Thursday, January 18, 2018

County-level maps show one reason opioid epidemic worsens: lack of treatment, especially medication-assisted

HIV/AIDS advocacy group amfAR offers three maps that illustrate some reasons for the worsening opioid epidemic. They show three things: the number of substance-abuse treatment facilities in each county, which facilities provide at least one medication for opioid addiction, and which provide all three kinds of available medications for opioid addiction, German Lopez reports for Vox.
mfAR maps; clicking on the images will enlarge them slightly.
The first map makes clear that there are a lot of coverage gaps, especially in rural America. It likely understates the level of addiction treatment available in some areas, since doctors can prescribe medication-assisted treatment (MAT) drugs like buprenorphine through a special waiver in their general practice, and that wouldn't show up on the first map, so they did this one:
The number of MAT facilities is markedly smaller, 41.2 percent of the 12,000-plus facilities, German reports. That's an issue, because MAT is "widely considered by experts to be the gold standard in opioid addiction care," German reports, cutting mortality rates among opioid addicts by half or more. MAT is considered so effective that President Trump's commission on the opioid crisis called for a big expansion of MAT.

The last map shows an even smaller subset of treatment facilities: those that offer all three kinds of MAT. "The individual types of medications don’t work for everyone — nothing in addiction treatment does — so it’s important to provide multiple options," German reports.
One reason for the lack of substance-abuse treatment facilities is social stigma, but another is federal funding. "In the past few years, for example, the only new federal effort to dedicate a serious amount of money to the opioid crisis was the Cures Act, which committed $1 billion over two years," German reports. But experts say tens of billions of dollars are needed annually to deal with the opioid epidemic.

Stanford University drug-policy expert Keith Humphreys told German, "Crises in a nation of 300 million people don’t go away for $1 billion. This is the biggest public health epidemic of a generation. Maybe it’s going to be worse than AIDS. So we need to go big."

Bipartisan report says not all rural areas need a hospital

According to a new study by the Bipartisan Policy Center, a one-size-fits-all approach won't work in curing rural America's health care woes. BPC and the Center for Outcomes Research and Education spoke with more than 90 national thought leaders and key stakeholders about the state of rural health in the Upper Midwest states of Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming.

They wanted to understand the real-world implications of federal health policies, discover what health-care challenges the area is facing, and identify ways rural health care could improve. The report could be useful to policy makers in other parts of the U.S., since the problems found are not unique to the Upper Midwest.

One conclusion of the report that could surprise or upset many people: Not every rural community needs a hospital. The Rural Emergency Acute Care Hospital Act proposes turning critical-access hospitals in some communities from inpatient care centers to rural emergency centers or other useful facilities.

The report also recommends creating funding mechanisms for rural health care that reflect specific problems in rural areas, such as low population and high operating costs. It also recommends that rural communities start grooming young, local residents to become health-care workers through middle school, and high-school programs that encourage their interest. Finally, the report recommends expanding telemedicine services, noting that broadband availability is an ongoing problem in doing so.

FCC chairman proposes $500 million for rural broadband

Federal Communications Commission Chairman Ajit Pai has proposed an order that would provide $500 million in additional funding to bring broadband internet to rural America. The funding would go to cooperatives and small telecommunications companies. The proposed order hasn't been released yet, so more details aren't yet available.

Besides trying to close the rural broadband gap, the order would "institute new regulations aimed at preventing abuse of the Connect America Fund and promote broadband access in tribal lands," Mallory Locklear reports for Engadget. The Connect America Fund, also known as the Universal Service High-Cost Program, is an FCC program to expand telephone and broadband services to rural areas. Under the program, "the FCC provides funding to local telephone companies to subsidize the cost of building new network infrastructure or performing network upgrades to provide voice and broadband service in areas where it is lacking," according to the FCC website.

The proposed order "comes on the heels of President Donald Trump signing an executive order that speeds up federal permitting for broadband expansion in rural areas and makes it easier for wireless operators to put cell towers on federal lands," Jake Smith reports for ZDNet. "As part of a Connect America Fund promise, AT&T has been rolling out wireless internet to rural areas since April of last year and as of September, it had launched its services in 18 states," Locklear reports. 

