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Indiana proposal to boost nuclear development, recover costs from customers clears committee

Indiana proposal to boost nuclear development, recover costs from customers clears committee

Yahoo12-03-2025

Rep. Ed Soliday, R-Valparaiso, leads an energy committee on Tuesday, March 11, 2025. (Leslie Bonilla Muñiz/Indiana Capital Chronicle)
Indiana legislation boosting early forays into nuclear power earned utility company support on Tuesday, but passionate opposition from ratepayer groups. It advanced from committee on a bipartisan 10-3 vote.
With demand on the rise, Hoosier political and energy leaders are increasingly eyeing emerging technology — small modular nuclear reactors, or SMRs — as a possible solution.
The United States hosts no operational SMRs. Across the globe, only China and Russia have functional ones. Some want Indiana to lead, but nuclear development is pricey.
Sen. Eric Koch, R-Bedford, told the House's energy committee that he hopes to 'incentivize earlier deployment by removing what I understand to be the single-biggest barrier.'
His Senate Bill 424 would offer public utilities bringing SMRs to Indiana a path to recover pre-construction costs — including anticipated spending — from their customers before they obtain certificates of public convenience and necessity from the Indiana Utility Regulatory Commission.
Included are expenditures for design; engineering; environmental analyses and permitting; federal approvals, licensing and permitting; equipment purchases and more.
Once the IURC gives a utility permission to start spending, the company would be able to request approval of a rate schedule to pass those costs on to customers. Regulators would have to approve if they find the costs reasonable in amount, consistent with their best spending estimate, and necessary to support SMR development.
A utility could recover 80% of approved costs under the resulting rate schedule within three years at most. It would defer the remaining 20% for recovery as part of its next general rate case.
Indiana Michigan Power — one of the state's 'big five' investor-owned, regulated monopolies — featured heavily in discussion.
Two of the state's largest incoming data centers, for Amazon Web Services and Google, will be in I&M territory. President and CEO Steve Baker said tax incentives and other economic development efforts are drawing more big customers and big loads into Indiana.
'Our customers are concerned about our ability to supply these loads and do that in a sustainable sort of way,' Baker told the committee.
I&M is 'considering' an SMR at its coal-fueled Rockport power plant, he said, which is set to shutter in 2028 by federal consent decree. A state-funded Purdue University report last year found the plant is among eight Indiana coal plant sites well-suited to SMR development.
Several representatives from Spencer County, which hosts the plant, said the legislation would ensure a major property tax contributor, charitable giver and employer stays in their community.
That prompted Rep. Matt Pierce, D-Bloomington, to remark later, 'I can understand why, from the perspective of the locals, they would certainly want to have that project built, particularly if the cost of the project is borne by people outside of their area.'
Ratepayer advocates maintained opposition.
'Say no, no, to subsidizing financially healthy, investor-owned utilities (and) tech behemoths who have deep, deep pockets,' Citizens Action Coalition Executive Director Kerwin Olson said.
Olson expected I&M to begin its cost recovery asks once the bill becomes law — although an SMR wouldn't come online at Rockport until at least 2036, in the utility's estimate.
'If they make a filing in 2025 or 2026, whatever they file for, this bill says they have to recover that by 2029 — for a project that may never, ever happen,' Olson said. '… Where are the provisions that require the utilities to refund customers their money?'
Koch previously said his proposal contains 'important consumer protections.'
Under Senate Bill 424, costs exceeding the IURC's best estimate wouldn't get passed to ratepayers unless regulators deem the spending 'reasonable, necessary, and prudent' in supporting reactor development.
Expenditures for canceled or abandoned projects wouldn't be recoverable without the same 'reasonable, necessary, and prudent' finding. Even so, a utility wouldn't earn returns in such cases unless regulators also find the decision was 'prudently made for good cause,' that profit is 'appropriate … to avoid harm' to the utility and its customers; and that costs will be offset or reimbursed through other, listed means.
Olson and others weren't convinced.
