The mass deportations of immigrants that President-elect Donald Trump has promised aren’t likely to make a dent in the nation’s housing crisis, many experts say, despite what he and his supporters claimed during his campaign.

Experts say the reasons for that are many. Immigrants in the U.S. without documentation are more likely to live in low-income rental housing than they are to live in higher-income areas or to buy homes. They often live in multigenerational groups with many people in a household. And they are a key cog in the construction industry, meaning fewer homes would get built without their labor.

Yet, as the United States’ ongoing housing crisis grew more visible this year, Trump seized on immigration as a chief cause.

“Immigration is driving housing costs through the roof,” he said at a September rally in Arizona.

U.S. Sen. J.D. Vance, the incoming vice president, in his October debate against Democratic vice presidential candidate Tim Walz, went further, arguing that “illegal aliens competing with Americans for scarce homes is one of the most significant drivers of home prices in the country.”

Neither of those statements is true, according to many housing and immigration experts.

The relationship between immigration and housing affordability is far more nuanced, housing experts say. At best, immigration has an understated effect on the housing crisis. At worst, large-scale deportation plans could cripple an already strained construction labor industry heavily reliant on low-wage workers in the country without authorization. Unable to meet most requirements for a mortgage on a home, immigrants living in the U.S. illegally often rely on extremely affordable rental housing. And multigenerational living is more common due to economic necessity, said Riordan Frost, a senior research analyst with the Harvard Joint Center for Housing Studies.

In recent years, he added, members of the millennial generation — not immigrants — have driven the rise in new households, especially during the pandemic.

“It’s important to push back against the argument that housing for one group comes at the cost of another,” Frost said.

‘Voters have expressed support’

More than 22 million people were living in households in 2022 with at least one immigrant who’s not in the United States legally — about 6.3 million households in total, according to Pew Research Center data.

Homes with immigrants living here illegally are just 4.8% of the United States’ 130 million households, according to Pew. In 86% of those households, either the head of the household or their spouse didn’t have legal authorization.

And with a major demographic shift in the coming decade — a large, aging baby boom generation and declining birth rates — the United States will need immigrants or begin to lose population, Frost said.

He pointed to a January demographic outlook report from the nonpartisan Congressional Budget Office, which notes that “net immigration increasingly drives population growth, accounting for all population growth beginning in 2040.”

Some housing experts say the math Trump describes can work out: Deporting immigrants living here without authorization would open more housing space, which could lower housing costs overall.

“Deporting 2 million individuals would reduce housing demand and relieve supply constraints, because those 2 million individuals are living in homes somewhere,” said Edward Pinto, a senior fellow and co-director of the AEI Housing Center at the right-leaning American Enterprise Institute.

Pinto acknowledged that immigrants living in the U.S. illegally aren’t the sole driver of the housing crisis, citing the high cost of land and ineffective affordable housing programs as other barriers.

Yet while Trump’s plan for mass deportations has drawn criticism and partisan opinion, Pinto said it is in direct response to American voters’ fears about immigration.

“The voters have expressed support for deportation and repatriation,” said Pinto, who emphasized that Trump has pledged to focus first on deporting people with criminal convictions.

Uncertain market effects

If anything, some brokers say, deportations could hurt rental property owners. Any impact would most likely be felt first in among apartments in low-income communities, some brokers told Stateline.

Jeff Lichtenstein, who owns a real estate company in Palm Beach Gardens, Florida, said the effects would ripple beyond the low-cost rental market, where many immigrants without documentation are tenants. A decline in rental prices in extremely low-income areas could create a domino effect, he said, dragging down prices in higher-priced rental categories and eventually affecting home sales.

“As cheaper rentals become more accessible, individuals who might otherwise save for a down payment on a home could opt to rent instead, slowing housing sales and potentially driving down home values across price points,” Lichtenstein said.

Meanwhile, the nation relies heavily on immigrant labor, including workers who are living in the United States illegally, to build new homes.

According to National Association of Home Builders data from 2022, immigrants account for at least 40% of the construction labor force in California and Texas, and for at least 30% in Florida, Maryland, Nevada, New Jersey and New York. Certain occupations are especially reliant on immigrant workers — plasterers, drywall installers and roofers among them.

In disaster-prone areas such as Florida, labor shortages driven by deportations could delay essential repairs and, if property owners can’t get them done, drive up insurance costs after storms, said Renata Castro, an immigration attorney in Coral Springs, Florida.

Those shortages also jack up repair costs, she added, which in turn affects housing prices when property sellers pass along those expenses.

“From roofers to plumbers, the demand for labor is insatiable,” Castro said. “However, Americans refuse to fill these positions — jobs they do not want to do.”

This report was first published by Stateline, part of the States Newsroom nonprofit news network. It’s supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org.

Louisiana Illuminator is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Louisiana Illuminator maintains editorial independence. Contact Editor Greg LaRose for questions: info@lailluminator.com.

Andrea Deutsch, the mayor of Narberth, Pennsylvania, and the owner of a pet store in town, doesn’t get health care coverage through either of her jobs. Instead, she is enrolled in a plan she purchased on Pennie, Pennsylvania’s health insurance exchange.

Deutsch, who has been mayor since 2018, is paid $1 per year for the job. Her annual income, from Spot’s – The Place for Paws and her investments, is about $50,000. The 57-year-old, who is diabetic, pays $638.38 per month for health care coverage — about half of the $1,272.38 she’d owe without the enhanced federal subsidies Congress and the Biden administration put in place in 2021.

But that extra help is set to expire at the end of 2025. It would cost an estimated $335 billion over the next decade to extend it — a step the Republican-controlled Congress and the Trump administration are unlikely to take as they seek budget savings to offset potential tax cuts.

States say they don’t have the money to replace the federal aid. In Pennsylvania, for example, doing so would take about $500 million per year, according to Devon Trolley, the executive director of the state’s exchange.

“That is a significant amount of money, an insurmountable amount of money,” Trolley said.

The disappearance of the federal help would make coverage unaffordable for millions of Americans, including Deutsch. She said it would be a struggle to pay double what she is paying now.

“You try not to go bankrupt by the end of your life,” Deutsch told Stateline. “You need assets to take care of yourself as you get older and to have a little bit of security.”

Enhanced subsidies

The 2010 Affordable Care Act included some subsidies to help people purchase health insurance on the exchanges created under that law. Under the enhanced subsidies that started in 2021, some people with lower incomes who qualified for the original subsidies have been getting bigger ones. And those with higher incomes, who wouldn’t have been eligible for any help under the original rules, are now receiving assistance.

Thanks to the enhanced subsidies, people making up to 150% of the federal poverty level, or $22,590 for an individual, are now getting free or nearly free coverage. And households earning more than four times the federal poverty level, who didn’t qualify for subsidies before, are getting some help.

The enhanced aid also has helped push ACA marketplace enrollment to record levels, reaching more than 21 million this year. Southern states that have not expanded Medicaid as allowed under the ACA have seen the most dramatic growth in marketplace enrollment since 2020, according to KFF, a health policy research organization. The top five states with the fastest growth are Texas (212%), Mississippi (190%), Georgia (181%), Tennessee (177%) and South Carolina (167%).

If the enhanced subsidies go away, premium payments will increase by an average of more than 75%, according to KFF. Some people, like Deutsch, would see their payments double.

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Given those premium hikes, millions of Americans would no longer be able to afford the coverage they’re getting on the exchanges, according to the nonpartisan Congressional Budget Office. CBO estimates that enrollment would drop from 22.8 million in 2025 to 18.9 million in 2026 to 15.4 million in 2030. Some of those people would find coverage elsewhere, but others would not.

Edmund Haislmaier, a senior research fellow at the conservative Heritage Foundation, said Republicans view the expiration of the enhanced subsidies as “an opportunity to rework and address some of the basic flaws in the ACA.”

Before the ACA, Haislmaier said, many self-employed people, such as small-business owners and freelancers, were able to find their own private insurance at competitive prices. But the health care law destroyed that market, he said, leaving such people with a selection of expensive and subpar plans.

Haislmaier said it would take time for the Trump administration to determine how it wants to change the ACA — which President-elect Donald Trump unsuccessfully tried to repeal during his first term — but that “you can do that in a way that preserves access and preserves subsidies for the lower-income people who were the primary focus of the ACA.”

States’ limitations

But Jared Ortaliza, a research associate at KFF, said letting the enhanced subsidies expire could result in higher premiums for everyone. That’s because higher prices likely would prompt many healthier people to forgo insurance, he said. Their departure would leave only chronically ill people on the exchanges, and the cost of their care is higher.

“If sicker enrollees need coverage because they need care, they’ll still choose to buy it, potentially. And if the market were sicker as a whole, that could drive premiums upward as well,” Ortaliza told Stateline.

Ortaliza said states might consider keeping premiums down through so-called reinsurance, or reimbursing insurers for their most expensive enrollees. Theoretically, they also could try to replace the expiring federal aid with their own money.

But few if any states have the financial flexibility to do that, said Hemi Tewarson, executive director of the nonpartisan National Academy for State Health Policy.

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“There might be a couple states who don’t have current state subsidies that might add that, but that will be very nominal,” Tewarson told Stateline, adding that officials from different states have been discussing potential solutions. “They are all assuming that they would just have to absorb the loss of coverage across the population.”