Americans without a college degree, more common in rural areas, are dying 'deaths of despair,' researchers say

"The data are clear: Life is getting harder and harder for Americans without college degrees. People with a high-school education or less tend to face worse economic prospects and have poorer health," Sarah Brown reports for The Chronicle of Higher Education.

The increase in mortality among middle-aged white Americans who don't have a college degree is primarily due to "deaths of despair" caused by alcohol, drugs and suicide, according to researchers at Princeton University. President Trump won 67 percent of white voters without a college degree, a demographic that can be a rough analogue for rural America, and he performed particularly well in counties with the highest mortality rates from these deaths of despair.

Dunklin County (Wikipedia map)
Is the despair connected to why people voted for Trump? Brown went to Missouri's rural Bootheel to find out what the locals thought. In Dunklin County, where only 10 percent of adults have a 4-year degree, 76 percent of voters went for Trump. The life expectancy there is 72.6 years, 6.5 years less than the national average. Because of job losses in the manufacturing and agricultural sectors over the past few decades, more people are relying on government assistance.

Brown talked to several people who expressed disdain for people who receive public aid because they're "too lazy to work." One man, David Ross, said that he has open positions at his trucking and excavation company that he can't fill. "If there were less government assistance, he says, maybe more people would be forced to take the jobs that are available, even if the work isn’t glamorous," Brown reports.

The county was devastated in 2006 when Emerson Electric Co., its largest employer, closed its plant in the county seat of Kennett. Many of the jobs went to Mexico., so Trump's emphasis on bringing manufacturing jobs back to the U.S. resonated in Dunklin.

Some locals noted that those who go to college don't tend to come back, since there are no high-skill jobs available in the area, so boosting college attendance among small-town teenagers isn't a cure-all for rural America's woes. Many rural high schools lack the resources to offer Advanced Placement courses that can help prepare them for college and possibly earn course credit. In Illinois, a new program will help 75 students at 10 rural high schools take AP courses, The Associated Press reports. If the program is successful, Lt. Gov. Evelyn Sanguinetti, who leads the Governor's Rural Affairs Council, says the program may expand.

Another California movement seeks to create a 51st state

The proposed New California map
The difference between rural and urban areas in a state can be striking, and California has seen several separatist movements, mostly to break off the rural north. The latest one goes farther, "separating rural areas in California from the state's coastal cities and Sacramento, with supporters saying the state has become 'ungovernable,'" Julia Manchester reports for The Hill.

The conservative-oriented movement says California is a "failed state" because of its high taxes and declining health care. "There’s something wrong when you have a rural county such as this one, and you go down to Orange County which is mostly urban, and it has the same set of problems, and it happens because of how the state is being governed and taxed,” founder Robert Paul Preston told CBS Sacramento.

"Unlike other separation movements in the past, the state of New California wants to do things by the book, citing Article 4, Section 3 of the U.S. Constitution and working with the state legislature to get it done," CBS reports. "The group is organized with committees and a council of county representatives, but say it will take 10 to 18 months before they are ready to fully engage with the state legislature." Abby Hamblin of the Los Angeles Times writes that the effort is a long shot, to say the least. But it could be a barometer for rural sentiment.

Wednesday, January 17, 2018

Rural hospitals in states that expanded Medicaid have been six times less likely to close than in states that didn't

Rural hospitals in states that expanded Medicaid were six times less likely to close than those in states that didn't, according to a study published in the January edition of the journal Health Affairs. "Richard Lindrooth, a professor at the Colorado School of Public Health and lead author of the study, says hospitals saw more people showing up to hospitals with that insurance — so Medicaid payments increased. That helped the hospitals' bottom line," John Daley reports for NPR.

Lindrooth and his team of researchers at the University of Colorado examined national hospital data and local market conditions from the four years leading up to the Patient Protection and Affordable Care Act (2008-2012) and the two years after the act took full effect with Medicaid expansion (2015-2016). They found that about half the hospital closures in non-expansion states could have been averted through Medicaid expansion. Expansion-state hospitals had more insured people, so they made more money and provided less free care, reducing cost margins, he told Daley.