'I think 'reasonable' and 'prudent' are my least favorite words in the English dictionary; (they're) written by lawyers for lawyers,' Olson said. He noted that the legislation doesn't define those terms. His other concern: 'It's the 'shall' provisions. The bill is littered with, 'The utility shall recover,' (and) 'The commission shall approve.''
Delaney Barber Kwon, the community and government affairs manager for Indiana Conservation Voters, asked the committee to consider alternative ways to support SMR development, like tax credits, public-private partnerships and more.
Joe Rompala, representing Indiana Industrial Energy Consumers Inc., similarly requested that lawmakers pursue other forms of cost recovery, like the partnership-heavy pilot program in Senate Bill 423. The trade organization includes more than 20 of the state's largest energy consumers, he said.
Sam Carpenter, executive director of the Hoosier Environmental Council, noted that Virginia has capped SMR development cost recovery totals to just $125 million over five years and limited rider increases for the typical residential customer to $1.40 monthly.
Disagreements abounded over the legislation's timing.
Pierce, the Bloomington Democrat, said SMR is 'not quite proven' and that Indiana should wait for the technology to get better and cheaper. Advancing Koch's proposal now, he said, would make ratepayers into 'guinea pigs for this experiment called an SMR.'
But I&M's Baker previously feared that if Indiana moves too slowly, it may struggle to compete for power-needy economic development projects. Baker said I&M wants to ensure that 'we're not too far in front, but we're not so far behind that we don't have the ability to act on this.'
The legislation earned a full-throated endorsement from Energy and Natural Resources Secretary Suzanne Jaworowski, one of Gov. Mike Braun's cabinet appointees.
She said this chance to 'deploy proven technology' aligns with Braun's agenda and 'all-of-the-above approach' to energy.
'This is (such) a unique moment in time that I don't want to see Indiana miss out on the opportunity to have federal support, private-public partnership support,' Jaworowski said. 'Not only do we have a demand signal from industry that they want this technology, … they're also willing to help pay for it so that it is not all on the backs of the ratepayers.'
Identical language within another measure, House Bill 1007, has also crossed into the Senate.
That's after the committee on Tuesday stripped out the only difference: a 2035 expiration date on the cost-recovery provisions. Chair Rep. Ed Soliday, R-Valparaiso, said he 'convinced' Koch to remove it because 'we don't know when these are going to come online.' The Indiana General Assembly meets often enough that it can enter a date later if needed, he said.
The twinned language is necessary because lawmakers plan to push both across the finish line, Soliday told the Capital Chronicle, citing 'powers above my head.'
The committee didn't take up detailed edits filed for a carbon dioxide storage and transmission measure — or accept testimony — before a vote.
Author Sen. Sue Glick, R-LaGrange, has dubbed it a 'clean-up' effort for previous legislation. Lawmakers authorized a pilot project, led by Wabash Valley Resources, in 2019 and revisited it in 2023. In between, in 2022, they established regulations for carbon sequestration projects and exempted the pilot from those requirements.
Glick's Senate Bill 457 seeks to build on those endeavors.
Indiana Senate approves education measures, narrowly OKs carbon storage measure
It would exempt pipeline companies from needing to get certificates of authority in certain cases. The legislation would also create a permit for exploratory wells and well conversions; add inspection provisions; charge new fines for legal violations; and tweak other fee amounts.
It would direct fee and fine proceeds away from topic-specific funds toward the state's General Fund — changes made by Sen. Ryan Mishler, R-Mishawaka, who leads the powerful Senate Appropriation Committee.
An exhaustive amendment filed ahead of the committee's meeting would've undone that, redirecting monies back to carbon sequestration trust and administrative funds and specifying that the funds exist to defray state spending to manage and monitor projects. It wasn't called.
'The chair will not be accepting any amendments,' Soliday said during the meeting. 'There will probably be an amendment as a trailer to another bill. The debate is who can create funds.'
'We are at the mercy of the Appropriations Committee, as you all know, and (the) Ways and Means (Committee),' Glick added later. 'So we'll live with whatever they decide we can do.'
