As congressional Republicans seek about $4.5 trillion to extend expiring tax cuts, the federal government will need to find savings elsewhere. Experts say budget cuts could affect Medicaid coverage for as many as millions of Americans, at a time when the program may need more funding, not less.

The proposed House bill requires the Committee on Energy and Commerce to find $880 billion in spending cuts, which means some aspects of Medicaid, which the committee oversees, may be on the chopping block.

Medicaid is a massive government program that provides free and reduced-cost health care for eligible enrollees. It offers critical coverage to a wide variety of Americans, including children, adults with disabilities and older people in nursing homes.

Even for Americans who have private insurance, Medicaid can play a part in their health care. That’s because Medicaid is such a large engine of funding for so many aspects of the country’s health coverage.

The public health insurance option is funded in part by the federal government and in part by states, covering around 72 million people as of October. A total of 84 million people across the U.S. and its territories were covered either partially or in full as of June, the most recent month for which the government has data.

The federal government spent about $880 billion on Medicaid in fiscal year 2023, the most recent year for which there’s data, according to an analysis by the nonprofit health policy research organization KFF.

Medicaid is an extremely popular entitlement program, said Robin Rudowitz, director of the program on Medicaid and the uninsured at KFF.

More than 9 in 10 adults say Medicaid is “very” or “somewhat” important to their local community, according to recent KFF polling. Forty percent of respondents said they wanted Medicaid funding to remain the same, while 42 percent wanted to increase funding for the program. Just 17 percent wanted to decrease funding “a little” or “a lot.”

READ MORE: Supreme Court to consider if states can cut off Medicaid funding to Planned Parenthood

Some studies have found that expanding Medicaid can save money for states, including in spending reductions in corrections health care as well as mental health and substance abuse care.

President Donald Trump has said his administration will not cut Medicaid benefits, and will instead reduce spending by eliminating waste and fraud.

According to health policy experts, there may not be a way to fund the tax cuts without cutting Medicaid. Doing that will have real implications, said Allison Orris, senior fellow and director of Medicaid policy at the Center on Budget and Policy Priorities.

“It’s fair to say [that] if Medicaid is cut by hundreds of billions of dollars, people will lose coverage. But some of the ways in which they will lose coverage and health care and access are a little bit tricky,” she said.

Who and what relies on Medicaid?

Medicaid covers low-income Americans in all 50 states, as well as D.C. and the American territories, but the program’s benefits are farther reaching.

Medicaid pays for around 2 in every 5 births in the country. The program accounts for about 20 percent of both hospital funding and total health care spending nationwide, according to KFF. That organization’s analyses of hundreds of studies conducted since 2014 largely found that Medicaid expansion helped cut hospital costs associated with uninsured patients. Many studies also found that Medicaid expansion helped with overall hospital funding and resulted in fewer hospital closures, though KFF notes that may vary.

And Medicaid – not Medicare – is the single largest payer of long-term care coverage, including nursing home care.

Here are some of the ways Medicaid is crucial for so many Americans’ health care.

Long-term care for people with disabilities

According to KFF analyses, 35 percent of people with disabilities have Medicaid, around 15 million people. That compares with 19 percent of people without disabilities, the majority of whom have employer-provided health insurance.

Currently, Medicaid covers about 60 percent of long-term care coverage, much of which provides care for younger adults with disabilities.

Nursing homes

Medicaid is the primary payer of nursing care in the U.S.; it covers 63 percent of nursing home residents, according to KFF.

For many older adults, “Medicaid is the safety net,” says David Grabowski, professor of health care policy at Harvard Medical School. “An individual can be middle-income their entire life and then reach their older, long-term care years and have to enter a nursing home.”

Because nursing homes can be so expensive, families can quickly deplete their assets, then rely on Medicaid to cover long-term care.

Children

Thirty-seven percent of people enrolled in Medicaid are children, but they account for only about 15 percent of the program’s spending.

In 2023, KFF found that of the 72 million people enrolled in Medicaid, about 30 million were children. Millions more children are enrolled in the Children’s Health Insurance Program, which some states run with Medicaid expansion funds. So far, political conversation has not focused on cutting CHIP funding.

READ MORE: Texas schools and families struggle as hundreds of thousands of kids lose Medicaid coverage

Rural maternal health

Medicaid covered around 40 percent of births nationwide in 2023, KFF found, and nearly half of all rural births.