Jason Clecker, CEO of Delta Memorial Hospital in rural western Colorado, said Medicaid expansion helped his hospital's finances. Between 2011 and 2016, the number of Medicaid patients seen in his hospital increased from 10 percent to 20 percent, and since the hospital had to provide less free care, it saved more than $3 million. "Our bad debt decreased significantly, and the uninsured rate decreased significantly," Cleckler told Daley. "It's pretty remarkable, and I would venture to say that most hospitals, even ones with a lower percentage of Medicaid, have experienced a similar story."

Cleckler also said Medicaid was a "mixed bag" for rural health care providers, since reimbursement rates are sometimes very low. Because of that, some providers won't accept or limit the number of Medicaid patients they'll accept.

Kentucky partnership creates system to track drug overdoses, to help fight opioid epidemic

Kentucky has been hit hard by the opioid epidemic, but the state is trying to fight it with innovative efforts to gather more specific data about overdose deaths. The Kentucky Injury Prevention and Research Center, a partnership between the state Department for Public Health and the University of Kentucky College of Public Health, built a "drug-overdose fatality surveillance system" that combines information sources like death-certificate information, post-mortem toxicology analysis, and victims' prescription history to get a better picture of which drugs are killing people and under what circumstances.

"The efforts that KIPRC and the state have made to improve this data have led to crucial findings, including that Kentucky’s crisis isn’t one crisis, but many," Kathryn Casteel reports for FiveThirtyEight. "Different parts of the state are afflicted with different drugs. Northern Kentucky, for example, has a high prevalence of heroin and fentanyl — a synthetic opioid that is more deadly than heroin and other types of opioids — while in the eastern part of the state, prescription opioids are still the main concern.
KIPRC chart; click on the image to enlarge it.
"We’re not doing this for the sake of research," Svetla Slavova, a biostatistician with KIPRC, told Casteel. "We provide actionable data for policymaking, treatment and prevention. We’re trying to be responsive and provide data that will help make these decisions." Because of KIPRC's research, Van Ingram, the executive director of the Kentucky Office of Drug Control Policy, said he was able to push legislation increasing the availability of the anti-overdose drug naloxone.

One of KIPRC's biggest efforts is to make death-certificate information more uniform across the state, because "even the smallest differences in language can leave overdose deaths uncounted," Casteel reports. Sarah Hargrove, a data management analyst for KIPRC and former autopsy technician for the state, is spearheading the effort. It's tough going, since some coroners in the state's 120 counties, many of them small, have limited resources and funding, and many have little medical experience.

But KIPRC is making headway. "Researchers were able to determine the specific drugs that were involved in 97 percent of drug overdose fatalities in 2016; that’s compared with 82 percent using death certificates alone," Casteel reports. The also used the surveillance system "to find which drugs were most commonly involved in deaths linked to a combination of substances, as well as which drugs were involved in overdose deaths among people of different age groups and genders."

Analysts think Ky.'s newly approved Medicaid work requirement poses little political risk

"On Jan. 12, Kentucky became the first state to get federal permission to suspend Medicaid coverage for "'able-bodied' adults who don't complete 80 hours per month of community engagement activities," like employment, education, job-skills training and community service," Tony Pugh reports for McClatchy's DC bureau. And though Kentucky is one of the poorest states and its residents the sickest, Pugh found the decision is unlikely to have much political blowback. A 2017 Kaiser Family Foundation poll found that 70 percent of Americans support work requirements for Medicaid recipients, and Bevin is betting deep-red Kentucky feels the same way.

Kaiser Family Foundation chart. Click here for more information.

Read more here: http://www.mcclatchydc.com/news/politics-government/article194990909.html#storylink=cpy
In Kentucky and other states with many low-income residents, people who work--and often struggle to pay for health care--tend to resent those who get government-subsidized health care, according to Al Cross, director of the Institute for Rural Journalism and Community Issues. "If you can say, 'All we’re doing is requiring people to be more active participants in their health care and require some work-related activities,' I think the general population looks at that and says, 'What’s the matter with that?'" Cross told Pugh.

"Supporters say the Medicaid work policy will cut government dependency, weed out people who don’t really need the assistance and build work ethic among low-income enrollees," Pugh reports. "Critics say the requirement will be expensive to administer, provide an unnecessary barrier to coverage and penalize people who can’t work due to undiagnosed medical problems." Kentucky's new policy estimates nearly 100,000 fewer Kentuckians will have health coverage in five years, than if the policy were not implemented.