Trolley, the head of the Pennsylvania exchange, said her state is working to provide its own subsidy to make the marketplace plans even more affordable. But even when fully implemented, it would spend only $50 million on that help, a tenth of what it would need to replace the federal aid.

Two-thirds of the 435,000 Pennsylvanians who purchase insurance on the marketplace joined after the enhanced federal subsidies were put in place in 2021. If they expire, Trolley said, she worries that 100,000 or more exchange participants will leave.

Jessica Altman, executive director of California’s exchange, said her state is in a similar situation. California currently receives $1.7 billion annually in enhanced subsidies from the federal government and spends an additional $165 million of its own money to keep costs down.

California estimates that if the subsidies expire, monthly premiums for the state’s enrollees would increase by an average of 63%. More than 150,000 people would no longer be eligible for federal help, and between 138,000 and 183,000 would disenroll, the state estimates.

Editor’s note: This story was corrected to clarify that Pennsylvania is working to create its own subsidy but hasn’t yet done so.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org.

For abortion rights supporters in Florida, it was a tumultuous day of highs and lows.

On April 1, the Florida Supreme Court paved the way for the state to ban nearly all abortions after six weeks of pregnancy. But it also OK’d a ballot measure that would allow Florida voters to overturn the ban this November.

“I was elated and devastated,” said Natasha Sutherland, the communications director for Floridians Protecting Freedom, a coalition of state and national organizations that gathered nearly 1 million signatures for a proposed constitutional amendment enshrining the right to abortion.

“Many women don’t even know they’re pregnant by the time they’re outside of the six-week window for abortion care,” said Sutherland, who lives in Tallahassee. “Considering the stakes are so high with the abortion ban we’re now under, it was really important for us to ensure we gave it all we’ve got.”

This November, voters in as many as nine states could sidestep their legislators and directly decide whether to expand access to abortion through citizen-led ballot initiatives. Constitutional amendments in Colorado, Florida and South Dakota already have qualified for the ballot, while coalitions in Arizona, Arkansas, Missouri, Montana, Nebraska and Nevada are still collecting signatures or awaiting state approval on their measures.

Two more states, Maryland and New York, have abortion rights ballot measures that were referred by their state legislatures, though New York’s is currently tied up in litigation.

In June 2022, the U.S. Supreme Court dismantled the constitutional right to an abortion, kicking the issue back to the states. Fourteen states have outlawed abortion with almost no exceptions, while another seven states ban abortions at or before 18 weeks of pregnancy, according to the Guttmacher Institute, a pro-abortion rights research organization.

Yet access to abortion remains popular, even in conservative states. Since the high court’s 2022 decision, voters in six states have approved abortion access via ballot measure, including in red states such as Kansas and Kentucky.

“The whole idea of the initiative process is to put pressure on state lawmakers when there appears to be support for an issue that the median voter in the electorate might want but the median lawmaker doesn’t want,” said Daniel Smith, a professor and chair of the political science department at the University of Florida, who has authored books and papers on ballot initiatives.

In several states, Republican lawmakers opposed to abortion rights have tightened signature requirements or raised the percentage of the vote required for ballot initiatives to pass. Proponents of stricter rules say they want to prevent out-of-state interests from manipulating the process by funneling money to initiative campaigns. They say they also want to ensure that populous urban centers don’t have too much power. But in several cases, GOP backers have acknowledged that their goal is to thwart abortion rights measures that are broadly popular.

Mat Staver, an attorney based in Orlando, Florida, said it should be harder to get constitutional amendments passed because organizations from outside the state are funneling money into ballot initiatives such as the ones expanding reproductive rights. Staver is the co-founder of Liberty Counsel, a Florida-based nonprofit that opposes abortion-related ballot measures in Florida and other states.

“Even though we have a 60% threshold [in Florida], if you have the financial resources, you can get pretty much anything on the ballot you want,” he said. “That’s not good for Floridians because that doesn’t allow for debate.”

Critics argue that legislators’ attempts to impose new restrictions subvert one of the purest forms of direct democracy available to citizens.

“Democracy requires compromise,” said Alice Clapman, senior counsel at the Brennan Center for Justice at New York University School of Law, a progressive law and policy nonprofit. “I am concerned that there seems to be a resistance to leaving these issues to the democratic process. Some people in power in these states feel certain issues shouldn’t be up for democratic debate.”

‘Monopoly power’

For decades, legislators on both sides of the political aisle have tried to make it harder for citizens to get various proposals on the ballot, said Smith. It just depends on who’s controlling the state’s levers of power.

“The ballot initiative takes away the monopoly power of lawmakers,” he said. “We can look at restrictions by Republicans right now on the initiative process, but doing so is myopic. It happens on both sides.”

In today’s polarized political climate, voter support for a ballot measure doesn’t necessarily translate into support for a political candidate who backs it. Smith’s research has found that many people may vote for a ballot measure while also voting for candidates from the political party that opposes it.

“And they’re fine with that,” Smith said. “There’s no cognitive dissonance in the voter’s mind. [The ballot measure] is a one-off.”

Ballot measures typically don’t boost voter turnout in presidential election years like they do in midterms and special elections. But 2024 could be different, Smith said, thanks to tepid public enthusiasm for the repeat matchup between President Joe Biden and former President Donald Trump. A ballot measure might prod more people to head to the polls.

‘Not unlike gerrymandering’

Last month, the Missourians for Constitutional Freedom campaign turned in more than twice the likely number of signatures needed for its measure to qualify for Missouri’s ballot in November. The proposed constitutional amendment, like Florida’s, would legalize abortion up to fetal viability — the point at which a fetus can survive outside the uterus, often considered around 24 or 25 weeks of pregnancy.

“The signature-gathering piece of this campaign was the most incredible thing I’ve ever been a part of,” said Mallory Schwarz, executive director at Abortion Action Missouri, one of the organizations participating in the campaign. “I have never seen the level of enthusiasm about the issue that I saw this year.”

New rules protect pregnant workers, but red states sue over abortion provisions

Coalition organizations trained more than a thousand volunteers who canvassed in their communities, held house parties, and knocked on tens of thousands of doors in less than three months, Schwarz said, eventually gathering more than 380,000 signatures. The state must now certify the petition for it to appear on the ballot.

Missouri voters of all political stripes have a deep attachment to the ballot initiative process that dates back more than a century, Schwarz said: “We’ve seen issues that may be presented as partisan really appeal to people across the board, year in and year out.”

In recent years, ballot measures in Republican-controlled Missouri have raised the state minimum wage, expanded Medicaid, overturned a so-called right-to-work law and decriminalized cannabis use.

This year, Missouri Republicans put forth several proposals designed to defeat abortion rights initiatives, including one that would require ballot measures to win not just a majority of votes statewide, but also a majority of votes in Missouri’s congressional districts.

After heated debate, the bill passed the Senate, but the House couldn’t reconcile different versions of the bill before the session ended.

“It’s not unlike gerrymandering,” Schwarz said. “The only way they can stop the will of the people is to change the rules of the game.”

Florida lawmakers filed a similar bill last year. They proposed a constitutional amendment to increase the percentage of votes a ballot measure needs to pass, from 60% to a two-thirds supermajority. The bill passed the House but died in the Senate.

In 2023, ballot initiatives in eight states attracted more than $205 million in donations, according to OpenSecrets, a nonprofit that tracks campaign financing and lobbying. Sutherland, with Floridians Protecting Freedom, pointed out that the campaign raised nearly $12 million in April and May, but about 70% of contributions coming from within Florida.

An array of tactics

Ohio voters pass constitutional amendment to protect abortion and reproductive rights

After abortion rights advocates gathered nearly 500,000 signatures in Ohio to get a reproductive rights amendment on the November 2023 ballot, the Republican secretary of state and the Ohio Ballot Board changed the wording of the amendment’s summary in a way that opponents said was incomplete and inaccurate. Ohio voters approved the ballot measure anyway, enshrining abortion access in the state constitution last November.

A similar scenario unfolded In Missouri, where Republican Secretary of State Jay Ashcroft attempted to change the wording of a proposed abortion rights ballot measure so that it would ask voters whether they were in favor of “dangerous and unregulated abortions until live birth.” A Missouri court later struck down the language.

In Arizona, GOP lawmakers have put their own constitutional amendment on the November 2024 ballot that would require organizers to gather a certain percentage of signatures from every one of Arizona’s 30 legislative districts rather than in the state as a whole. They’ve also considered a strategy to introduce their own abortion-related ballot measures to compete with the abortion rights measure.

If reproductive rights ballot amendments pass, they’ll likely face legal challenges that stretch far beyond the election.

Staver, of the Liberty Counsel, said his organization would investigate legal channels for blocking implementation of Florida’s amendment.

“There may be litigation that would be necessary to argue that preexisting constitutional rights override this amendment,” said Staver, who believes the amendment is overly broad.

Clapman, with the Brennan Center, said she also expects lawmakers to continue pushing back against ballot measures: “It’s not a fight that’s going to go away even if initiatives pass.”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and X.

With less than six months before voting begins, the legal jousting over the rules for the 2024 election is already underway. And former President Donald Trump’s campaign is getting support from allies who have stayed mostly under the national radar: red-state attorneys general.

