Sources reported that at this year’s Nativity County Fair, a fundraising bonanza that could teach the city of St. Paul a thing or two about money, Kaohly Her was an affable attendee, apparently unannounced, engaged and forthright. One fellow told me he could have been knocked over with a feather, as she not only answered his questions but did so without cloying staff or factotums trying to hustle her away for a merry-go-round ride or something similarly safer than talking to an actual voter.

Her is not one of her pronouns. That’s her name.

State Rep. Kaohly Her will be St. Paul’s new mayor, the city’s 55th since Thomas R. Potts kicked us off in 1850. Everything has gone swimmingly. Her won smoothly and without contention. Mayor Melvin Carter was ramrod straight and dignified in his concession. Her was once one of Carter’s policy advisers, of whom he had many. Perhaps Her can trim the heft from a mayor’s office that has grown preposterously bloated with too many assistants to the assistants.

Pinch me, but by all accounts, Her is a detail person who embraces the unglamorous nitty-gritty of trying to make things work.

There is a more important reason to believe that Her is just what the doctor, or our city’s current condition, has ordered. She is 52. She fled Laos with her family 50 years ago. She spent time in refugee camps. It has been reported that her family moved to Chicago, followed relatives to Wisconsin and then joined Her’s maternal grandparents in St. Paul.

The family prospered in St. Paul. Yes, prospered, as in did not wish to accept anything less. They bought houses for a dollar each under a city program and turned a profit. Her’s dad got a college degree. Kaohly went to the University of Wisconsin-Madison. She had a 15-year career in the banking industry, living in Chicago and Maryland before returning to St. Paul after her second child was born.

According to the Star Tribune, Her and her husband saved aggressively and invested in land and housing. She lives on Summit Avenue and the family owns a hobby farm in Stillwater.

Pinch me.

In other words, Kaohly Her is not a professional activist. She has worked and succeeded in the real world. She believes others can as well. She is not a socialist. She apparently doesn’t recite a constant litany of despair, oppression or victimization that she would intend for other people to pay for. It’s easy to sense that she doesn’t suffer fools gladly or in any other way.

Nobody, certainly in the last 50 years, has come into the mayor’s office with such a history of non-political success. She is heavily invested in the city as a homeowner. She has to understand that St. Paul cannot survive the constant property-tax increases. She must understand that spending be brought under control, that government not only must work, but that its employees must show up for work.

Related Articles

Working Strategies: The things you need for networking post-60

Skywatch: Long starry nights are back

Real World Economics: Senators wake up and smell the tariffs

Working Strategies: Job search outreach: Don’t call it ‘networking’

Joe Soucheray: Marjorie Johnson, award-winning State Fair baker, I owe you a great thanks

A fellow can really let the fantasy off the leash about that farm. That means that Her owns stuff and knows how to use stuff. They probably have a tractor and shovels and a lawn mower, pitchforks and a couple of ladders. She not only goes to the hardware store, but maybe even likes going to the hardware store. She is leading the life of a regular person.

This is actually a shock to the system. St. Paul and Minneapolis are governed by young people, some of whom who haven’t done anything except attend gender-issue seminars and anti-police rallies. And along comes a mayoral candidate — she only got into the race in August – who saw her city in decline and decided to do something about it, encourage business growth of any size, trim spending, demand results and accountability from the people she puts in place, wave to a cop once in a while.

Happy days might not be here yet, but the city at least has a chance.

Joe Soucheray can be reached at jsoucheray@pioneerpress.com. Soucheray’s “Garage Logic” podcast can be heard at garagelogic.com.

By Céline Gounder, KFF Health News

In late October, Maine Family Planning announced three rural clinics in northern Maine would close by month’s end. These primary care and reproductive health clinics served about 800 patients, many uninsured or on Medicaid.

Related Articles

Minnesota officials say SNAP benefits will be funded for November

A study questions melatonin use and heart health but don’t lose sleep over it

The ‘hard, slow work’ of reducing overdose deaths is having an effect

From Narcan to gun silencers, opioid settlement cash pays law enforcement tabs

Sock hops and concerts: How some places spent opioid settlement cash

“People don’t realize how much these clinics hold together the local health system until they’re gone,” said George Hill, the group’s president and CEO. “For thousands of patients, that was their doctor, their lab, and their lifeline.”