Eight other states with Republican governors (Arkansas, Arizona, Indiana, Kansas, Maine, New Hampshire, Utah and Wisconsin) and one state with a Democratic governor (North Carolina) have asked the Trump administration for the green light to enact similar requirements. Several of those states could be battlegrounds in statewide and congressional elections in November. But the Medicaid work requirements aren't likely to be a problem for most Kentucky Republicans, since there are no statewide races this year.

The traditionally lower turnout among low-income voters who would be affected by the measure could also help protect Republicans, Cross said. And it's worth noting that the Kentucky counties with the highest Medicaid rates backed Bevin in 2014, mostly because of social issues such as religion, abortion and anti-Obama sentiment.

But the political dynamics at play in Kentucky may not apply in other states. "It may depend on rival Democrats making a linkage between Medicaid and overall concerns about health care and insurance," Pugh writes. Democrats are likely to emphasize health coverage in elections this year, since 3.2 million Americans lost health coverage in 2017 and it's an issue that most people care about. A poll by Hart Research Associates last week showed that voters cared about health care more than the economy, taxes, immigration, or terrorism in the 2018 congressional elections.

Tuesday, January 16, 2018

Feb. 2 is entry deadline for Scripps Howard Awards, including a $10,000 prize for community journalism

Entries for the 2017 Scripps Howard Awards, which include a category for community journalism, will be accepted through 11:59 p.m. local time Friday, Feb. 2.

First place in each of the 16 categories carries a $10,000 prize. New this year is the Impact Award, formerly called Public Service, which will honor the year's best work from all winners. Finalists will be announced Tuesday, Feb. 27; winners will be announced Tuesday, March 6. The awards are sponsored by the Scripps Howard Foundation, started by the E.W. Scripps Co., parent firm of Scripps-Howard Newspapers. For more information click here.

Walmart fires about 3,500 store co-managers

In the days since Walmart announced that it was raising its starting wage, giving out employee bonuses and expanding paid parental leave, the mega-chain has quietly tightened its belt in other areas. On Jan. 12, the company announced it is laying off about 3,500 salaried store co-managers, replacing them with 1,700 lower-paid assistant store managers, Matthew Boyle reports for Bloomberg.

Hours after Walmart's Jan. 11 announcement about the wages, which it credited to the recent corporate tax cut, the news media got wind that Walmart had abruptly closed 63 Sam's Club stores across the nation, with 9,400 employees. Some workers only found out that they had lost their jobs when they showed up to work to find a sign printed on the barred door. Ten of the Sam's Clubs will be turned into distribution centers for online orders, and employees will have the opportunity to apply for jobs there.  

Business Insider reporter Hayley Peterson, who broke the Sam's Club story, said on NPR, "It's highly unusual for companies as big as Walmart to not give employees notice about store closings," but that focusing on its online operation is a sound strategy for competing with Amazon.

Private grain buyers working with senators to change tax-overhaul provision that favors grain cooperatives

"Republican U.S. senators are working with some of the world's biggest agricultural merchants to undo a last-minute provision in the tax overhaul that threatens to distort the grains market and starve private firms of corn, soy and wheat supplies," Tom Polansek reports for Reuters. "The provision gives farmers a 20 percent deduction on payments for sales of crops to farmer-owned cooperatives, but not for sales to private or investor-owned grains handlers." The language was intended to help co-ops and their farmer-owners because the tax overhaul eliminated a part of the tax code that had benefited them for more than a decade.

"If legislators do not address the provision by the autumn harvest, private grain companies could lose out on deals to buy billions of bushels of corn and soybeans," Polansek reports. "Farmers already are looking at how they can transfer grain stored at private elevators to co-ops to take advantage of the new law."

Co-ops defended the new tax law. "Chris Pearson, chief executive of the South Dakota Wheat Growers co-op, said on Twitter on Wednesday that the law 'gives farmers some nice tax advantages when doing business with the ORGANIZATION THEY OWN!'" Polansek reports.