In court filings made in recent months, these chief state legal officers have advanced a string of arguments — some strikingly far-reaching — that appear designed to lay the groundwork for Republican legal victories in the event of a contested presidential vote, or to otherwise boost Trump and the GOP.

Often led by Alabama Attorney General Steve Marshall, a loose coalition of Republican-led states has submitted briefs urging judges to throw out certain mail ballots.Weaken long-standing protections against racial discrimination in voting.

“These are all setting up an argument, potentially, to say that the 2024 election was flawed because of all these state practices that are questionable,” said Paul Nolette, a political science professor at Marquette University in Milwaukee who has written in depth on the role of state AGs. “The AGs just have been critical in pushing these arguments.”

Marshall’s office did not respond to a request to comment for this story. But last month Marshall also led a coalition of red states in submitting an amicus brief urging the Supreme Court to pause Trump’s election subversion trial tied to the events of Jan. 6, 2021 — a stance that aligned the group perfectly with the interests of the Trump campaign.

And in 2020, many of these same state AGs, including Marshall, sought to have the courts overturn Trump’s election loss.

An election decided in the courts?

The danger of outright election subversion this year appears to have receded somewhat, election law experts have said, thanks to important federal legislation and the results of the last midterms. But the chances that the election will be contested, and ultimately settled in the courts, remain very high.

In that scenario, advocates and experts say, these Republican AGs look well-placed to provide the kinds of conservative legal arguments that could prove pivotal, both by directly influencing court decisions and by infiltrating the broader public debate.

But many of these claims, democracy advocates warn — especially those that support new voting restrictions, reduce the power of minority voters, or undermine courts’ authority to set election rules — could threaten fair elections.

“A huge part of the overall anti-democracy movement is really based on continuing to find ways to use legal tactics as a jumping-off point to spread the election denier message,” said Lizzie Ulmer, senior vice president of strategy and communications for States United Democracy Center, a pro-democracy group.

“There are good and pro-democracy state AGs on both sides of the aisle. But the truth is there are AGs in office right now that have the potential to do real harm. And we’ve seen that in the past and we’re seeing it today.”

Growing politicization

The involvement of the Republican AGs in elections cases with national stakes marks the latest step in a decadeslong trend toward AGs taking on more politicized roles.

In less polarized times, experts say, state AGs mostly presented as apolitical prosecutors, and frequently teamed up across party lines to tackle issues of public concern.

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That began to shift in earnest during the George W. Bush administration, when Democratic AGs used a series of splashy lawsuits against Wall Street firms and corporate polluters, among others, to advance national policy and political goals — and to boost their own national profiles.

But in the Trump era, the shift has intensified. Several close observers said a key moment came in 2017, when Republicans sought to oust then-Virginia AG Mark Herring, a Democrat — ending a long-standing custom in which neither party spent money targeting incumbent AGs of the other party. Herring ultimately won reelection, but that cycle saw record campaign spending on AG races.

In Republican-led states, the politicization of AG offices reached its height around the 2020 election, centered around the Republican Attorneys General Association, an advocacy group for Republican AGs. In the leadup to the events of Jan. 6, 2021, the group’s fundraising arm, the Rule of Law Defense Fund, sent robocalls urging people to gather for a march to the U.S. Capitol to “stop the steal” and “protect the integrity of our elections.”

Marshall, the Alabama AG, served as chair of RLDF at the time, and has said he was unaware of the robocalls. He has declined to say whether RAGA or RLDF staff were at the Capitol on Jan. 6, and his office has denied public records requests by the Alabama Political Reporter for his calendars covering the period.

Along with other Republican AGs, Marshall sought to cast doubt on the 2020 election results, telling Newsmax not long after the vote: “We obviously have concerns about some of the issues, specifically of irregularities and fraud in other places.”

On Dec. 10, 2020, Marshall and other Republican AGs joined Trump for a meeting at the White House. A day earlier, Marshall had announced that Alabama would join a lawsuit filed by Texas Attorney General Ken Paxton seeking to overturn the results in Pennsylvania and three other states narrowly won by Joe Biden. Seventeen Republican-led states ultimately signed on to the Texas case.

Idaho AG disagreed

One state that didn’t join the suit was Idaho, whose AG at the time, Republican Lawrence Wasden, saw the Texas lawsuit as an improper attempt to use the AG’s office to make policy — and to interfere in other states’ business.

“The policy-making function under both the state and federal constitutions is clearly put in the hands of the legislative branch of government,” Wasden told States Newsroom. “The AG is an executive officer, and does not have those powers. That’s not how we should make public policy.”

After 20 years in office, Wasden lost his 2022 reelection bid in the Republican primary to former U.S. Rep. Raul Labrador — a defeat Wasden attributes to GOP voter anger at his decision not to join the Texas case. But he hasn’t wavered in his view that it was the right call.

“If Texas can control or influence the outcome of the election in Pennsylvania, then California can influence the election in Idaho,” Wasden said. “And that is not how federalism works.”

Labrador was elected attorney general later that year, and has signed Idaho on to several of the elections cases brought by Republican AGs.

Raúl Labrador, who won his race for attorney general in 2022, has signed Idaho on to several of the elections cases brought by other Republican AGs. Otto Kitsinger for Idaho Capital Sun

As for Marshall, in 2021, he withdrew Alabama from the bipartisan National Association of Attorneys General, saying the group had “moved too far to the left.” The next year, Texas, Missouri and Montana followed suit.

In 2022, Marshall declined to say, when asked under oath while testifying before Congress, that Biden was “duly elected,” answering only that “he is the president of this country.”

Months later, Marshall was elected chair of RAGA. Now, he’s leading the charge among Republican AGs on election cases with an eye on 2024.

Weakening voting protections

Marshall has battled on behalf of strict voting laws in his own state.

His office energetically, and successfully, fought off a 2020 court challenge to an Alabama law that bars people with past convictions from casting a ballot. In that year’s election, he also succeeded in getting the Supreme Court to block an effort to allow curbside voting, which voting advocates said could offer easier access for elderly and disabled voters.

But it’s Marshall’s work on behalf of Republicans looking to influence election rules far beyond the Yellowhammer State that could have an even greater impact.

In January, Marshall led a coalition of 17 red states that submitted an amicus brief supporting a bid by national Republicans to require Pennsylvania to reject mail ballots with incorrect or missing dates.

In Pennsylvania’s 2020 election, there were over 10,000 such ballots, and how the case is resolved could help determine the winner of this pivotal swing state, if the result is very close. Democrats have voted by mail at significantly higher rates than Republicans in recent elections.

But the impact could be broader still. A district court found last year that the missing or incorrect dates are irrelevant to establishing a vote’s legitimacy.

That means, the court ruled, that under the materiality provision of civil rights law — first included in the 1964 Civil Rights Act, then extended to cover non-federal elections in the Voting Rights Act the following year — a missing or incorrect date can’t be used as a reason to reject a vote.

In their brief, Alabama and the other states called the district court’s ruling “seriously misguided.”

They argued that the materiality provision should be read more narrowly, and doesn’t bar states from imposing reasonable ballot integrity measures. And, they claimed, the provision contains no “private right of action,” meaning it can be enforced only by the U.S. Justice Department, not by the civil rights groups involved in the Pennsylvania case.

By itself, making the materiality provision harder to use would likely have only a limited impact, since it hasn’t been among the tools most commonly used to protect voting rights, noted Cameron Kistler, counsel at Protect Democracy, a nonpartisan democracy advocacy group.

But, he said, it comes in the context of other ongoing conservative legal attacks on voting protections — including attempts to weaken the Voting Rights Act, and suggestions by the Supreme Court that it may lower the level of scrutiny it applies to voting laws that are accused of harming voters.

“The tools that you’d use to ensure free and fair elections are slowly being pulled away,” said Kistler. “When you take them all together, that’s when it starts to get really problematic.”

Voting Rights Act

As if to prove the point, a separate amicus brief submitted in December by Marshall’s office argued that Section 2 of the Voting Rights Act — the law’s most important plank, since the Supreme Court neutered Section 5 a decade ago — also contains no private right of action.

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Marshall and his allies were urging a federal appeals court to reverse a ruling striking down Louisiana’s congressional map as a racial gerrymander under Section 2.

The notion that Section 2 contains no private right of action had until recently been seen by many advocates as outlandish. But a federal judge endorsed it in a separate 2022 case involving an Arkansas redistricting plan, brought by Arkansas Attorney General Tim Griffin, a Republican, who has signed his state on to several of Marshall’s amicus briefs. That decision was upheld on appeal in December.

The issue is likely to come before the Supreme Court. A ruling for Arkansas could dramatically limit the power of the VRA to stop racial discrimination in voting.

Separately, Marshall has sought to defend Alabama’s own redistricting plan. In arguing that the state should not have to draw a new map with an additional majority-Black district, his office adopted an interpretation of the VRA that, experts said, would have made it all but impossible to use for stopping racial gerrymanders.

Nicholas Stephanopoulos, a prominent election law scholar at Harvard Law School, has called Alabama’s approach to the question “directly contrary to 40 years of precedent.”

The claim was too extreme even for the conservative-dominated Supreme Court, which ultimately ordered Alabama to create a new map.

In response, Marshall signaled an agenda that went well beyond Alabama.