Maine Family Planning’s closures are among the first visible signs of what health leaders call the biggest setback to reproductive care in half a century. The U.S. Department of Health and Human Services’ Office of Population Affairs, which administers the Title X family planning program, has been effectively shut down. At the same time, Medicaid cuts, the potential lapse of Affordable Care Act subsidies, as well as cuts across programs in the Health Resources and Services Administration and Centers for Disease Control and Prevention are eroding the broader safety net.

“When you cut OPA, HRSA, and Medicaid together, you’re removing every backup we have,” said Clare Coleman, president of the National Family Planning and Reproductive Health Association. “It’s like taking EMTs off the road while closing the emergency rooms.”

Asked about the cutbacks, HHS press secretary Emily G. Hilliard said, “HHS will continue to carry out all of OPA’s statutory functions.”

How the safety net frays

For more than 50 years, Title X has underwritten a national network of clinics, now numbering over 4,000, that provide contraception, pregnancy testing, testing and treatment for sexually transmitted infections, cancer screening, and other primary and preventive care to nearly 3 million low-income or uninsured patients annually. OPA managed nearly $400 million in grants, issued clinical guidance, and ensured compliance.

In mid-October, OPA’s operations went dark amid federal layoffs that also affected hundreds of CDC staffers. “Under the Biden administration, HHS became a bloated bureaucracy — expanding its budget by 38% and its workforce by 17%,” a spokesperson for the department said at the time, adding, “HHS continues to eliminate wasteful and duplicative entities, including those inconsistent with the Trump administration’s Make America Healthy Again agenda.”

According to Jessica Marcella, who led OPA under the Biden administration, the office was previously staffed by 40 to 50 people. Now, she says, only one U.S. Public Health Service Commissioned Corps officer remains.

“The structure to run the nation’s family planning program disappeared overnight,” said Liz Romer, OPA’s former chief clinical adviser.

“This isn’t just about government jobs,” Coleman said. “It’s a patient care crisis. Every safety net program that touches reproductive health is being weakened.”

A policy linking health, autonomy, and opportunity

Created in 1970 under President Richard Nixon and rooted in President Lyndon Johnson’s War on Poverty, Title X was designed as a cornerstone of preventive public health, not a partisan cause. Nixon called family planning assistance key to a “national commitment to provide a healthful and stimulating environment for all children,” and Congress agreed overwhelmingly across party lines.

Sara Rosenbaum, a professor of health law at George Washington University, said the program reflected a pivotal shift in how policymakers understood health itself.

“By the late 1960s, there was a deep appreciation that the ability to time and space pregnancies was absolutely essential to women’s and children’s health,” she said. “Title X represented the idea that reproductive care wasn’t a privilege or a moral issue. It was basic health care.”

UCLA economist Martha Bailey later found that children born after the first federally funded family planning programs were 7% less likely to live in poverty, and had household incomes 3% higher, than those born before. Research by Bailey just published by the National Bureau of Economic Research showed that when low-income women can access free birth control, unintended pregnancies drop by 16% and abortions drop by 12% within two years.

Those findings underscore what Rosenbaum calls “one of the great public health achievements of the 20th century — a program that linked economic opportunity to health and autonomy.”

That bipartisan foundation and evidence-based mission, Rosenbaum said, make today’s unraveling especially striking.

“What was once common sense, that access to family planning is essential to a functioning health system, has become politically fragile,” she noted. “Title X was built for continuity, but it’s being undone by neglect.”

The hidden health risks behind unplanned pregnancies

Family planning is central to maternal and infant health because it gives women the time to optimize medical conditions like high blood pressure, diabetes, and heart disease before pregnancy, and allows them to safely space out their births.

“Pregnancy is the ultimate stress test,” said Andra James, a maternal-fetal medicine specialist who advised the CDC on its contraceptive guidelines. “It increases the heart’s workload by up to 50%. For people with heart disease, diabetes, or hypertension, that stress can be dangerous.”

Brianna Henderson, a Texas mother, learned this firsthand. Weeks after delivery, she developed peripartum cardiomyopathy, a form of heart failure that can occur during or after pregnancy. She survived. Her sister, who had the same undiagnosed condition, died three months after giving birth to her second child. Those kids are now 12 and 16, and they’re growing up without a mom. Their dad and his mother look after the kids now.

“Contraception has been a lifesaving option for me,” Henderson said.

James and other specialists warn that without CDC-informed guidance on contraceptive safety for complex conditions, clinicians and patients are left without clear, current standards.

What history and the data predict happens next

Title X clinics provide millions of STI tests each year and are often the only cancer screening sites for uninsured women. Cuts to Medicaid and ACA subsidies will make it even harder for people to afford preventive visits.