READ MORE: Hourslong drives and huge bills. Here’s what the pregnant and uninsured face in South Dakota

Studies also show that being enrolled in Medicaid leads to improved health outcomes for children, including declines in infant and child mortality, preventive care visits on par with privately insured children and even potentially positive outcomes into adulthood, such as improvements in education.

American Indian/Alaskan Natives

Four in 10 American Indian/Alaskan Native people are enrolled in Medicaid – the highest enrollment rate among any race and ethnicity category. This includes about 23 percent of nonelderly AIAN adults and 44 percent of AIAN children.

How the federal government funds states’ Medicaid plans

Medicaid began as an optional program in 1966 alongside Medicare, with around 8 million people eligible for enrollment. By the 1980s, all states had opted into providing health insurance through Medicaid.

Though eligibility requirements have changed over the last 60 years and vary by state, the most significant change to Medicaid was the enactment of the Patient Protection and Affordable Care Act in 2010. It required states to cover adults with incomes up to 138 percent of the federal poverty line. After the Supreme Court ruled in 2012 that expansion for states should be optional, 40 states and Washington, D.C. have expanded Medicaid, accepting federal funds at a much higher rate than the match rate for non-expansion coverage.

If enforced, President Trump’s order will deny transgender youth access to medically-necessary care, like puberty blockers and hormone therapy, even as these same treatments remain readily available to their cisgender peers. The order also intends to cut or reduce federal funding for health care providers who refuse to prioritize the Trump administration’s political preferences over their patients’ medical needs.

After President Donald Trump issued an executive order restricting access to gender-affirming medical care for transgender people under 19, many hospitals nationwide abruptly cut off treatment for trans youth. This sent thousands of families scrambling, with some even wondering if they needed to leave the country to protect their family’s future.

“politics and partisanship have no place in patient care and we all deserve the freedom to be ourselves.”

Since his first term, Trump and his administration have carried out a years-long effort to roll back protections for LGBTQ people. Beginning in January, the Trump administration issued a series of executive orders that remove protections for trans people. His directives include targeting transgender students, banning trans Americans from military service, and giving federal agencies the green light to openly discriminate against their trans employees. These orders align with the extremist vision of Project 2025, a sweeping right-wing agenda that seeks to dismantle civil rights protections, consolidate presidential power, and dehumanize transgender people.

At the American Civil Liberties Union, we know that politics and partisanship have no place in patient care and we all deserve the freedom to be ourselves. On February 4th, alongside Lambda Legal and the ACLU of Maryland, we sued the Trump administration to block its discriminatory efforts to limit needed health care. We filed our suit on behalf of transgender young adults and their families, as well as PFLAG and GLMA, two of the nation’s largest organizations supporting LGBTQ+ people and healthcare professionals.

After seeing a therapist, Cameron’s parents consulted a doctor who first spoke to them about puberty blockers, a temporary pause that gives people time to decide whether to undergo male or female puberty. Getting more time was a relief to Cameron who, after starting treatment at 12, remembers feeling “less stressed and a little more hopeful.”

For Cameron, words like “boy” or “girl” were never meaningful. Being seen as nonbinary makes them feel “strong, happy, recognized, and loved.” Before puberty, they worried about how others would treat them based on their clothes and pronouns. Now, as their physical-self matures, Cameron worries about how they see their own body. “The changes feel violating,” they say. “It makes me depressed, stressed, and anxious.”

For Cameron, Gabe, and Robert, three of the five trans young people challenging the Trump administration’s anti-trans agenda, this fight goes beyond the courtroom. It’s about their fundamental right to make deeply personal medical decisions without government interference.

President Trump “is determined to use every level of government to drive transgender people out of public life,” says Joshua Block, senior counsel for the ACLU’s LGBT & HIV Project.

However, Cameron’s appointment for a puberty-blocking implant was abruptly canceled after the Trump administration issued its executive order. Their anxieties came rushing back, resulting in stomach pain, restless sleep, and missed school. Their parents fought to find a new doctor. Though Cameron did finally receive their implant, they fear losing care again. “I do not want to feel like a stranger in my body,” they told the ACLU.

For Gabe, a 14-year-old transgender boy, he hopes gender-affirming medical care will help him look and sound more like himself. Often, when strangers see him in public, they address him using male pronouns. Until he speaks. His voice still does not reflect who he is and causes people to misgender him, which only adds to the anxiety and dysmorphia that began when he started puberty.