Senate Bill 457 will head there next for a finance-focused review, after committee members advanced it in an 11-2 vote featuring bipartisan support. Rep. Tim Wesco, R-Osceola, critiqued the concept but voted in favor.
'Carbon sequestration, in my view, is likely the most expensive boondoggle of this decade. It is wasteful and pointless — but, I feel, otherwise harmless,' Wesco said. 'Companies … want to spend money to do it, so, we'll let them.'
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Back in December, Rep. Dustin Burrows' grasp on the speakership was, at best, tenuous. His main rival, Rep. David Cook of Mansfield, had already won the endorsement of the House Republican Caucus, a victory his backers argued should've clinched his ascent to speaker of the GOP-controlled Texas House. Instead, Burrows, surrounded by Republicans willing to defy caucus rules, claimed just minutes later that the race was over and that he had the 76 votes needed to lock up the gavel. He touted an even mix of Democratic and GOP support, though some Republicans immediately asked for their names to be removed, pushing him back under the threshold to win. The competing pronouncements deepened a bitter, months-long power struggle within a Republican Party that had churned through three speakers in four sessions, and it amplified demands by grassroots activists to sideline Democrats and lean into the party's most partisan impulses. 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Burrows began the session with a clear eye toward retaining the speakership and detaching himself from the tenure of his now-politically radioactive predecessor, Beaumont Rep. Dade Phelan. He aligned the House closely with Lt. Gov. Dan Patrick, the powerful presiding officer of the Senate and frequent antagonist of past speakers, and built goodwill with Gov. Greg Abbott by prioritizing school vouchers, the governor's top priority. And he worked methodically to win over skeptical members of his caucus, giving some committee chairmanships and making sure others saw their pet issues reach the floor. A careful tactician with years of experience in House leadership, Burrows managed to deliver almost all major Republican priorities, including vouchers, tougher bail laws and a raft of socially conservative policies. Yet he did so without fully alienating the Democrats who powered him to the speaker's chair, even as they saw their party's priorities die and failed to stop most of the GOP's top items. 'We really didn't know what to expect because of how he was elected,' said Rep. Mitch Little, a Lewisville Republican and Cook devotee who once slammed Burrows' supporters for making a 'brazen attempt to circumvent the will of the voters.' 'But to be quite honest,' Little said at the end of the session, 'if he had been elected by all Republicans, I don't know how this session would have really gone any differently.' Complaining about the few unfinished items, he added, would be 'picking nits more than anything.' Not everyone came away from the session happy. Some far-right lawmakers and activists continued to bemoan that the Legislature didn't provide enough property tax relief and that other legislation was left on the table, including a sweeping bill to restrict the flow of abortion medication into the state and legislation to require proof of citizenship to register to vote. 'I cannot go back in good conscience to my constituents and tell them that out of $24 billion in surplus money that belongs to them, I supported a budget that only is going to return $6.5 billion,' Rep. Mike Olcott, R-Fort Worth, said on the floor in opposing the House's budget proposal for not devoting enough to tax cuts. Some Democrats walked away feeling like they got little for their vote to secure Burrows' speakership, having expected more conservative legislation to get bottled up by the speaker's appointed committee chairs. Democrats were particularly incensed about a bill banning K-12 student clubs focused on sexuality and gender identity, which they argued would endanger children and strip them of their dignity. Rep. Rafael Anchía, a Dallas Democrat whose daughter was vice president of a school pride club, told the Tribune in the final days of session that he ​​'didn't sign up for five anti-LGBT bills this session.' It was an allusion to other measures Burrows greenlit through the House, including one that strictly defines man and woman in state records based on reproductive organs — a change that could have far-reaching implications for transgender Texans. Still, barring an unexpected challenger or upheaval in the 2026 elections, Burrows is primed to maintain control of the chamber with greater Republican support, while avoiding the level of scorched-earth infighting that defined the end of Phelan's speakership. And despite the session's conservative bent, Democrats have not shown any makings of a revolt that could imperil Burrows' position. 