“If these clinics close, we’ll see more infections, more unplanned pregnancies, and more maternal deaths, especially among Black, Indigenous, and rural communities,” said Whitney Rice, an expert on reproductive health at Emory University.

And the geographic gaps are large already. Power to Decide, a nonprofit reproductive rights group, counts more than 19 million women living in “ contraceptive deserts,” where there’s no reasonable access to publicly supported birth control.

“These are places where the nearest clinic might be 60 or 100 miles away,” said Power to Decide interim co-CEO Rachel Fey. “For many families, that distance might as well be impossible.”

The high price of short-term savings

Each pregnancy averted through Title X saves about $15,000 in public spending on medical and social services, according to an analysis by Power to Decide. And an analysis by the Guttmacher Institute shows that every $1 invested in publicly funded family planning programs saves roughly $7 in Medicaid costs.

Cutting federal funding for reproductive health services “isn’t saving money. It’s wasting it,” said Brittni Frederiksen, a KFF health economist and former OPA scientist. “We’ll spend far more fixing the problems these cuts create.” KFF is a health information nonprofit that includes KFF Health News.

Supporters of cuts argue federal spending must be reduced and states should set their own priorities.

Strain on the ground

Affirm, Arizona’s Title X grantee, oversees a statewide network of clinics that provide family planning services to more than 33,000 patients each year.

Affirm CEO Bré Thomas said the state could lose $6.1 million in Title X funding if federal appropriations expire after March 31. It’s a cut that would reduce access to care across the network. “That’s $6.1 million for Arizona,” she said. “That means over 33,000 patients in our state could lose access to services.”

Thomas noted that two consecutive funding reductions, combined with 11 years of flat federal support and rising health care costs, have already strained operations. Without new funding, she warned, clinics may be forced to limit contraceptive options to cheaper methods, reduce preventive care, and lay off staff, especially in rural communities. “We’re talking about impacts to people’s jobs and their ability to access the care they need,” she said.

Megan Kavanaugh, a scientist at the Guttmacher Institute, underscored those limits.

“Federally Qualified Health Centers do not have the capacity to absorb the number of patients who will lose care,” she said, referring to federally funded community-based clinics for underserved populations. “Some people may find another clinic, but a large share simply won’t, and we’ll see that reflected in higher rates of unintended pregnancy, untreated infections, and later-stage disease.”

Hospitals are beginning to absorb the spillover.

“The safety net is shrinking, and hospitals can’t absorb everyone,” said Sonya Borrero, a reproductive health expert at the University of Pittsburgh School of Medicine and a former chief medical and scientific adviser at OPA. “Wait times will get longer, and preventable problems will rise.”

Funding frozen, oversight halted

With OPA offline, Title X dollars already awarded can be spent, but no new funds are moving.

“Most programs can hang on for a few months,” Romer said. “By spring, many won’t have enough money to stay open.”

The halt also suspends compliance reviews and technical assistance tied to CDC-aligned guidelines.

Marcella, the former OPA leader, warned of a “backdoor dismantling.”

“If there aren’t people to administer the grants, then the administration can later argue the program isn’t working and redirect the funds elsewhere,” she said. “This is a functional elimination, done quietly.”

Kavanaugh called the moment “one more step toward dismantling the public health infrastructure that has supported people’s reproductive health for decades.”

Without staff to move money and guidance, she said, “that’s how a system collapses.”

What can still be done

According to the National Association of Community Health Centers, Federally Qualified Health Centers can still use HRSA money that was already approved, even during the government shutdown. But no new funding is being released, similar to the freeze on Title X funds. At the same time, HRSA has stopped first-quarter payments for its Title V Maternal and Child Health program, which limits how states can provide preventive care and services for children and young people with special health needs.

Some states — California, New Mexico, Washington — are plugging holes with state dollars, and health systems are expanding telehealth, but most jurisdictions cannot replace federal support at scale.

“Private donors can’t replace the federal government,” said Hill, of Maine Family Planning. “You can’t crowdfund your way to a working health system.”

Congress could restore Title X and rebuild OPA’s staffing, but without administrators in place, money can’t reach clinics quickly. States have a short window to bridge care by stabilizing Medicaid coverage, shoring up community health centers, and protecting contraceptive access.

“This isn’t a political debate,” Romer said. “It’s women showing up for care and finding the doors locked.”

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

Amy Lindgren

This is the third of 12 columns on career planning post-60, which will appear the second Sunday of each month from September through August.