“Even when I wasn’t sure why the changes felt wrong, I just knew they were,” Gabe says, reflecting on his experience trying to navigate his changing body.

To treat his dysphoria, Gabe’s parents consulted a doctor who explained how testosterone could help him feel more comfortable in his body. Gabe knew it was the right choice for him. “I want to be in a grown-up male body when I’m older,” he says. “I want the choice to tell people, not to be revealed by my voice.”

Gabe hoped to begin testosterone treatments in March 2025, but the administration’s actions put his plans at risk. Like many trans youth, Gabe now fears that he won’t have the choice to present as he truly is.

Families of trans youth also feel the impact of Trump’s discriminatory order. Rachel, a member of PFLAG, has always prioritized her son Robert’s health and well-being. From a very early age, she knew that Robert was meant to be a boy and that “he would thrive in school and the rest of his life if we let him live that way.”

At nine, Robert was diagnosed with gender dysphoria. Rachel made sure he received the care he needed. Under medical guidance, he began puberty blockers to prevent changes that would conflict with his identity. By 14, after years of therapy and careful consideration, he started testosterone. “As his mother, I agreed with his doctors that Robert would benefit from going through puberty alongside his peers,” Rachel says.

Robert is 16 now and is “healthy, social, and thriving.” But on January 29th, Rachel received a call: Robert’s appointment, a routine check-up for his hormone therapy, was canceled. “I am devastated that the president has sought to prevent my child from accessing the health care that allows him to be his true self,” Rachel says.

Without testosterone, Rachel fears that Robert will face severe distress. “This is a child who has told me since age two that he is a boy,” she says. “He is now a young man. It would be alarming for him to suddenly develop a woman’s body.”

Cameron, Robert, Gabe, and so many families like theirs see President Trump’s assault on their rights for what it is: an overreach of presidential power to deny them the health care that serves as the foundation of their lives and their future. At the ACLU, we refuse to let politics dictate who can and cannot receive essential healthcare, but our fight is about more than policy. Like all of us, trans youth deserve to grow up with the care and support they need. We will not stop fighting until their rights are protected.

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The use of medical marijuana dates to ancient civilizations, though historians are undecided about whether the first medical use of cannabis was in China, where the plant is indigenous. [1]

Archaeologists unearthed traces of cannabis with high levels of THC (the main psychoactive component of cannabis) in wooden bowls dating to 500 bce in the Jirzankal Cemetery in China, marking the earliest instance of marijuana use found to date. This particular use of marijuana was more likely for a religious rite than medicinal purposes, though religion and medicine were not necessarily kept separate. Such use was described by Greek historian Herodotus: “The Scythians then take the seed of this hemp and, crawling in under the mats, throw it on the red-hot stones, where it smolders and sends forth such fumes that no Greek vapor-bath could surpass it. The Scythians howl in their joy at the vapor-bath.” [2][3][4]

What do you think? Should Recreational Marijuana Be Legal? Explore the ProCon debate

The mythological Chinese Emperor Shennong’s pharmacopoeia, Treatise on Medicine (which itself has disputed dates–2737 bce or 1ce and unknown authorship), included marijuana as a treatment for “malaria, constipation, rheumatic pains, ‘absentmindedness’ and ‘female disorders.’” [5][6]

From China, marijuana was introduced to Iran and Anatolia by the Scythians and then spread to India, Greece, Egypt, and throughout Africa. Evidence suggests Arab physicians used marijuana for pain, inflammation, and epileptic seizures, while in India marijuana was used for fevers, sexually transmitted infections (STIs), headaches, sleep, dysentery, digestion, and appetite inducement. In Rome, Emperor Nero’s private physician, Dioscorides, used the plant to treat pain in ears. Marijuana was similarly used in Africa, as evidenced by the Egyptian Ebers papyrus (circa 1550 bce), for fever, pain, infected toenails, and uterine cramps. Other Egyptian papyruses include cannabis as treatment for eye infections (perhaps glaucoma), cholera, menstrual ailments, headaches, schistosomiasis, fever, and colorectal cancer. [1][4][7][8][9][10]

The Moors brought marijuana to Spain during the 8th-century occupation. The Spanish, in turn, took marijuana to the Americas where it was mainly used as a cash crop for producing hemp fiber. Medical use followed quickly, with Mexicans using the drug for gonorrhea, menstrual ailments, pain, and toothaches. [10][11][12][13]