'He knows that we have a voice, and he knows we represent a whole lot of Texans, so he did give us some opportunities to be heard, at least,' Rep. Ramon Romero Jr., D-Fort Worth, said. 'He's a good listener. Because of that, I welcomed the opportunity to minimize as much damage as I could.' Burrows' elevation by Democrats to speaker was met with immediate skepticism from many Republicans, and, importantly, from Patrick, who tightly controls the Senate. 'If he can pull it off — if he is the Houdini of the House, and he can pass all the conservative bills that we want — then I'll pat him on the back and say job well done,' Patrick said in an interview with The Texan News, while also emphasizing that he was willing to give Burrows a chance. 'But man, he's put himself in a tough spot.' In his acceptance speech after winning the gavel, Burrows promised to protect the House as an independent institution, where lawmakers could disagree with each other without fear of repercussions and get a fair shake, even if they'd opposed him. 'This is the people's House,' he said. 'I commit to you today: Every member will have a voice.' To many members, he followed through. His goal from the start, several lawmakers of both parties said, was to ensure all members felt like they were able to contribute to the work of the House, and to establish a solid footing with the Senate and governor's office. 'Whether someone supported me for speaker or not,' Burrows said, 'my message was the same to every member: If you're serious about governing and ready to do the work, you'll have a voice at the table.' Hardline Republicans won their main demand of barring Democrats from chairing committees, ending a House tradition in place since the 1970s that preserved a smidgen of power for the minority party. Still, Burrows worked to ensure that Democrats would continue to have a role to play, granting them a vice chair position on each panel that some later said helped foster a sense of cooperation. And he held regular, substantive meetings throughout the session with both chairs and vice chairs, according to lawmakers in both parties. Burrows' committee assignments also signaled a desire to move beyond the infighting, lawmakers said. He appointed four Republicans who opposed his speakership to lead various panels, and he named Rep. Gary VanDeaver, R-New Boston, to chair the Public Health Committee — a move that VanDeaver said he took as a vote of confidence, despite his opposition to school vouchers, a major GOP priority of the session. 'He forgave the people who had come after him,' the rural Republican said. 'It was clear that he wanted to let bygones be bygones and bring the House together and work for the future. And I think it paid off.' Burrows also worked to develop his relationship with Patrick and advance Abbott's priorities, all seven of which made it across the finish line. It was a stark departure from Phelan's last term, when his bitter feud with Patrick boiled over into multiple special sessions on property taxes, border security and vouchers — issues that were each wrapped up by the time lawmakers adjourned this week. The speaker's interest in wiping the slate clean was evident when, in early March, he handed over two boxes of 'detailed expenditures' outlining how much the House spent on Attorney General Ken Paxton's impeachment in 2023. That fulfilled Patrick's longstanding insistence on auditing each chamber's impeachment spending and symbolically closed the chapter on an issue that divided the chambers above all else. Throughout the session, the 'Big Three' also met weekly for breakfast, and Patrick refrained from publicly criticizing Burrows, even when it seemed the House was moving slowly. 'The alignment of interests between the three this time, and the assessment that each made about getting along to some extent with the other, also helped Burrows,' said Jim Henson, director of the Texas Politics Project at the University of Texas at Austin. 'That was clearly purposeful.' Burrows also made early moves to consolidate his support among Republicans, the majority of whom had opposed his bid for speaker. The House took up and passed the voucher program early in the session, clearing away a top priority of Abbott and Patrick's that had torn Republicans apart in the past. The vote also earned Burrows and every other pro-voucher Republican a pledge of support from President Donald Trump, whose endorsement is significant with GOP primary voters. And Burrows freed members to pursue their priorities, regardless of their seniority or whether they initially supported him, lawmakers said. Little, the anti-Burrows Republican who was serving his first term, was thrust into the middle of high-stakes negotiations over bail policy, a top priority of Abbott and Patrick's, and over legislation to curb personal injury payouts. Rep. Shelley Luther of Tom Bean, another freshman Republican who had vowed to oppose the Burrows-Phelan leadership contingent, carried a conservative priority through the House to hold vaccine manufacturers liable for injuries caused by their vaccines. 