“There should be nothing more offensive to the people of our great state than to be sidelined in 2023 by a view of Alabama that is stuck in 1963,” he said in a statement. “This racial agenda is pressed by left-wing activists, not just in Alabama, but in any Republican state where it might advantage Democrats.”

And he compared the ruling, which aimed to empower Black voters, with Jim Crow.

“If this brazen and divisive commandeering is permitted without even a whisper of concern from other quarters, America’s congressional elections as we know them will never be the same,” Marshall continued. “We will be grouped together by race alone, with counties and cities split down the middle—the same way that we were so wrongfully segregated once before.”

Marshall also led a coalition of 18 GOP-led states that filed a 2021 amicus brief supporting Arizona’s defense of a law requiring voters who don’t sign their mail ballots to do so by 7 p.m. on election night.

The issue may seem minor, but Marshall’s brief invoked a far more fundamental question, arguing that state legislatures, not the courts, are in charge of setting election rules.

“The U.S. Constitution is unambiguous about the right of state legislatures to determine the manner of holding elections within their respective states,” wrote Marshall. “Accordingly, state legislatures, not federal courts, are vested with the legal authority to determine state election laws. Court attempts to micromanage election laws duly passed by state legislatures conflict with our constitutional structure and legal precedent.”

When North Carolina brought a version of this claim — known as the Independent State Legislature Theory — to the Supreme Court last year, experts warned that it could radically reshape election law, giving partisan state lawmakers almost unfettered power to make the rules. The Justices ultimately rejected the argument.

Why AGs enjoy influence

Advocates say it’s difficult to assess whether, and to what extent, courts are swayed by amicus briefs. But, they add, the role of state AGs as their state’s chief legal officer gives their claims an invaluable sheen of authority.

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“State AGs are taken seriously because of the governmental role they play, in a way that parties, who do not have a governmental role, typically are not,” said Dax Goldstein, a senior counsel at States United Democracy Center. “So there’s a real difference between a sitting AG filing a brief and [Donald Trump lawyer] John Eastman filing a brief.”

In addition, since a 2007 Supreme Court ruling in a case where a group of states led by Massachusetts sued the George W. Bush administration’s Environmental Protection Agency, states have enjoyed more power than individual plaintiffs to bring lawsuits on public policy issues.

“States have a greater ability to bring legal challenges than private citizens do,” said Kistler. “So when you have these super active state officials with a greater ability to bring cases than private parties and a judiciary that’s willing to entertain the cases, it makes a difference.”

Nolette, the Marquette political scientist, noted that if the AGs’ series of briefs in election cases appear coordinated, it’s no accident.

“There’s a lot of strategy that goes into planning these far-reaching arguments,” Nolette said, adding that AGs of both parties use their partisan organizations — the Republican Attorney Generals Association, and the Democratic Attorney Generals Association — to align their efforts and figure out the venues where they might have the most chance of success.

“It’s almost like buying a lottery ticket, trying to boost the chances of those arguments taking hold somewhere,” Nolette continued. “And once they get one district court judge to agree with it, then it moves them to a different state of respectability. It’s like, well, a federal judge has agreed with us, so this is a legitimate argument, even if it was considered totally out there in previous years.”

Ralph Chapoco contributed to this report.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

Kentucky state Rep. Mark Hart has been drinking fluoridated water his entire life. In 1954, five years before Hart was born, his home state mandated adding or adjusting levels of the mineral, which occurs naturally in water, in drinking water systems of populations larger than 3,000.

But after hearing from a constituent a few years ago, Hart believes the matter of what’s in Kentucky cities’ drinking water should be a decision made by those drinking it. He’s been trying to reverse the state’s mandate since 2018, with several unsuccessful legislative attempts.

This year, with more than 20 co-sponsors, his bill has so far passed out of committee on its route to the House floor.

In 1945, Grand Rapids, Michigan, became the first city to fluoridate its water. The decline in tooth decay that followed the widespread adoption of fluoridation has been hailed as one of the greatest public health achievements of the past century. Fluoridation lessens tooth decay in children and adults by 25%, according to the federal Centers for Disease Control and Prevention.

But there’s been pushback against fluoridation, including a lawsuit by advocates seeking the federal government to ban the practice entirely. Some state lawmakers want to reverse or relax requirements for communities to fluoridate, and several localities across the country in recent years have chosen to stop doing it. Health experts say the rise in anti-fluoridation measures is an example of the increased skepticism toward science and public health measures — exacerbated by the mask and vaccine mandates during the pandemic.

“At the heart of these big public health issues — including water fluoridation — is science. But over the past few years, there’s been skepticism of science,” said Jane Grover, senior director of the Council on Access, Prevention and Interprofessional Relations at the American Dental Association.

Roughly 73% of the U.S. population with public water access in 2020 received drinking water with fluoride adjusted to the “optimal” concentration of 0.7 milligrams per liter, according to the CDC.

At least a dozen states have laws mandating that larger communities fluoridate. Among them are California, Delaware, Georgia, Illinois, Kentucky, Louisiana, Minnesota, Mississippi, Nebraska, Nevada, Ohio and South Dakota.

Yet lawmakers in three of those states — Georgia, Kentucky and Nebraska — have filed bills that would reverse the mandates and leave the choice up to a local voter referendum or to the governing body of local water systems.

Three states — Maine, New Hampshire and Utah — require a public vote for fluoridation by municipalities and their public water systems.

What the science says

Hart, a Republican, said he didn’t give much thought to his drinking water until a constituent sent him studies that linked very high levels of fluoridation to lower IQs in rural communities of China and India. (U.S. public health experts say those cases don’t correspond to fluoridation in the United States.)

“I was shocked by all the research I was reading. I hadn’t put much stock into my drinking water when I first joined the [Kentucky legislature],” said Hart.

He’d personally rather avoid fluoridated water altogether, but said at a minimum Kentucky’s statewide mandate ought to be overturned.

“What goes in your drinking water isn’t for the states or big government to decide. That to me is a local control issue — give people a choice on what they’re drinking, you know?” Hart said.

Much of the research used by anti-fluoride activists has been resoundingly debunked by the medical community. Public health officials note that studies touted by anti-fluoridation groups are often cited out of context, may not be peer-reviewed, and often are conducted in countries where fluoridation levels can be several times that of the U.S. Environmental Protection Agency’s recommendation.

“Good public health policy is built on decades and decades of scientific review, not junk science. Because we need reputable, peer-reviewed science to assess what’s necessary to protect public health,” said Kathleen Hoke, a University of Maryland law professor and the eastern region director of the Network for Public Health Law, a professional group that provides technical legal assistance on public health matters.

“The EPA’s recommendation for fluoride levels is based on scientific, peer-reviewed data. It’s up to our public health measures to reflect that same type of reputable science,” she added.

And organizations such as the CDC, the American Dental Association and the National Cancer Institute are in consensus that U.S. fluoridation is safe, and is not linked to lower IQs or critical health problems.

Local debates

For most of the United States, fluoridation already is a matter of local control. Hawaii is the only state that bans fluoridation; most others leave it to individual water systems or localities.

There are bills in Hawaii and New Jersey to mandate water fluoridation statewide, but the legislation is stalled in committee.

From flush to faucet: More places look to turn sewage into tap water

Hawaii state Sen. Stanley Chang, a Democrat, said his concern over the oral health of his newborn daughter inspired the bill, which would require all state suppliers of public water to meet fluoridation levels set by the EPA.

“I think this will prevail in the end. When it comes to health and science, there’s an information plateau if you’re not an expert,” Chang told Stateline. “I’m not an expert. It’s why my job is to ask experts, so that I can be equipped to make that information accessible and reliable for my constituents.”

Debora Teixeira, the oral health systems coordinator at the Vermont Department of Public Health, said her agency will send educators to local communities to talk about fluoridation in the hope of helping residents understand the benefits.

“When requested, we go to the place where fluoridation is being challenged,” Teixeira said.

“It’s less of advocating law, and more of an education and information about the science behind it,” she said. “Because there’s decades and decades of research that supports fluoridation, but we want to engage with those who may be skeptical or have been misinformed.”

This year, local governments in Union County, North Carolina, and Collier County, Florida, prohibited the adding of fluoride to their drinking water.

Last year, State College, Pennsylvania, and Brushy Creek, Texas, stopped adding fluoride to their water systems.

In a September 2023 memo announcing the decision to terminate fluoridation, Shean R. Dalton, general manager of Brushy Creek Municipal Utility District, cited health concerns, personal choice and cost-effectiveness as reasons to forgo the practice.

Sewer rates soar as private companies buy up local water systems

A 2022 University of Calgary study showed increases in tooth decay procedures in Calgary, Canada, and Juneau, Alaska, after each city ended water fluoridation.

Last month, a federal court in San Francisco heard arguments in a lawsuit by Food and Water Watch and anti-fluoridation advocacy groups against the EPA, arguing that fluoride ought to be regulated as a toxin. The lawsuit, filed in 2017, is seeking a ban on fluoridation of drinking water “to protect fetuses and children” from the risk of neurodevelopmental problems.

“There is a very real trend of states looking to reverse these mandates. We believe that the court’s ruling — which we hope is in our favor — will give more states cause to look at what we’re doing to our drinking water,” said Stuart Cooper, executive director of the Fluoride Action Network, an anti-fluoride advocacy group that is among the plaintiffs in the case.