Robert Burton’s The Anatomy of Melancholy (1621) heralded the arrival of marijuana in medieval Europe by suggesting that cannabis be used to treat depression. Thereafter marijuana was recommended for inflammation (New English Dispensatory, 1764) and coughs, STIs, and incontinence (Edinburgh New Dispensary, 1794). [1]

Medical use of marijuana did not gain much popularity in the United Kingdom until W.B. O’Shaughnessy, an Irish professor at the Medical College of Calcutta, India, tested the indigenous Cannabis indica on animals and children after seeing how Indians used marijuana in medicine. O’Shaughnessy reported in 1839 that cannabis was safe and used marijuana to treat rabies, cholera, delirium from alcohol withdrawal, pain, rheumatism, epilepsy, tetanus, and as a muscle relaxer. He deemed marijuana “an anticonvulsant remedy of the greatest value” and brought the drug with him when he returned to England in 1842. [1][7]

The Provincial Medical and Surgical Journal (now the British Medical Journal) put medical cannabis on the front page in 1843, prompting popularity and regular use of the drug as a painkiller, with even Queen Victoria reportedly being prescribed marijuana postpartum and for premenstrual syndrome (PMS) by her private physician J.R. Reynolds. A tincture of marijuana, frequently added to tea, was used commonly in Victorian England. The 1894 Indian Hemp Drugs Commission stated marijuana was not harmful if used in moderation and could be particularly helpful in treating malaria. [7][14]

In 1860, American doctor R.R. M’Meens, crediting W.B. O’Shaughnessy, extolled the virtues of marijuana to treat “tetanus, neuralgia, dysmenorrhea (painful menstruation), convulsions, the pain of rheumatism and childbirth, asthma, postpartum psychosis, gonorrhea, and chronic bronchitis” as well as the drug’s use for sleep-inducement and appetite stimulation. Other American doctors prescribed marijuana for restlessness, anxiety, “senile insomnia,” neuralgia, migraines, depression, gastric ulcers, morphine addiction, and asthma, and as a topical anesthetic. [1]

However, the arrival of marijuana wasn’t lauded by everyone. Mark Stewart, a member of the UK Parliament, complained in 1891 that “the lunatic asylums of India are filled with ganja smokers.” Along with negative associations with mental illness, marijuana was also attacked with racist political commentary. In the United States, the Federal Bureau of Narcotics (FBN) Commissioner Harry Anslinger claimed there were “100,000 total marijuana smokers in the U.S., and most are Negroes, Hispanics, Filipinos and entertainers. Their Satanic music, jazz and swing result from marijuana use. This marijuana causes white women to seek sexual relations with Negroes, entertainers and any others.” Additionally, the agency was concerned that “marihuana leads to pacifism and communist brainwashing.” [1][7][13][15] [16]

By the 1890s, marijuana was falling out of favor among doctors, and U.S. states were working to ban marijuana because of the drug’s association with Mexican immigrants. Massachusetts led the charge, passing a ban on the drug in 1911. [7][10]

The FBN, which would merge with other departments to form what is now the Drug Enforcement Administration (DEA), worked to pass the Marihuana Tax Act of 1937. While the law only taxed marijuana, it effectively banned the drug as well as industrial hemp. The Marihuana Tax Act survived until 1969 when it was declared unconstitutional. However, President Richard Nixon would reinstate the marijuana ban in 1970 with the Controlled Substances Act, which classified cannabis as a Schedule 1 drug (“drugs with no currently accepted medical use and a high potential for abuse”), beginning Nixon’s “War on Drugs” and effectively ending medical research on the drug. [7][10][16][37]

In the United Kingdom, the Misuse of Drugs Act was passed in 1971, declaring marijuana to have “no known or limited medical use.” The law now classifies marijuana as a Class B drug, which are considered less dangerous than Class A drugs including cocaine, ecstasy, and crystal meth. Class B drugs include amphetamines, barbiturates, and ketamine, along with marijuana. The possession of any Class B drug carries a penalty of up to 5 years in prison. [7][17] [18]

While the American federal war on drugs would continue, U.S. states began legalizing medical marijuana in the 1990s. California was the first to legalize cannabis for medical use in 1996, quickly followed by Alaska, Oregon, and Washington state in 1998, and Maine in 1999. By Dec. 2022, 37 states and DC had legalized medical marijuana, leaving only 13 states where medical marijuana is illegal: Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Nebraska, North Carolina, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. [19]