'The members that wanted to show up for work every day and represent their districts and roll up their sleeves and go to work found a speaker that was ready and eager to lock arms with them and put them to work,' GOP Rep. Jeff Leach of Allen, a close Burrows ally, said. Those who came to the Capitol intent on playing politics or elevating themselves, he added, were 'probably leaving Austin feeling pretty frustrated right now, and that's a good thing.' Any flashes of right-wing opposition throughout the session were quickly dispatched. In April, Rep. Brian Harrison, R-Midlothian and chief House agitator, raised a motion to oust Burrows from the speakership. The motion was swatted down, with all but one other member rejecting it and House lawmakers jeering during Harrison's speech. Burrows 'used that as a tool to draw the caucus together,' Little said. Harrison, who sought to be the voice of the resistance, ultimately alienated many of his natural ideological allies, Henson said. He posted frequently on social media accusing the House of not working — even as members were grinding through all-day committee hearings — and was openly accused by his colleagues of using theatrics to raise his own political profile. Harrison's 'particular profile and people's impression of him,' Henson said, 'disrupted any chance of a real, sustained, active opposition to Burrows from inside the caucus.' In a statement, Harrison said that the 'only thing the caucus was united in was passing big government liberalism,' pointing to what he cast as insufficient property tax relief and a bloated budget, among other issues. 'Texans deserve leaders willing to stand up to the swamp, even if it means standing alone,' Harrison said. 'My motion to vacate speech was the most enduring truth spoken on the floor all session, and I was speaking for every freedom-loving Texan who was betrayed.' By the last month of session, Republican priorities — including socially conservative items like a requirement that the Ten Commandments be posted in public school classrooms, bills targeting transgender Texans, and a ban on diversity, equity and inclusion in K-12 schools — were winning approval in the House at a steady clip. Burrows, whose record as a member focused more on property tax relief and limiting the powers of progressive city leaders, was quiet on many of the red-meat issues that featured prominently on Patrick's priority list. Instead, Republican lawmakers said, he let the members decide. 'My role as speaker is to call balls and strikes, managing the legislative process so the priorities of the chamber move forward when they have the support to pass,' Burrows said. 'And the truth is, the House and Senate found alignment on a number of long-debated issues. That's not about falling in line — it's about recognizing when the timing, support and momentum are there to act.' Any one of those items failing could have triggered a fight with the Senate. Their passage reflected not only the speaker's firm conservative views, lawmakers said, but also a chamber remade by last year's cutthroat primaries. Burrows accepted the House's appetite for a more ambitious conservative agenda, rather than fighting to preserve the role it once played in moderating Patrick's hardline impulses. 'The House is lurching toward more conservative representation,' Little said. 'Burrows appreciates that, and is using that moment to his advantage to move the policy initiatives that he has to move.' The House's close alignment with Patrick, however, raised the question of whether Burrows had stood up for his chamber enough against the Senate. Though some argued that the ideological alignment between the bodies meant Burrows didn't have to fight back as much as previous speakers, critics of the dynamic argued that the speaker let the House and its members get run over by the Senate on a few key issues. Some lawmakers argued that Burrows made a critical tactical error in passing school vouchers so early in the session without an ironclad agreement that the Senate would move in tandem to approve the House's public school funding package. Burrows had branded the two bills as the 'Texas Two-Step,' in an effort to help soothe lawmakers who were open to supporting the voucher program but worried about its effect on public schools. Instead, the school funding package got caught in negotiations that became colored by an unrelated Patrick priority: a ban on all THC products. Though Rep. Ken King, R-Canadian and chair of the influential State