Meanwhile, residents of Buffalo, New York, have filed a class-action lawsuit against the city after it quietly ended fluoridation without informing residents. One resident said her elementary school-aged son suffered from oral health problems from a lack of fluoride.

The latest effort at stopping fluoridation was in Rutland, Vermont, where residents this week took their second vote in less than a decade on whether to keep adding the mineral to their drinking water. In 2016, the ballot measure failed.

On Tuesday, it failed again. Rutland will keep its fluoride.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

EMERSON, Neb. — Corliss Hassler rushes in the front door of Post 60 Market and heads straight for the produce case.

“I’m back,” she announces.

It’s around lunchtime, but it’s already her second trip in today — this time, she’s picking up a few items for the Friday fish fry at the local Catholic church.

Hassler is a regular customer and investor in the small grocery store, opened in 2022 as a cooperative. The store provides convenience, sure: It’s the only place in town to buy fresh fruits, vegetables and meats. But it’s also a social hub for the northeast Nebraska town of Emerson, population 891.

“The store is the lifeblood of the community,” Hassler said. “We have to keep our store, we have to keep our schools, we have to keep our churches — and it’s all a struggle right now.”

The market opened four years after the closure of the town’s only grocery store. Some 110 community members bought shares, which funded the transformation of a shuttered American Legion post into a brightly lit store packed with fresh and packaged foods.

Preserving grocery stores has been a perennial challenge for rural communities. Small, often declining populations make it tough to turn a profit in an industry known for its razor-thin margins. Increased competition from online retailers, the onslaught of chains such as Dollar General stores and an aging lineup of independent grocers have only made things tougher.

The U.S. Department of Agriculture has tracked the decline of rural grocery stores.

By 2015, USDA research showed a total of 44 counties had no grocery store at all — all but four of the counties were rural.

In Kansas, 1 in 5 rural stores closed between 2008 and 2018, according to the Rural Grocery Initiative at Kansas State University. No new store has opened in half of the 105 communities that lost grocers over that time.

Proposed legislation at Nebraska’s capitol in Lincoln could provide some relief for stores like Post 60 Market.

If passed, the new law would provide grants and loans for small grocers. It’s among several legislative efforts in the region that aim to tackle the complex problem. In neighboring Kansas and Iowa, lawmakers have introduced bills with similar goals, following the lead of states — including Illinois, Minnesota, North Dakota and Oklahoma — that have enacted laws setting up special funds to boost rural grocery stores.

“We’re in a global economy and Amazon’s dominating, but that doesn’t mean we should surrender,” said Kansas state Sen. Rob Olson, a Republican.

GOP Governors’ Cutoff of COVID Benefits Hits Hard in Rural America

For two years in a row, Olson has introduced bills that would provide tax incentives for the development of rural grocery stores. A native of rural Kansas who now represents a suburban Kansas City district, Olson said lawmakers should be investing in grocery stores, broadband and housing to improve rural communities.

“If we think about it and we’re smart about it, there’s plenty of opportunities — all throughout the Midwest especially — to grow these economies,” he said.

The pandemic underscored both the importance and fragility of rural grocery stores, said Jillian Linster, interim policy director at the nonprofit Center for Rural Affairs.

“After the pandemic, we have seen a lot of these local grocery stores just struggling to keep the doors open with all the economic and workforce challenges we face in the current economy and the competition from the big-box retailers,” she said.

Based in Lyons, Nebraska, the center has backed bills in both Nebraska and Iowa this session to provide small grants or loans to grocery stores with fewer than 25 employees in underserved communities. The hope is that providing money to replace a broken freezer or leaky roof could make the difference in keeping stores open.

Aside from preserving fresh food access, Linster said, grocery stores serve a wider social role.

“It’s a place where you see your neighbors, where your teenagers get their first job, where there’s a bulletin board with help wanted and things for sale,” she said. “So it’s a really important part of the social infrastructure in our small rural towns.”

‘A service to the community’

Brian Horak knows his customers.

The general manager of Post 60 Market, he knows the busy mom who runs to the frozen foods aisle to find something for dinner that night. He knows the families that only load up their carts on paydays. And he knows when he should check up on someone who hasn’t been in for an unusually long stretch.

Emerson sits at the convergence of three counties, including one of Nebraska’s poorest.

The market can’t compete with the prices of mega retailers like Walmart. But Horak tries to at least beat the costs found at the regional grocery store chain 20 miles away and loads the shelves with plenty of generic options.

Still, some customers will pay with loose change. Others drop in to rummage through the bin of discounted items nearing their expiration dates.

Brian Horak rings up Corliss Hassler at Post 60 Market in Emerson, Neb. Hassler is a regular customer and investor in the cooperative grocery store, which opened in 2022. Kevin Hardy/Stateline

Remote stores like this can struggle to secure vendors. No bakers will deliver fresh bread here, so all the sandwich bread, buns and cupcakes come in frozen. And the store only gets one delivery of fresh food every Wednesday.

“By Tuesday, the bananas start to look pretty sketchy,” Horak said.

But whatever it lacks in variety, the store makes up for in service. Horak will special order just about anything if customers ask.

On a back shelf, he’s set aside a case of Rice-A-Roni for one man, a pack of small Pepsi bottles for a woman in a nursing home and a case of wet cat food for a woman who feeds strays. One man has a standing order for a case of pickled beets every week.

There have been some months when Horak wasn’t sure Post 60 Market’s doors would remain open.

But things changed for the better in January, when a storm blanketed the region with record snow. The two-lane roads connecting Emerson to Sioux City were impassable for days, pushing many locals to try or rediscover Post 60 Market.

“It was kind of a wake-up call,” he said. “People were so happy the grocery store was here.”

The pending legislation could help with a litany of items on the market’s to-do list: a leaky basement, the rubber gaskets that need replacing on the produce cooler — not to mention the dream of a room to butcher fresh cuts of meat.

Named after the town’s former legion post, the co-op sold common shares for $500 and preferred shares for $1,000. While shareholders could one day see dividends, their investments were in reality more like contributions.

Community members in Emerson, Neb., transformed a shuttered American Legion hall into Post 60 Market, a cooperative grocery store serving the town of 891 people. Kevin Hardy/Stateline

Nathan Mueller, who leads the co-op board, said the store just aims to break even.

“At its heart, this is a business,” he said. “But really, the business is being a service to the community.”

Nebraska state Sen. Teresa Ibach said rural grocery stores, whether they’re for-profit, cooperatives or nonprofits, deserve the state’s support.

“I think the trade-off is, if you’re willing to invest in small local communities, we are willing to invest in you.”

A Republican, Ibach sponsored the legislation that would set aside $4 million over two fiscal years for rural grocers. While the legislation got favorable reviews during its January hearing, Ibach was unsure whether it would advance out of committee.

“It’s got legs and it’s got substance and I hope it does, but we’re halfway through the session already,” she said. “And so who knows what will make it to the floor.”

If approved, the measure could help Greg’s Market in Exeter, Nebraska, about 50 miles west of Lincoln. The store has “a honey-do list a mile long,” said Mitchell Schlegelmilch, who leads the board overseeing its operation.

Just before he heard about the legislation, Schlegelmilch said, a freezer sensor failed, costing some $2,500 in spoiled inventory.

“It was a real punch in the gut,” he told lawmakers at the January hearing. “It just took our breath away.”

Investors aren’t looking to make money or even get their money back, Schlegelmilch said in an interview. Greg’s Market just aims to break even. So something as seemingly small as the failed sensor could pose an existential threat.

The legislation “gave me a sense of relief that maybe there is hope,” he said.

Investing in grocery stores

Kathryn Draeger says rural communities need more than just dollar stores and gas stations.

“We need places where you can buy a kiwi, an onion, potato, beets,” she said.

As Rural Groceries Fade Away, Lawmakers Wonder Whether to Act

The director of regional sustainable development partnerships at the University of Minnesota, Draeger works with grocery stores across the state. Aside from the health benefits of fresh food, she said, rural stores are key to building more resilient supply chains since they can procure products from a variety of small vendors.

Draeger advocated for a state program to improve healthy food access that began offering grants to rural and urban stores in 2017. Last year, the state agriculture department funded 15 projects at a cost of $426,862 — though nearly five times as much was requested.

“I believe every rural grocery store we lose is at our own peril,” Draeger said. “There’s so much public good in these small private businesses. That is why this public investment in this private sector is really important. “

Draeger recalled one Minnesota grocer who had to choose between fixing her broken front tooth or her store’s leaky roof.

“She chose the roof,” Draeger said. “So she worked at the cash register at the store she owned without a tooth for over a year.”

Just as important as money, though, is leadership, said North Dakota Democratic state Sen. Kathy Hogan. She co-sponsored a new law last year that made $1 million available to help preserve rural grocery stores. That money will only help if communities have strong leaders willing to work together, she said.

“Sometimes people think money is the answer to everything,” she said. “The secret of the success of this is not so much money but local organization.”

Republican state Sen. Janne Myrdal, another co-sponsor, said the legislation was inspired by the work of grocery stores, communities and schools in the northeast corner of the state. After struggling to find vendors willing to make small deliveries to remote areas, three stores formed a cooperative that can demand more inventory and better prices from suppliers — benefiting consumers, schools and businesses.