While states were legalizing medical marijuana, some of the earliest adopting states also began legalizing recreational, or adult-use, marijuana. Colorado and Washington legalized this in 2012—19 other states and D.C. had done so by December 2022. Only states with legal medical marijuana have thus far legalized adult-use marijuana. [20]

An Apr. 2021 Pew Research Center poll found that 91 percent of Americans believed marijuana should be legal for medical use (60 percent for medical and recreational legalization; and 31 percent for only medical legalization). Only 8 percent believed marijuana should not be legal for any reason, and 1 percent did not answer the question. Support for marijuana legalization has steadily increased over the years. [21]

The House has passed the Trump-backed SAVE Act. Here are 8 things to know

toggle caption Frederic J. Brown/AFP via Getty Images

The House of Representatives passed the Safeguard American Voter Eligibility Act, known as the SAVE Act, on Thursday morning by a vote of 220-208.

The bill, which received unanimous support from House Republicans along with four Democrats, would make sweeping changes to voter registration, including requiring those signing up to present documents proving U.S. citizenship. But tens of millions of Americans say they don’t have easy access to such documents, and critics say the proposal would dramatically depress voter participation.

The bill now heads to the Senate where it will need bipartisan support to overcome a filibuster.

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The Safeguard American Voter Eligibility Act was first introduced last year as President Trump and his allies focused on the baseless narrative that noncitizens presented a major threat to the 2024 election.

The current federal voter registration form requires voters to swear — under penalty of perjury — that they are U.S. citizens, and some states take additional steps to verify citizenship. Noncitizens who attempt to vote face steep penalties like jail, fines and deportation. A sweeping executive order Trump signed last month directs the Election Assistance Commission to change the federal registration form to include a requirement to show proof of citizenship. That directive is now facing multiple legal challenges in federal court.

Backers of the SAVE Act say requiring voters to show citizenship documents is necessary to protect election integrity — though they have yet to provide evidence that instances of illegal voting by noncitizens are anything but incredibly rare.

“They are trying to take something that we all agree on — that only U.S. citizens should vote in U.S. elections — and use that to make it harder for millions of eligible citizens to cast their vote,” Michigan Democratic Secretary of State Jocelyn Benson said in a video denouncing the bill.

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Here are eight things to know about the SAVE Act.

1. The bill was first introduced last year as Republicans focused on noncitizen voting

Ahead of the 2024 election, Trump and his allies repeated the groundless claim that Democrats planned to cheat by encouraging noncitizens to illegally vote. Many political observers and election experts saw the baseless narrative as an attempt to sow doubt about the election results in case Trump lost.

“We all know, intuitively, that a lot of illegals are voting in federal elections, but it’s not been something that is easily provable,” House Speaker Mike Johnson, R-La., said at a news conference introducing the SAVE Act last May. The bill passed the House in July, with five Democrats voting for it, though it languished in the Senate.

toggle caption Kent Nishimura/Getty Images

No evidence came to light of any plot to encourage noncitizens to vote in the 2024 election, but that didn’t stop Republicans from reintroducing the measure at the start of the 119th Congress.

“American elections belong to American citizens, and the public’s confidence in those elections is the cornerstone of our republic,” the bill’s sponsor, Rep. Chip Roy, R-Texas, said in a January news release.

2. Millions of Americans don’t have easy access to proof-of-citizenship documents

The requirement to show proof of citizenship would apply to new voters as well as existing voters who update their registrations, such as after a move or name change.

But one in 10 voting-age American citizens, or an estimated 21.3 million people, either don’t have a proof-of-citizenship document like a birth certificate, passport or naturalization certificate, or don’t have easy access to one, according to a 2023 survey commissioned by voting rights groups. The survey found people of color are more likely not to have a document proving citizenship.

Obtaining these documents takes time and money. Only about 43% of Americans have passports, according to an analysis by the Voting Rights Lab. The bill says voters can show an ID that indicates citizenship, but currently only five states — Michigan, Minnesota, New York, Vermont and Washington — offer IDs that meet that criteria.

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Voters who don’t have a citizenship document with a photo, like a passport, would need to show two documents — such as a government-issued photo ID along with a document proving citizenship, like a birth certificate.