Affairs Committee, developed a sweeping regulatory framework that would have preserved some THC products, the House reverted his legislation to a ban, with supporters pointing to a promised expansion of Texas' medical marijuana program as a counterbalance. At first, the expansion Patrick agreed to did not go as far as some House lawmakers who supported the THC ban believed. That gave some the impression that the House had been played. Still, Patrick later agreed to the core elements of the House's proposed expansion of the Texas Compassionate Use Program, and on school funding, lawmakers arrived at a compromise both sides could endorse, with Burrows playing a central role in the negotiation. Burrows argued that the voucher program always had the votes this session, and was never a 'trade-off or a bargaining chip.' 'It was never a matter of trading this for that, or the House would have moved them in one bill or made them contingent on the other,' he said. The school finance bill was a massive and complex package that couldn't be rushed, he said, adding, 'It was never a matter of 'if.'' Leach, who spearheaded negotiations with the Senate on a number of high-priority bills, added that the openness between Burrows and Patrick 'helps all of us do our jobs.' 'I was in those rooms, and the relationship between the chambers is strong,' Leach said. 'You've got House members and senators working together like we haven't in a really long time.' In a statement last month, Patrick disputed the notion that either chamber 'gets its way over the other' and noted that, without cooperation from both, 'nothing gets to the governor's desk to be signed into law.' 'The Speaker and I don't keep track of what's a Senate bill or a House bill,' Patrick said. While some Democrats found meaningful roles behind the scenes and a willing audience in Burrows, others left the session feeling betrayed. One Democratic lawmaker, who requested anonymity to speak candidly, said their 'biggest regret' of the session was supporting Burrows for speaker. 'He couldn't have won without us, and we've gotten run over on almost all of our major issue areas,' the lawmaker said. 'He ran on protecting the House from the lieutenant governor and the governor. That was his pitch to Democrats. That has certainly not happened. If anything, the governor and the lieutenant governor have way more influence and control of the House than they ever have.' Other Democrats maintained their support for Burrows, arguing that he protected the institution, recognized that he was speaker of the entire House and provided space for Democrats to express their preferences and dilute some conservative legislation they largely did not support. Burrows especially developed a relationship with Democratic members of the Mexican American Legislative Caucus, lawmakers said. To demonstrate the House's resolve, lawmakers of both parties pointed to the bail package, which the House amended to win the requisite bipartisan support while rejecting two other proposals demanded by Abbott. Members also spotlighted the school finance bill, which included Democratic priorities such as pre-K funding and more flexibility for school districts than the Senate had initially proposed. The changes those bills underwent, the lawmakers said, reflected the ability of House Democrats and Republicans alike to make their mark on priority legislation. 'The fact that Dustin is a rock solid conservative should surprise no one,' Leach said. Still, he added, if lawmakers 'wanted to work and fight for their values, even if it's stuff that he disagreed on, they were able to do so. Maybe not successfully — but the House was the people's House, and that's largely due to his leadership.' The alternative, as promised by Cook and the insurgent movement, was to prevent any Democratic bills from receiving a vote before all conservative priorities passed, and to cut Democrats — who make up more than 40 percent of the House — out of dealmaking entirely. As he gaveled out the session on Monday, Burrows noted how much the chamber had evolved since January. 'We started the session as a House in a bit of uncertainty,' he said as lawmakers embraced and readied themselves to leave Austin. 'I believe that we ended in a much more unified and solid place.' Disclosure: University of Texas at Austin has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here. Big news: 20 more speakers join the TribFest lineup! New additions include Margaret Spellings, former U.S. secretary of education and CEO of the Bipartisan Policy Center; Michael Curry, former presiding bishop and primate of The Episcopal Church; Beto O'Rourke, former U.S. Representative, D-El Paso; Joe Lonsdale, entrepreneur, founder and managing partner at 8VC; and Katie Phang, journalist and trial lawyer. Get tickets. TribFest 2025 is presented by JPMorganChase.