“As a conservative, I love seeing that happen,” Myrdal said.

The legislation required a local match from organizers and aims to pull multiple retailers and community organizations together to help stabilize deliveries and costs.

“I don’t believe in just handing out money from the government,” Myrdal said. “It has to rise from the bottom up.”

A town missing its ‘centerpiece’

People like to say the town of Malvern, Iowa, punches above its weight.

Though it’s home to fewer than 1,300 people, the town touts miles of bicycle trails, a community garden and public art sculptures. On Main Street: two restaurants, medical clinics, a bank, a pharmacy and even a fitness center.

But a fenced-in gaping hole is an obvious reminder of what’s missing: the town’s staple grocery store, lost in a 2021 fire.

Tom Mulholland stands near the site where a 2021 fire destroyed Mulholland Grocery, long a staple of Main Street in Malvern, Iowa. Kevin Hardy/Stateline

Tom Mulholland was the fourth-generation owner of Mulholland Grocery, which traces its history to the 1870s.

Since the fire, the community has rallied around him. Meta, parent company of Facebook and Instagram, funded a documentary short film about the effort to rebuild the grocery store last year.

But even with an Oscar-winning documentarian as the director and scores of headlines, Mulholland has struggled. He’s faced problems with insurance, finances and construction headaches that set the rebuild back.

When the store was open, it was a hub of activity. People would drive long distances to buy from his meat counter. And in times of crisis, such as a recent flood in the area, customers would hand him cash, knowing he’d get it to the folks who needed it most.

“It’s those little things about being human and caring about your community and others that add up,” he said.

Mulholland, 63, could have walked away from the store. But he said it’s too important to the community — and his family. The morning after the fire, he wrote an apology to his ancestors on Facebook.

In an interview, he said: “My great-grandfather and my grandfather, everybody put in so many decades of sweat and tears and frustration and joy. And on my watch, it disappeared.”

The fourth generation of his family to own the store, Mulholland aims to revive the operation that got its start as a dry goods store in the 1870s. Courtesy of Tom Mulholland

After two years, people around town have grown weary of waiting for a store.

“In here it’s a big topic of conversation,” said Janella May, who owns C&M’s Cafe with her husband.

It’s a Main Street institution known for its ice cream and Cheeseburger Saturdays — $4.99 for a burger and fries. Weekday mornings, the place is home to a coffee klatch — a few older men around town have their own key to get in before the place opens.

“We need it here,” she said of the grocery store. “It’s important.”

Without Mulholland Grocery, Malvern residents must drive 15 minutes to reach another small-town grocery store or a half-hour to reach supermarket chains over near Omaha.

The absence of the grocery store is a sharp contrast to Malvern’s otherwise encouraging trajectory.

Some $40 million worth of new projects are in the works in the town, including public school renovations, a new subdivision and a new early education center.

“We’re a growing town,” said Jay Burdic, the president of Malvern Bank.

The third generation of his family to own the bank, Burdic is bullish on the community’s future.

But every day brings a reminder of what’s missing: His desk overlooks Main Street, directly across from the empty grocery store lot.

“It was the centerpiece of our Main Street,” he said. “And now it’s just a hole in the ground.”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

Medical debt is the leading cause of bankruptcies in the United States, and more than 2 in 5 American adults have some.

In many cases, the money people owe to health care providers forces them to cut spending on food or utilities, forgo other medical care or take on even more debt. Medical debt can make it impossible to buy a home, pay for college or save for retirement.

To address the problem, Connecticut, New Jersey and a growing list of counties and cities are using public money to purchase and forgive millions of dollars of their residents’ medical debt. Earlier this month, Pennsylvania Democratic Gov. Josh Shapiro, unveiled a budget proposal that would set aside $4 million to purchase and pay off the debt of Pennsylvanians with low incomes. A disproportionate number of the 1 million state residents who owe money to health care providers live in rural areas, according to Shapiro.

“Combined with higher prices at the stores, this debt is an anchor holding those families and communities back,” Shapiro told lawmakers during his budget address. He noted that a relatively small state investment can make a huge difference, because hospitals will sell the debt for pennies on the dollar.

Such programs “can be truly life-changing,” said Gabriela Elizondo-Craig, a project lead at Innovation for Justice, a research program at the University of Arizona and the University of Utah. Her research has focused on state policies that impact medical debt.

“They didn’t choose to get sick, [and] didn’t choose to incur these expenses that can have these devastating effects on their lives,” she said.

Americans owe at least $195 billion in unpaid health care bills, according to a 2022 analysis of U.S. Census Bureau data by KFF, a health policy research organization. Black residents, residents of Southern states — many of which have not expanded Medicaid — and people with chronic conditions or low incomes are most likely to owe money to medical providers. Nearly a quarter of households with children have unpaid health care bills, compared with 17% of those without children.

Many Patients Can’t Afford Health Costs Even With Insurance

Berneta Haynes, a senior attorney at the National Consumer Law Center, noted that even people with health insurance can fall into medical debt when they can’t afford to pay deductibles or copayments or they receive care outside of their insurer’s network of providers. About half of adults with medical debt say they owe less than $2,500, according to KFF.

Unlike with other kinds of consumer debt, people rarely plan to take on debt from medical care. A one-time or short-term expense such as a hospital stay causes about two-thirds of all medical debt, according to the Consumer Financial Protection Bureau. Even people who might want to shop around for the best health care value are thwarted by opaque pricing, restrictive insurance networks, too few providers or a lack of options in an emergency situation.

“Medical debt is a systemic problem, which is what the government is situated and expected to address,” said Allison Sesso, president and CEO of RIP Medical Debt, a national nonprofit that takes donor money and uses it to purchase medical debt from providers and collection agencies at a steep discount and then forgive it. The organization has been a popular partner for state and local governments looking to cancel medical debt.

“This is an area that is ripe for public involvement and public-funded solutions,” Sesso said, “because the fact is that medical debt is not an individual choice. It is the result of a broken system.”

A 2022 poll from YouGov found two-thirds of Americans support government relief for medical debt, making it more popular than relief for other types of debt, including for student loans.

In May, New Orleans set aside $1.3 million from the federal American Rescue Plan Act to establish a medical debt forgiveness program with RIP Medical Debt.

New Orleans will use the $1.3 million to purchase and cancel an estimated $130 million in debt for residents with incomes below 400% of the federal poverty level (about $124,000 for a family of four) and those who have medical debt that’s equal to at least 5% of their household income.

The novel use of one-time pandemic funds made sense, said Jeanie Donovan, deputy director of the New Orleans Health Department. More than 1 in 5 adults in Louisiana have medical debt, one of the highest rates in the nation. City leaders figured that erasing medical debt could help as many as 80,000 New Orleans residents.

“Not accessing medical care can be costly and deadly,” said Donovan, who noted that New Orleans acted after hearing about a similar effort in Cook County, Illinois, which includes Chicago. “We also know there are inequity issues, that nationwide, Black and brown people are more impacted by medical debt and more likely to owe money for care, and it’s particularly problematic in the South.”

New Orleans residents don’t have to sign up for the program; those who qualify will receive letters in the mail informing them their debt has been paid.

Last month, New York City entered a similar partnership with RIP Medical Debt, following cities and counties in Michigan, Ohio and Pennsylvania. New York City plans to spend $18 million to erase $2 billion worth of city residents’ medical debt.

Connecticut, New Jersey and Pennsylvania also are looking to partner with RIP Medical Debt. In Connecticut, Gov. Ned Lamont, a Democrat, announced this month that the state would spend $6.5 million in federal pandemic aid to erase as much as $1 billion in medical debt for residents.

In response, Connecticut House Republican leader Rep. Vincent Candelora shared on social media his concern that medical debt relief might draw attention from other budget issues and disappoint those who don’t qualify for debt relief.

New Jersey’s current state budget allocates $10 million to cancel medical debt in partnership with RIP Medical Debt. Last month New Jersey Gov. Phil Murphy, a Democrat, urged legislators to increase that amount for the coming year.

Like New Orleans and Cook County, many localities have used federal pandemic relief money to pay for their programs. With the end of that money, Sesso said, it remains to be seen whether local and state officials will find other funding to pay down residents’ medical debt.

“This is not a permanent solution to the issue of medical debt. It is something [state and local governments] can do today,” Sesso said. “But they should be thinking about broader solutions they can get behind” and starting conversations with stakeholders about how to address medical debt.

State-level consumer protections for medical debt are patchy. Elizondo-Craig studied the issue for the Medical Debt Policy Scorecard, a research project from the University of Arizona and the University of Utah.

Erasing medical debt, she said, “really is a Band-Aid solution because the root cause of the problem is that a part of the population is un- or underinsured, and providers can essentially charge whatever they want in different amounts to different payers.”

“Across all health care services, the pricing is just way too high for people to afford, and we need transparency on pricing to make informed health care decisions,” she said.

New Safeguards May Help Those Who Are Drowning in Medical Debt

Democrats have pushed the debt erasure efforts. But in some places, other medical debt relief measures have been bipartisan.