“Adding more requirements to the process — especially costly, unnecessary ones that are a sudden and dramatic departure from existing requirements — will depress turnout overall,” said Lauren Kunis, executive director of VoteRiders, a nonpartisan organization that helps people obtain ID to vote.

3. Married women who changed their names would likely face additional requirements

Up to 69 million American women changed their names after they got married and therefore don’t have birth certificates that match their current names, according to an analysis by the progressive Center for American Progress. These women would likely need additional documentation, such as a name change document or marriage certificate, to register to vote.

The center’s Greta Bedekovics told NPR that would unfairly burden the women’s right to vote.

“Every move, every party affiliation change … and these women would be required to go with all of their documentation every single time,” Bedekovics said.

Cleta Mitchell, an advocate for stricter voting requirements who supports the SAVE Act, pushed back against that argument in a post on X.

“Under this nonsensical theory, married women are not capable of bringing the necessary documentation that shows citizenship AND married status,” she wrote.

Rep. Mary Miller, R-Ill., a SAVE Act co-sponsor, defended the bill in a congressional hearing, saying, “The SAVE Act does have robust protections for married women whose names have changed.” The legislation does not mention married women but says states should come up with processes to accept additional documentation when voters have a discrepancy on their proof-of-citizenship document. Miller’s office did not respond to a request for comment.

4. Voter registration would likely require a visit to a government office

The bill specifies that if someone registers by mail they must present their documents “in person to the office of the appropriate election official” before the voter registration deadline passes (or if they are in a state where voters can register at a polling place, they could show their documents there). That requirement would also “completely upend” third-party voter registration drives that rely on mail forms, said Jonathan Diaz, an attorney with Campaign Legal Center, which advocates for expanded voter access and opposes the SAVE Act.

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The bill does not mention online voter registration, which is an option in most states. Neither Roy or Rep. Andrew Garbarino, R-N.Y., the bill’s other lead sponsor, responded to an NPR inquiry requesting more details.

Some 80 million Americans registered to vote or updated their registrations between the 2020 and 2022 elections, according to data from the Election Assistance Commission (EAC). The most common way people registered was through department of motor vehicles offices, but 9% of voters registered to vote by mail, fax or email, and 14% registered online in 2022, according to the EAC.

Requiring voters to show documents in person would be particularly burdensome for rural voters, people who rely on public transit and people who cannot leave work during business hours. In the 30 largest counties by area in the West, voters would have to drive an average of 260 miles to get to their election office, according to an analysis by the Center for American Progress. The same analysis found some voters in Alaska and Hawaii could have to fly to get to election offices.

That’s a concern espoused by Arizona Secretary of State Adrian Fontes, a Democrat.

“Because of [a voter’s] physical condition or their age or their distance from their county registrar’s office, they just don’t get to vote anymore?” Fontes questioned. “This is a radical shift in the way we consider preserving the voter’s right to vote.”

5. Election officials have concerns about implementation and new criminal penalties

Fontes said the lawmakers who came up with the SAVE Act may have had a noble idea, but the bill as written is deeply flawed.

“It’s going to put a heavy burden on localities and it’s really bad for voters,” Fontes said.

Some Republican state officials have also voiced concerns with how the bill would be implemented.

Michael Siegrist, a Democrat who runs elections as town clerk in Canton, Mich., said it would be necessary for his office to add some evening hours to accommodate voters who work during the day.

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And he would have to evaluate people’s birth certificates, which are not uniform. “How am I supposed to know if you forged that birth certificate?” he questioned.

Raising the stakes further, the SAVE Act says election officials can face five years in prison or be sued if they register a noncitizen or a citizen who did not show proof. Siegrist worries he and his colleagues could be prosecuted for human errors or targeted by frivolous lawsuits.

“It creates too much risk, I think, for any reasonable person to want to stay in the profession,” he said.

6. Key details are still up in the air

The bill leaves the thorniest implementation questions up to states to decide with guidance from the EAC. If an applicant does not possess one of the proof-of-citizenship documents described in the bill, it says states should have a process for those applicants to submit additional evidence and for officials to decide if it is sufficient. The bill also says states should come up with accommodations for voters with disabilities.

Voting rights advocates say it is problematic to have gray areas in a bill that also says election officials can face criminal prosecution for missteps.