Everyone has heard it; maybe you’ve even said it yourself: The best way to find work and build careers is through other people. Networking is the common name for this process, although that term (and the practice) can sometimes feel off-putting to the very people who need to do it.

For workers in their 60s and beyond, those are simple problems compared to the reality of a retiring / expiring cohort. To put it bluntly, the older we get, the more likely our contacts have left the workplace (or worse, this mortal coil) on a permanent basis.

Now what? That’s this week’s subject for my Second Sunday series on career planning for workers in their 60s, 70s and 80s.

My job is to a) convince you that networking at this stage in your life is possible, acceptable and useful and, b) help you identify how you might go about it.

We’ll tackle the convincing aspect first. If you’ve been put off by the concept of networking, it may be from a sense of pride or the perception that requesting career help from others is “using” them. Or, you may feel that networking into a job takes unfair advantage or hints of nepotism.

Feelings aside, the facts are clear: Networking is key to creating job opportunities and always has been. To ease any discomfort, try changing the terminology to “building professional relationships.” This might clarify the mutuality of the practice, as well as its importance.

You may still have misgivings, but since you’re still reading we’ll move on to the whys and hows of building professional relationships in your later working years.

The whys go far beyond the possibility that a contact will lead you to a job — although that happens frequently. As you build relationships you’re also broadening your perspective. Each person you talk with in this capacity helps you know more about the field you’re in or currently considering, or provides insight into other fields for you to explore.

Professional contacts can also be problem-solvers, helping you identify the best pathways forward in your work life or connecting you to people who have solutions for whatever challenge you’re facing. They can also provide essential resources or otherwise offer shortcuts that accelerate your process.

These are solid reasons, but how does someone in their 60s or beyond build professional relationships when their own cohort may not be viable? The same ways a younger person does it, but with some variance.

• Attend things. That’s not very specific, for a reason: The broader your interpretation of “things,” the more spontaneous the contacts could be. Rather than focusing only on events designed for networking, broaden your list to include open houses, community forums, conferences, and any other meeting where people from your field (or from a variety of professions) might be gathered. For quality connections, in-person attendance is key.

• Join things. If you know the work you want to do or the broader industry (such as education or health care), joining a related committee or a professional association or even the board of a relevant nonprofit will bring you into immediate and meaningful contact with others in the field.

• Learn things. Anything from hour-long sessions to full certificates or degree programs will introduce you to experts and instructors who might be open to providing additional advice or contacts. As a bonus, the other learners can become a cohort for you.

• Do things. As an example, volunteering can be a good path to building connections with others who share your interests, and to the paid staff of the organizations themselves.

In all four “things” categories — attending, joining, learning and doing — the emphasis is on meeting people in fields that currently or potentially interest you.

Naturally, not every connection will blossom into a relationship but every person you meet can still be part of the larger puzzle. For that reason, remember to collect contact information when possible, while asking if they’d be open to a conversation at some later point.

After the initial encounter, sending a brief email or text is both gracious and strategic. This lets them know you valued the time together, while also providing them a cue to respond if they’d like.

If these connecting practices don’t come naturally to you, give them time. They get easier, and the rewards can be life-changing.

Related Articles

Working Strategies: Job search outreach: Don’t call it ‘networking’

Working Strategies: Job search best practices require discipline

Working Strategies: Customize cover letters, but there are shortcuts

Working Strategies: Job search over 60: “purpose” vs. paycheck

Working Strategies: Making the most of college internships

Amy Lindgren owns a career consulting firm in St. Paul. She can be reached at alindgren@prototypecareerservice.com.

Bernard J. Wolfson, KFF Health News

Medical educators and health professionals warn that new federal student loan caps in President Donald Trump’s tax cut law could make it more expensive for many people to become doctors and could exacerbate physician shortages nationwide.

Related Articles

Minnesota officials say SNAP benefits will be funded for November

A study questions melatonin use and heart health but don’t lose sleep over it

The ‘hard, slow work’ of reducing overdose deaths is having an effect

From Narcan to gun silencers, opioid settlement cash pays law enforcement tabs

Sock hops and concerts: How some places spent opioid settlement cash

And, they warn, the economic burden will steer many medical students to lucrative specialties in more affluent, urban areas rather than lower-paying primary care jobs in underserved and rural communities, where doctors are in shortest supply.

“The growing financial barriers may deter some individuals from pursuing a career in medicine, particularly those from low-income backgrounds,” said Deena McRae, a psychiatrist and associate vice president for academic health sciences at University of California Health.