North Carolina State Treasurer Dale Folwell, a Republican, championed a bill in North Carolina last year called the Medical Debt De-Weaponization Act that would cap the interest allowed on medical debt, require transparency in medical billing and add additional consumer protections. The bipartisan bill stalled in committee, but its primary sponsors were Republicans.

Illinois and Oregon enacted laws last year that require hospitals to take on a more active role in limiting medical debt by screening patients to determine if they’re eligible for financial assistance. And in August, Colorado became the first state in the country to enact a law that prohibits medical debt information from being included on consumer credit reports. Its primary sponsors were two Democrats and one Republican.

Haynes, of the National Consumer Law Center, said she and her colleagues have seen much more interest in medical debt relief at the state level. She predicted upcoming state action to remove medical debt from credit reports and to increase eligibility for financial assistance.

Other changes might include bans on aggressive medical debt collection tactics such as wage garnishment or liens; increased transparency in pricing; and requirements that health care providers inform people who might qualify for charity care or debt relief.

But Elizondo-Craig emphasized that universal health care insurance “would be the single most effective thing to do.”

Expanding Medicaid under the Affordable Care Act would significantly reduce medical debt in the 10 states that still have not done so, she said. People who live in states that haven’t expanded Medicaid are 40% more likely to have medical debt than those living in expansion states, according to a 2022 study.

Not only does Medicaid expansion extend insurance coverage to more people, Elizondo-Craig said, but it also gives the government more leverage to negotiate with health care providers on pricing, “reducing how much medical bills even are in the first place.”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

HUNTSVILLE, Ala. — Help at Home employed nearly 800 caregivers scattered across every county in Alabama, helping 1,100 older and disabled clients with activities such as bathing, housework and meal preparation.

And then suddenly, it was gone.

Alabama’s largest provider of home care services said it abruptly left the state last fall because the state’s “reimbursement and regulatory environment” made it difficult to recruit and retain enough workers, according to Kristen Trenaman, the company’s vice president of public relations. Its departure sent state agencies scrambling to find new caregivers for the people who relied on it.

Help at Home’s departure from Alabama “had a significant effect,” according to Debra Davis, deputy commissioner for the Alabama Department of Senior Services. Davis said her agency worked with former Help at Home clients to find replacements on the fly.

Help at Home, owned by private equity firms Centerbridge Partners and Vistria Group, continues to provide in-home and community-based care in a dozen other states, with 49,000 caregivers and 66,000 monthly clients. It’s been aggressively expanding outside Alabama, acquiring home care companies and posting thousands of job openings on its website. Neither firm responded to Stateline’s request for comment.

Proponents of private equity investment in health care say the infusion of capital helps smaller companies expand into new markets, streamline their costs and pay for new technology.

But critics point to Help at Home’s departure from Alabama as a cautionary tale for what can happen when states that spend little on health care rely on private equity-owned providers to care for their most vulnerable residents.

Private equity-owned health care companies are focused on generating robust profits for investors. Typically, they want to cut costs, increase cash flow, use debt to fund expansion and then sell within a few years for maximum profit. In health care, critics say, that business model can diminish the quality of care, increase costs and narrow access for patients — particularly in more lightly regulated industries such as home care and hospice care.

“We leave a lot to the whims of the market and allow private players to dictate access to and quality of health care, and the case of Help at Home is a great example of that,” said Mary Bugbee, senior research and campaign coordinator for health care at the Private Equity Stakeholder Project, a research and advocacy group.

“At the end of the day it’s about money, and if we don’t have guardrails in our policies to prevent these pullouts, they’re going to keep happening.”

Private equity firms pool investments from pension funds, endowments, sovereign wealth funds and wealthy individuals to buy controlling stakes in companies. They’ve drawn increasing legislative scrutiny and public outrage as they’ve grown their footprint in U.S. health care companies.

And while much of that negative attention has focused on hospitals and nursing homes, many private equity firms also have turned their sights to the lucrative and less regulated home health care industry.

“There are favorable demographic trends in the aging population that’s only going to keep getting older,” Ankeet Patel, a vice president at private equity firm Shore Capital Partners, told the audience at the Home Health Care News Capital + Strategy Conference in April 2023. “Pair that with home-based settings being cost-effective and the preferred setting for people that receive care, and that creates a lot of opportunity.”

Around 10,000 baby boomers turn 65 every day. By 2030, 1 in 5 Americans will be over age 65, the largest share in U.S. history. That’s tens of millions of people who will need care in the coming years, and most older adults say they would prefer to age in their homes, rather than in a nursing home, for as long as possible.

As long-term care for older adults moves away from nursing homes and toward home care, private equity is following close behind.

Increasing demand

Home care can mean a variety of things. Home health is often the term for more skilled care provided by licensed nurses and therapists, including wound care and medication management. Personal home care typically refers to nonclinical services from professional aides, such as help bathing and dressing, or performing household chores that might include cleaning, cooking and laundry.

It’s not just aging consumers who prefer home care to nursing homes: Insurance payers like it too. For both public and private insurance, It’s a potential cost-saver for people who don’t need round-the-clock supervision.

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Monthly costs for in-home care average about $5,000 for 40+ hours per week, compared with $8,000-$9,000 at a nursing home, according to the most recent Cost of Care Survey from insurance company Genworth. The survey is cited by agencies including the U.S. Department of Health and Human Services.

But costs vary widely from state to state. In Mississippi, in-home care averages around $3,800 monthly, while a private room in a nursing home is nearly twice that, about $7,300 per month. In Massachusetts, in-home care is nearly $6,000 monthly while a private nursing home room is more than $13,500 a month.

For those who need 24/7 care, home health is far less economical, averaging around $19,000 per month, more than twice the cost of a private room in a nursing home.

A 2019 analysis of Medicare claims found total costs 90 days after an emergency department visit were lower for patients treated at home versus those treated in the hospital. The home health patients also had lower hospital readmissions.

As consumer demand increases and insurance giants such as Humana and UnitedHealth Group wade into the market with their own home health agencies, private equity continues to gobble up smaller home health companies, consolidating them into regional networks. From 2018 to 2019, private equity was involved in nearly half of home health care industry deals.

Piling on debt

Private equity firms typically aim to acquire a company and boost profits before selling it within five to seven years. They often purchase companies with borrowed money, using the company’s assets as collateral for the loans.

Help at Home’s private equity owners, Centerbridge Partners and Vistria Group, partially funded their 2020 purchase of the company by loading it with $745 million in debt. Now, Help at Home — and not its private equity owners — must pay off the debt and interest, which can leave it less able to turn a healthy profit in a state such as Alabama with low Medicaid reimbursement rates.

Piling debt onto a company to finance additional purchases or to pay investors a dividend is a private equity hallmark. The industry tends to use debt more recklessly than publicly traded companies that must be more transparent about their financials, said Bugbee, of the Private Equity Stakeholder Project. Plus, there’s an attitude of high risk, high reward.

A private equity-owned company struggling under high debt payments might make the business decision to unload its services in one state while expanding in a state that can better help the business stay afloat, Bugbee said.

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Extra debt can leave a company more financially vulnerable and more likely to look for less-profitable service lines to cut, said Michael Fenne, senior coordinator for health care at the Private Equity Stakeholder Project.

“This is a good example of the extent that private equity can shape the health care landscape in a state,” Fenne said of Help at Home’s abrupt departure from Alabama. “They can do that in different ways; sometimes it’s cutting staff, sometimes it’s shedding real estate.

“What stood out about this situation is that they went beyond any of those more mitigated measures toward a complete removal from the state.”

A high percentage of Help at Home’s revenue came from Medicare and Medicaid, leaving it vulnerable to regulatory changes and state budget challenges, according to a 2022 report from Moody’s Investors Service, a credit rating agency.

“It’s possible [for a business] to make money from Medicaid, even from low reimbursement rates, but if you have a business that’s saddled with debt it’s going to be a lot harder to do that,” Bugbee said.

Trenaman, of Help at Home, told Stateline that the decision to exit Alabama wasn’t made lightly.

“We take our responsibility to provide the safest, in-home personal care services to our clients very seriously,” she said in an email. “Taking that responsibility into account, we believe we had no choice but to make that very difficult decision not to renew our annual contracts effective September 30, 2023.”

Alabama’s Medicaid policies for in-home care made it difficult to hire and retain employees, she said, “and we have not been able to overcome these challenges in the state of Alabama.”

Alabama is one of 10 states that has not accepted federal funding to expand eligibility for Medicaid coverage to people making up to 133% of the federal poverty level. The state has some of the stingiest income-based eligibility requirements in the country.

Help at Home also operates in Florida, Georgia and Mississippi, none of which has expanded Medicaid. In the year or so before its Alabama exit, Help at Home purchased home care companies in Georgia, Indiana, New York, Ohio and Pennsylvania. As of late January, it had about 2,700 open jobs on its website, most of them for caregivers.

But Alabama does have especially low Medicaid reimbursement rates for home care services. The state reported paying home health agencies just $27 per day for each Medicaid client receiving care, according to KFF, a health policy research organization, though it did not share its rates for in-home personal care. Its home health reimbursement is the lowest daily rate for home health agencies out of the 26 states that reported their numbers to KFF.

Texas and Wyoming, which also have not expanded Medicaid, reimburse home health agencies about $181 and $58 per visit or per day, respectively.