“Every incentive is for officials to not interpret this law broadly and favorably for voters,” said Sean Morales-Doyle, an attorney with the Brennan Center for Justice, which advocates for expanding voting access and opposes the bill. “Because if they make a mistake, they’re putting their neck out there and themselves on the line.”

7. States would get more access to federal immigration data

The SAVE Act would require states to check voter rolls on an ongoing basis to ensure only U.S. citizens are registered. The bill would make it easier for states to use federal immigration data to do that, which has long been a point of contention between state election officials and the federal government.

Earlier this year, 21 Republican secretaries of state wrote to Homeland Security Secretary Kristi Noem to ask for improved access to a federal data system called the Systematic Alien Verification for Entitlements (SAVE) program to help detect noncitizens on their voter rolls.

Some past efforts by states to purge noncitizens from voting rolls, however, have ensnared eligible U.S. citizens due to data inaccuracies.

8. States are considering their own proof-of-citizenship laws

The Republican goals behind the SAVE Act have spread to states as well.

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Lawmakers in at least 20 states, including Texas, Florida and South Carolina, have introduced bills this year that would require documentary proof of citizenship to register to vote in state elections, according to an analysis by the Voting Rights Lab. New Hampshire passed a proof-of-citizenship law last year.

Kansas and Arizona pioneered such laws — and in both states they’ve been controversial.

In the first few years that Kansas’ law was in effect, more than 30,000 voter registration applicants were blocked due to not providing proof of citizenship — and a state expert conceded most of those people were citizens. In 2018 a federal court declared the state law unconstitutional.

Arizona uses a unique split system in which voters must prove citizenship to participate in state and local elections but not federal elections.

Unlike the protocol outlined in the SAVE Act, many Arizonans are able to fulfill the proof-of-citizenship requirement by writing their driver’s license or state ID number on the voter registration form, since the state’s motor vehicle division tracks citizenship. Still, some 32,000 Arizona voters are barred from voting in state and local elections due to proof-of-citizenship requirements, and an analysis by Votebeat found they are disproportionately young people near college campuses.

In February, a federal appeals court found portions of two 2022 Arizona laws that would have imposed further proof of citizenship requirements to be “unlawful measures of voter suppression.”

Gov. Laura Kelly worries about dwindling water resources that will need ongoing federal support if western Kansas is to remain habitable in 50 years.

She is concerned about the national health impact of firing more than two dozen federal scientists in Manhattan, Kansas, who protect Americans from animal-borne diseases and other health threats.

Mike Kelly, chair of the Johnson County Board of Commissioners, wonders what will happen to wastewater infrastructure and assistance for children or the aged in the face of looming federal spending cuts.

Both the governor and the county commissioner have been in touch with local members of Congress trying to shore up what has long been routine federal support.

“The fact we have had to have these conversations is disheartening,” the governor said. “We really do not know what is happening. It seems to change every hour.”

The Trump administration has slashed employment in the U.S. Agency for International Development and the Internal Revenue Service and is ready to move on to the Environmental Protection Agency, the Department of Education and many other departments and agencies.

On top of that, Congress by March 14 must come up with a plan to fund government operations for the current fiscal year.

The White House may be 1,071 miles from Kansas City, but its impact on the local economy is right around the corner.

The Kansas City metropolitan area, with nearly 30,000 federal employees, has the eighth-highest percentage among all metros in the country of federal workers in its population, according to David Warm, executive director of the Mid-America Regional Council, which serves 119 cities and nine counties.

“Everybody is rightfully concerned,” Mike Kelly said, “being in a period of unique uncertainty.”

Fretting about federal funding

Big worries about federal spending extend in every direction.

Consider the $17 billion in wind turbine investments that have made Kansas the third-largest state generator of wind power.

Federal “conditional commitment” funding of $4.9 billion for a new 800-mile transmission line, the Grain Belt Express, is imperiled, according to a Canary Media report. The project is designed to connect Kansas and three other states to power markets.

Chicago-based Invenergy, which is developing the transmission line, issued the following email comment to The Beacon:

“We believe that projects like Grain Belt Express, which will provide much-needed grid backbone infrastructure to regions serving 40% of American households and over 25% of Department of Defense installations, will be prioritized for investment. Grain Belt Express will deliver $52 billion in cost savings to American energy consumers over 15 years.”

Mike Kelly said that Johnson County over the next few years expected to receive $80 million in federal support. Earlier this week he was in the nation’s capital meeting with members of the local congressional delegation and attending a national gathering of county officials.