The new federal loan limits, which are enshrined in the GOP legislation signed by Trump on July 4, cap the amount professional degree students can borrow at $50,000 a year, up to a maximum of $200,000 — well below the average cost of a four-year medical school education.

For students who graduated this year with an MD degree from a four-year medical school in the United States, the median cost of attendance was $318,825, according to Kristen Earle, director of student financial services at the Association of American Medical Colleges. And for those who entered a U.S. medical school in the 2024-25 academic year, the median first-year cost was $83,700.

Health care experts and politicians on both sides of the aisle agree that medical schools must find ways to lower their costs, but critics of the loan caps say limiting federal lending isn’t the answer. Congressional Republicans, who voted for the caps, say they are intended to stem a sharp rise in federal student lending over the past two decades that has driven the cost of attendance higher.

“Uncapped loan limits gave no incentives for schools to reduce any of their costs, recognizing that taxpayers, students, or students’ families would eventually foot the bill,” said Sara Robertson, a spokesperson for the GOP-controlled House Committee on Education and Workforce. “Our reforms and loan limits will put downward pressure on costs to provide better outcomes and lower debt for all students.”

The budget law brings back caps for graduate and professional education that Congress eliminated in 2006. Since then, students have been able to get federal loans that cover the total cost of their degree programs. Reimposing the caps, along with other changes to federal student loans, is expected to save the federal government $349 billion over 10 years, according to the Congressional Budget Office.

Whether the new federal loan policy will push down tuition costs remains to be seen.

Robertson pointed to a 2023 study by the National Bureau of Economic Research showing that the more generous federal lending policy since 2006 has led to “significantly higher program prices” in graduate education. The study also found that the additional federal support failed to increase enrollment in graduate programs, including for underrepresented students.

However, data provided by the Association of American Medical Colleges shows that cost-of-living increases, not tuition, drove up the expense of studying medicine in recent years.

Students already in medical school who have taken out federal loans before the new rules take effect on July 1 will be exempted from the cap. But students whose loans are capped under the new law will need to make up the difference, in many cases by taking out private sector loans, which typically have less flexible repayment terms and require a strong credit rating — a heavy lift for students from low-income communities.

Robertson cited a 2017 analysis showing that nearly 60% of graduate students could have obtained a private loan at a lower interest rate than any available federal loan. Federal loans, however, come with advantages that private loans don’t. For instance, federal loans can include monthly repayments calibrated to income, and they offer two debt forgiveness paths, including the Public Service Loan Forgiveness program, which erases the balance for those who work in a government or nonprofit organization and make their monthly payments for 10 years.

Critics and proponents agree on at least one thing: Now is the time for medical schools to think creatively about lowering costs for students. This might include reduced tuition, more chances for debt forgiveness, and accelerated programs that allow students to graduate in three years rather than four, reducing costs by 25% and getting them more quickly into paid jobs.

“I hope that coming out of this, medical schools and others find a way to seize the moment and help us figure out how to reduce the total cost of medical school,” said Martha Santana-Chin, CEO of L.A. Care. “Maybe this is an opportunity for us to rethink how the system is working.”

Roughly a fifth of medical schools offering an MD degree have accelerated programs, including the University of California-Davis, according to the Consortium of Accelerated Medical Pathway Programs.

A data analysis of eight medical schools led by the NYU Grossman School of Medicine, whose core MD curriculum is three years, shows that students in three-year programs derive a lifetime financial gain totaling over $240,000 due to the cost savings of less time in medical school, interest not paid on the corresponding amount not borrowed, and faster progression to a salaried position.

In addition to lowering costs, accelerated medical programs seek to address health care workforce shortages by training physicians more quickly. And with the new loan caps about to make it more difficult for many students to finance their medical education, these programs suddenly have a new timeliness.

Students who spend three years in medical school instead of four have lower debt and get to a higher salary sooner, said Caroline Roberts, a family physician and director of rural education at the University of North Carolina’s School of Medicine. UNC offers a three-year track for students who want to be primary care doctors and work in rural areas of the state, where doctor shortages are a major problem.

Zoe Priddy, who is in her second year of UNC’s three-year program, said that if the federal loan limits had been in place at the time she was making plans to attend medical school, she would have needed a job that paid better than the research lab where she worked after completing her undergraduate degree.

“I would have had to change my trajectory if I still wanted to pursue medicine, and I don’t know if it would have been possible for me,” Priddy said. However, the lower debt associated with the three-year track “eased my decision” to go into pediatrics, a lower-paying specialty, she said.

(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.