“Medicaid and a state’s failure to expand it is definitely a valid reason a business might struggle,” said Bugbee. “But there are analogous examples of private equity-owned health care companies that will pull out of some states and not others because at the end of the day, it’s about their bottom line.”

Potential for regulation

Since private equity functions similarly across the health care sphere, state and federal laws that were spurred by private equity’s involvement in hospital systems and other health care sectors also could work for home health agencies.

Last year, 24 states enacted laws related to health system consolidation and competition, according to the National Conference of State Legislatures, an advisory think tank for lawmakers.

As Demand Grows, States Consider Better Pay, Benefits for Home Care Workers

“The change of ownership [of companies owned or being acquired by private equity] is a window of time that regulators can use to really look into a business and who’s acquiring it,” Bugbee said. “If they do their due diligence, it can go a long way toward protecting patients and workers.”

Improving transparency, requiring certain health care staff-to-patient ratios and boosting wages for health care workers can also help protect patients and communities.

This year California will begin enforcing a 2022 law that requires health care providers to notify the state of major financial transactions, including mergers and acquisitions. In January, New York increased minimum wages for home health care workers to $17.55-$18.55, depending on the region. Those wages will continue to rise annually through 2026.

Efforts to enact new rules often lag a few years behind, as policymakers want to see evidence of harm to workers or patients before enacting changes.

“But after watching private equity investments play out in health care for decades,” Bugbee said, “we do know enough about how private equity typically operates that there are still ways regulators and policymakers can be proactive.”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

Last weekend, 50 hunters gathered in New York’s Mohawk Valley to take aim at the local coyotes. A hunting club offered prizes for the largest male and female carcasses, paying out $400 to the winning contestants.

The event was among the last sanctioned animal hunting contests in the state, following lawmakers’ passage of a ban on such events that will take effect later this year.

“There’s growing awareness of these contests and the damage they’re causing ecologically,” said Renee Seacor, carnivore conservation director with Project Coyote, a nonprofit dedicated to protecting carnivore species. “Public attitudes on wildlife management are shifting.”

New York became the 10th state to ban or limit wildlife hunting contests with the December enactment of the new law. Oregon’s wildlife agency also imposed a ban last year on such events on state lands. So far, the bans have largely been passed in Democratic-led states. In some states, including Nevada, wildlife commissions — which are often stacked with hunting proponents — have rejected petitions to ban the practice.

So far this year, Illinois and New Jersey are following New York’s lead by seeking to ban contests through legislation rather than state agency rules. The Humane Society of the United States estimates that such contests kill more than 60,000 animals every year.

In addition to coyotes, hunting contests have targeted bobcats, foxes, crows, squirrels and many other animals that lack the strict regulations applied to traditional game animals such as deer and elk.

Advocates of the bans say the contests are pointless killing sprees fueled by bloodlust and cash, based on outdated perceptions that some species — primarily coyotes — are “nuisance” animals.

But some hunters fear the bans are part of a broader effort to crack down on hunting opportunities. Steven Rinella, a hunting advocate renowned for his “MeatEater” TV show and podcast, noted that contests must fall within existing rules set by wildlife managers.

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“Any of the individuals who are participating in these contests could at any time be out doing the exact same practice,” he said in an interview. “To target the competitive derby component in this is basically just saying, ‘I disapprove of hunting, and this is a thing I can go after and win.’”

Brian Gray, president of the Mohawk Valley Coon and Cat Club, said contests such as the one his hunting club held last weekend help sustain the organization’s membership.

He intends to continue holding contests once the ban takes effect, organizing by word of mouth to avoid state enforcement “unless someone tattles.” If challenged, Gray said, he intends to relabel the event a “photography contest,” with prizes for the best photos of dead coyotes instead of for the carcasses themselves.

“Some of our guys have $6,000 scopes on their rifles, and they’re never going to get to use them for anything else,” he said. “This club has been in my family since the ’40s, and I don’t want to lose it.”

Coyotes under fire

For much of America’s history, predator animals such as coyotes and wolves were viewed as troublesome varmints and subjected to state-sponsored extermination campaigns. While this practice cleared vast landscapes of wolves, grizzly bears and other animals, coyotes only became more abundant.

Coyotes respond to hunting pressure by dispersing and birthing larger litters, as author and historian Dan Flores describes in his book “Coyote America.” While coyotes once lived only in the arid West, the efforts to eradicate them have driven them to every corner of the North American continent. They’ve filled the ecological niches left vacant in places where wolves and cougars were killed off, and they’ve learned how to thrive in cities, with abundant prey of rats and mice.

“The American public has long regarded this animal as something like a cockroach with fur,” Flores said in an interview. “But our attempts to wipe them out triggered an evolutionary response from them to scatter and spread.”

Wildlife experts say efforts to protect livestock and pets by shooting coyotes only causes more breeding from surviving animals — which results in coyotes that are less schooled about avoiding conflict with humans.

“There’s the suggestion that these animals are really bad for us, but you can’t shoot your way out of that,” said Barbara Baker, chair of the Washington Fish and Wildlife Commission, which outlawed hunting contests in 2020.

Hunting advocates counter that the species’ resilience proves coyotes can be hunted sustainably.

Gray, president of the hunting club in New York, blamed coyotes for killing livestock and pets in Mohawk Valley, but said there has been no decline in those attacks following hunting contests that killed scores of coyotes. He asserted residents should be allowed to fight back.

In many states, even those that have banned contests, hunters can shoot as many coyotes as they please with few restrictions on seasons or weaponry.

A growing movement

California became the first state to ban hunting contests in 2014, following a vote from state regulators.

“Most ethical hunters object to these contests,” said Mike Sutton, who was serving as president of the California Fish and Game Commission at the time. “They’re inconsistent with our current understanding of predator ecology, and they give hunters a bad name.”

Tony Wasley serves as president of the Wildlife Management Institute, a conservation group with roots in the hunting community, and holds leadership roles in several hunting-related organizations. He supported an effort to ban hunting contests when he served as director of the Nevada Department of Wildlife in 2021.

In testimony before the Nevada Wildlife Commission, he noted that the agency’s role is to recruit more hunters, who supply much of the agency’s budget through license fees. That task, he said, is made difficult when images of mass slaughter circulated on social media tarnish their public image.

“I fear what indiscriminate killing says about hunters or the ethics of hunting more broadly,” he said in an interview. “To verminize every coyote and say that [killing it] is some benefit to another species would be difficult to substantiate.”

Despite Wasley’s support, the proposal to ban hunting contests was rejected by the agency’s commission, which by law is made up predominantly of hunters and anglers.

Tommy Caviglia, who was the commission’s vice chair at the time, argued that few members of the public are even aware of the contests, the Nevada Current reported, saying the proposal was driven by the “anti-hunting side of the world.”

While some individual hunters have spoken in favor of the contest bans, organized sporting groups have largely remained silent or opposed them as a “slippery slope” to further hunting limitations.

“Hunting is already highly regulated, and people don’t understand the amount of nuance that there is,” said Torin Miller, senior director of policy with the National Deer Association, a nonprofit that advocates for wildlife habitat and hunting. “All of these contests have to occur within the bounds of seasons and bag limits that agencies have put in place.”

Miller said that contest bans should be decided by wildlife agencies, not legislators.

State bans

In December, New York became the fourth state to enact a ban through legislation, following Maryland, New Mexico and Vermont. The bill passed 88-53 in the New York Assembly, and 46-15 in the Senate.

“This does not serve a wildlife management purpose,” said Assemblymember Deborah Glick, the Democrat who sponsored the bill. “There were hunters who felt it gave them a black mark and distorted what people thought of hunters.”

Some lawmakers who opposed the bill said the ban illustrates a growing urban vs. rural divide.

“It fails to understand and simply ignores the impact on the heritage and traditions of many rural upstate communities, farmers, and local environments and economies,” said Republican state Sen. Tom O’Mara, according to The Press & Sun-Bulletin.

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The New York bill followed an agency decision in Oregon to ban contests on state lands.

Under Oregon law, wildlife managers’ authority in the state does not extend to “predatory animals” on private lands, said Michelle Dennehy, communications coordinator with the Oregon Department of Fish & Wildlife, but the agency responded to public concern about the contests on public lands.

While many of the bans enacted so far have been issued by state wildlife agencies, advocates are increasingly turning to lawmakers to act — especially in states where wildlife commissions are dominated by hunters.

“We have an outdated state agency that’s comprised only of hunters, so we have to go the legislative route,” said Brian Hackett, director of government and community relations at the Associated Humane Societies in New Jersey, a nonprofit that rescues wild and domestic animals.

New Jersey lawmakers advanced a contest ban measure through a Senate committee last year, but the session ended before it could progress further. A bipartisan group of lawmakers introduced a similar measure earlier this month.

In Illinois, lawmakers also are considering a bill to ban hunting contests. Democratic state Rep. Anna Moeller, the bill’s sponsor, said that wildlife officials deferred the matter to the General Assembly in response to pressure from some hunting groups. While the bill has yet to see any movement, Moeller said backers are working to educate lawmakers who are still unaware that such contests even exist.

“We support hunting that’s done in a sustainable and responsible way,” Moeller said. “When you’re wiping out large numbers of animals at a time, you’re creating an imbalance, and oftentimes we find there’s harmful consequences from being so reckless.”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.