Last year, Johnson County received $44 million in federal funding.

The money is used to fund roads, wastewater treatment, police, sheriffs, children, the less fortunate and the aging community.

“Like all other counties, we rely on the federal government for significant partnership,” Mike Kelly said. Going forward, “the number one priority of local officials is to provide all the services we provide to the citizens of Johnson County. It’s going to take some innovation.”

Local and state governments have grown increasingly dependent on the federal government’s ability to raise large sums through taxation that have been returned to local communities to achieve a wide range of policy objectives.

Last year, federal spending directed at state, local and tribal governments amounted to more than $1 trillion.

Warm of MARC said that last week he and his board reviewed 60 grants his organization helps administer from 10 or more federal agencies.

In addition, local governments receive federal funds routed directly to them or from state agencies passing along federal money.

In transportation, “the 2025 projects we programmed totaled $137 million,” Warm said. “About $76 million is obligated and not considered at risk. The remaining $61 million is still in pre-contracting and approval phases and could be considered at risk, though we are hopeful that they will advance in a timely manner and receive federal approval.”

On the human services front, MARC oversees a $12.7 million program that makes fresh fruits and vegetables more readily available to 180,000 low-income people in Kansas and western Missouri.

“That’s continuing but they are slowing down applications for next year,” Warm said. The U.S. Department of Agriculture “has not offered reasons why it was paused.”

Brian Platt, city manager in Kansas City, Missouri, declined to discuss the city’s exposure to possible federal funding cuts at this time.

“Our team is still calculating and estimating these figures,” Platt wrote in an email. “We also aren’t quite sure at this moment exactly what is truly at risk. We can circle back in a few weeks once we’ve had a chance to dig deeper.”

Warm said he would not be surprised if the city’s exposure to federal funding reaches into hundreds of millions of dollars.

Widespread economic impact

In January, Gov. Kelly and Commissioner Kelly attended a briefing at the new $4 billion Panasonic electric battery manufacturing plant in DeSoto, the largest private investment in Kansas history.

Panasonic said it is in line to receive up to $6.8 billion in federal tax incentives by 2032. It is not known to what extent those incentives may be withdrawn. The Trump administration wants to end federal subsidies for electric transportation put in place by the Biden administration.

Both Gov. Kelly and Commissioner Kelly said they do not believe that the Panasonic project, set to open soon, faces any imminent federal support problems.

“They came here not because of the federal tax benefit,” Mike Kelly said. “I fully expect they will be successful.”

Mike Kelly said that change is a constant in government, and he looks to learn and be inspired by others in county and local government around the country innovating despite federal funding challenges.

During the first Trump administration, a new generation of leaders was inspired to get into government.

“I was one of them,” said Mike Kelly, who became mayor of Roeland Park in 2017. He said that cohort notably worked together to forge Climate Action KC, a regional nonprofit dedicated to fighting climate change.

While in Washington this week, Kelly said he reached out to the Trump administration to request a meeting.

“I am hoping I get an opportunity to sit down with the team in the administration,” he said.

Asked if his calls are getting returned, Kelly said, “I know it is a period of transition.”

Gov. Kelly said she is concerned about the fate of the sizable federal workforce in the state, which amounts to 18,000 workers.

She also is focused on state water resources. The governor said her administration has been developing a long-term plan “to ensure that two generations following us will have enough water.”

“It’s all premised on what we’ve gotten from the federal government for decades,” she said. “We’re looking for a dedicated funding source. We have to figure out how to do it well or there won’t be a western Kansas in 50 years.”

In addition, small Kansas cities depend on federal support for relatively small projects, maybe $1 million per community. “Not a ton of money but vital,” Gov. Kelly said.

Kansas farmers have been hurt by cuts in federal foreign aid programs that have been stimulating agriculture exports from the state.

About $6.4 billion of goods, half of all Kansas exports, go to Mexico, Canada and China, three countries currently in a burgeoning trade war with America.

The governor said that pushback from America’s trading partners may lead the federal government to adopt more sensible trade policies.

“Hopefully we figure out how to run the federal government more efficiently in a way that does not undermine the very foundation of our country,” the governor said.

“I am used to working in a difficult environment,” said Gov. Kelly, a Democrat who has had to work with a solidly Republican state legislature. “I figure out ways to get things done.”