Trump's new budget bill hides an assault on hospice
Trump's new budget bill hides an assault on hospice

Yahoo

timean hour ago

  • Yahoo

Trump's new budget bill hides an assault on hospice

President Trump's 'big beautiful bill,' which passed the House with almost unanimous Republican support on May 22, mandates $500 billion in cuts to Medicare. This is a cruel assault on some of the most vulnerable Americans that will strip them of vital health care services. It will also take an axe to hospice, which relies on Medicare reimbursement to function. Since 1982, when Medicare first began covering hospice, Americans have turned to it for essential end-of-life services that address the specialized needs of the dying and allow for death with dignity. Our current system doesn't always run perfectly and would benefit from greater funding and support. I know this because when my mother was 99.5 years of age and less than six months away from her death, medical staff at our local hospice agency determined she was not, in fact, dying soon enough. Presumably adhering to Medicare guidelines, they callously discontinued our hospice services. The abrupt cessation of care prompted my debilitated mom's eviction from an assisted living facility. The chaotic aftermath necessitated medicine, schedule and equipment adjustments for her and delivered a massive blow to me, her primary caregiver. Fewer resources means this financially draining and emotionally wrenching situation will become more common — perhaps even the norm. The shifting demographics make the picture even bleaker. The U.S. is a rapidly aging population, with the number of Americans ages 65 and older expected to more than double over the next 40 years. At a time when we should be buttressing hospice services, our government is threatening to starve them. According to the Office of the Inspector General, 'About 1.7 million Medicare beneficiaries receive hospice care each year, and Medicare pays about $23 billion annually for this care.' Hospice is an interdisciplinary service that provides everything from pain relief to spiritual support to medication management to dietary consulting to mobility equipment to bereavement counseling. While the price tag may sound hefty and our current administration would like us to believe that public services are an unbearable financial burden, an investigation published in the Journal of American Medical Association Health Forum found that hospice saves Medicare money. Research shows that hospice significantly benefits dementia and cancer patients at the end of their lives. On May 19, 2025, the Journal of the American Geriatrics Society published a study of 51,300 assisted living residents that concluded, 'Higher frequency of hospice staff visits was associated with better perceived hospice quality. Policies supporting greater hospice staff engagement, including nonclinical staff, may enhance end-of-life care experiences for assisted living residents.' The report matters because the findings illuminate the humane need for both clinical and nonclinical treatment that provides for medical and emotional support as life ends. We all heard President Trump campaign on promises to protect Medicare, but Richard Fiesta, executive director of the advocacy group Alliance for Retired Americans, describes the ongoing national budget scene as 'an all-out assault on Medicare and Medicaid that will hurt older Americans in every community across the country.' And Shannon Benton, the executive director of the Senior Citizens League, another advocacy group, now warns that the potential Medicare cuts could lead to lower reimbursement rates. This would be disastrous for millions of Americans and would threaten to eradicate end-of-life care as we know common belief, hospices are not run by volunteers. Volunteers might become part-time visitors or assistants for a variety of tasks, but hospice administrations are led by professionals who are evaluated on financial performance and organizational viability. Palliative care is free to recipients and families and available at all income levels, but hospices are businesses, and they must raise sufficient funds through donations, gifts, bequests and reimbursements to compensate employees, repay loans, cover operating costs, and plan for exigencies. Simply put, much of that money comes from Medicare. Specialized care for the dying was introduced to the U.S. in 1963, when Yale University's then dean Florence Wald invited Dame Cicely Saunders of the U.K. to participate in a visiting lecture at Yale. At that time Saunders said, 'We will do all we can not only to help you die peacefully, but also to live until you die.' Four years later, in 1967, Saunders created St. Christopher's Hospice in the U.K. Later, in 1974, Florence Wald founded Connecticut Hospice in Branford, Connecticut — America's first hospice. Within five years and after several national conferences, the U.S. Department of Health, Education and Welfare acknowledged that hospices provided alternative care programs for Americans losing their lives to terminal illnesses. Federal hospice regulations were drafted. In 1982, Medicare added hospice care to its benefits, and in 1985, Medicare hospice coverage became permanent. With that, the U.S. recognized the right of its citizens to die with dignity. Forty years later, our government has signaled that a rollback of that right may be on the horizon. Eventually, my mother died in a highly regarded long-term care complex without hospice support and with no prescribed opioids. It was an unnecessarily excruciating death that exacerbated my and my family's grief. The trauma we suffered was destabilizing and healing from it was slow and difficult. If Trump's Orwellian-named 'big beautiful bill' passes the Senate, I fear our experience will have been an ugly preview of what is to come.

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