mentorship, and exposure to various industries."

Some of the outside partners include local hospitals, the Da Vinci Science Center, and the IBEW 375 (International Brotherhood of Electrical Workers). The district also hires interns in various departments.

Birks says, "To date, we have more than 400 students who have participated in the Interns Corps. We only allow students to intern for 10 hours a week because we want to make sure that they're learning. Some students may have a few more hours because they're also taking classes at the community college, so they have some days off."

She says gaining professional skills and social capital are important for the students. "This is how the world works. You need to be on LinkedIn because you've got to be able to network. Now many of them are friends with the superintendent on LinkedIn, and so they're all excited about that."

At the end of the 2022-2023 academic year, Gianny Mojica Castillo learned about the Youth Interns Corps program. She was finishing her junior year at Dieruff High School when she applied to intern in the district's communications department.

Her participation began that summer and concluded last summer before she started her freshman year at The Pennsylvania State University.

Mojica Castillo says the interns were asked if they were interested in photography and social media. "We would go out to different school events across the district and get pictures, and then we'd come back to the office and create the social media posts, create the captions.

"We also got to work with Dr. Birks a lot, whether that was during the steering committee or the Back to School Bash, we were sitting in the meetings for that, as well."

Now as a human-centered design and development major at Penn State, Mojica Castillo says, "I had the opportunity of working on the [district's] new website that they were building, so that's a majority of what my major encompasses. So, I got to try it out and experience it before I committed to the major once coming here. It's a good taste of what the workforce would be like.

"Working at the district opened up my mind to how limitless my options can really be - because I never even saw myself working in the Department of Education. That wasn't something that was on my radar. That really made me realize that you can work in basically any field you would want."

She says her internship changed her life path, "Usually when you hear about things like the youth internship, that usually only happens in school districts that are known for having a lot of funding. But just seeing that we can also achieve that and it's more within my reach than ever, it really touches me and my parents."

Mojica Castillo wants her future work to allow her to "design and cover stories" that help underrepresented people be seen.

Creation of Theme-Based Schools

Birks says, "Our theory of change is to create theme-based schools across our district." That plan started with the elementary schools and up next - the re-imagining of Building 21 High School. It's being described as "a future-focused learning environment designed to prepare students for high-demand careers in AI, medical and health sciences, and computer science."

The district has invited participation from the community to help "re-imagine" the school. Currently a design team is working on the physical plant which Birks hopes can become a 6-12 facility. In addition to an internal team, business and higher education stakeholders are offering input.

The district asked the community including students, parents, guardians, staff, and alumni to submit suggestions for a new name for Building 21 High School. It will now be known as Bridgeview Academy of Health, Science, Innovation, and Technology.

And not forgetting elementary school, Tuerk says he enjoys his interactions with the district's youngest students, "They are really brilliant. I feel like combining youthful optimism with care can have a magic outcome.

"These young people who are full of hopes and dreams about the future, for them to know that the guy who's in charge of the firefighters and the guy who is in charge of the city pool is personally invested in their success - that gives me a lot of hope because they reflect that."

'A matter of personal pride to work for the City of Allentown'

"People observe that this is an incredibly desirable place to live," says Tuerk. "It has a lot of the benefits of being in places like New York or Philadelphia at a much lower cost. While it is a large urban area, it feels neighborly."

Tuerk - who is running for his second mayoral term - says engaging with his constituents makes him optimistic, "I talk to people as I'm just walking in the street, or when I'm running in our parkway, or at the farmer's market, or the supermarket."

At the same time, Tuerk acknowledges housing costs in Lehigh Valley have risen rapidly in the past five years. "When you say 'housing' to a mayor right now, their heart rate accelerates. They start to feel palpitations.

"We have to do things like continue to advocate for federal investment in housing vouchers to build more affordable housing. We have to make it easier for people to access bank financing, to make improvements to housing."

Noting that about 60% of the city's housing stock was built before 1940, Tuerk says, "They're amazing old houses. But there's a housing economist that I'm very fond of her saying - 'old architecture is quaint, but there's nothing quaint about old plumbing.'"

He adds his administration would like to attract federal workers who have been displaced to look at Allentown as a place where they can continue their public service roles. "I can sit down and introduce myself to every single employee that starts working for the City of Allentown. "I can take an opportunity to talk to them about the values that we have as a city, about respect for each other's work, about creating an environment of inclusivity. It's a matter of personal pride to work for the City of Allentown. I'm a transformed person by being the mayor of the city."


Laura Aka wrote this article for WorkingNation.

Support for this reporting was provided by Lumina Foundation.


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