Large private grain traders like Cargill Inc. and Archer Daniels Midland Co., which would lose out with the provision, have urged senators to change it, and it looks like they're listening. The National Council of Farmer Cooperatives and the National Grain and Feed Association have been working with Republican Sens. John Hoeven of North Dakota, John Thune of South Dakota and Pat Roberts of Kansas to find a more palatable solution. The Department of Agriculture said last week that it expects a solution soon.

Trump's Task Force on Agriculture and Rural Prosperity calls for connectivity, quality of life, other goals

Agriculture Secretary Perdue on RV listening tour (USDA photo)
On Jan. 8 the Interagency Task Force on Agriculture and Rural Prosperity gave President Trump its report on ways to improve life in rural America. The report identified five "Calls to Action": Achieving e-Connectivity for Rural America, Improving Quality of Life, Supporting a Rural Workforce, Harnessing Technological Innovation and Developing the Rural Economy. Each call to action included a list of recommendations for legislative, regulatory and policy changes to help implement each call to action.

"To achieve the objectives set out in the report, the task force also recommends the president establish a federal commission on agriculture and rural prosperity that would meet at least bi-annually and prepare regular reports to the president on its progress," Jenny Schlecht reports for AgWeek. "It also recommends establishing a stakeholder advisory council to advise the commission and establishing a managing director to oversee both the commission and the advisory council."

Trump established the task force April 25 and made Agriculture Secretary Sonny Perdue its chair. It solicited public feedback by holding listening sessions and taking comments from the public online. Perdue also went on a 30-state RV tour.

"Many of the recommendations throughout the report involve improving cooperation among federal agencies, establishing additional task forces, reducing regulatory burdens and finding better ways to utilize existing resources," Schlecht reports.

Monday, January 15, 2018

Transportation Secretary Chao tells automakers not to forget about rural areas as they develop self-driving vehicles

Transportation Secretary Elaine Chao
(Detroit Free Press photo by Kathleen Galligan)
As it develops self-driving vehicles, the automobile industry must keep rural communities in mind, Transportation Secretary Elaine Chao told industry leaders Sunday at the North American International Auto Show in Detroit.

Chao said autonomous vehicles have "tremendous potential" to improve safety and drive economic growth, "but she also said that automakers need to ensure that self-driving cars are accessible to people who live outside big cities," Nathan Bomey reports for USA Today.

"We want to be inclusive as well and consider how this technology can benefit rural America," Chao told Bomey in an interview. Self-driving cars are likely to be first available in ride-sharing fleets in metropolitan areas in 2019, "but not everyone lives downtown," Chao said in her speech. "And it is worth noting that rural America accounts for a disproportionately large share of highway fatalities. So, automated technology (has) an important role to play in rural mobility and safety."

Chao is married to Senate Majority Leader Mitch McConnell of Kentucky, one of the more rural states.

Farmworkers getting older; many have chronic ailments and spotty health coverage; production in California slows

Farmworkers harvesting in California, the No. 1 agricultural state (Photo from University of California, Davis)
As immigration from Mexico slows, "Harvesting U.S. crops has been left to an aging population of farmworkers whose health has suffered from decades of hard labor," Sarah Varney of Kaiser Health News reports for the Los Angeles Times. "Older workers have a greater chance of getting injured and of developing chronic illnesses, which can raise the cost of workers' compensation and health insurance."

Federal data show that the average age of a farmworker in the U.S. is 45, and that fewer have migrated from Mexico in recent years. "Researchers point to a number of causes: tighter border controls, higher prices charged by smugglers, well-paying construction jobs and a growing middle class in Mexico that doesn't want to pick vegetables for Americans," Varney reports.

Varney gives several examples of injuries and ailments that can result from working in the fields. "Many farmworkers don't have health insurance and pay what they can for medical care. Those who have immigration papers rely on Medicaid," she writes. "Only workers with legal status agreed to be interviewed for this story. Most farmworkers, however, are not working in this country legally, and their health coverage is spotty. They are employed by subcontractors who are supposed to offer them health insurance, but seven years after the passage of the Affordable Care Act, there's no good accounting for how many employers are complying with the law."

Farmer Brent McKinsey told Varney, "You start to see your production drop, but it's difficult to manage because there aren't the younger people wanting to come in and work in this industry." McKinsey "says farmers are trying to mechanize planting and harvesting to reduce their labor needs. But machines can only do so much, McKinsey said. You can replace the human hand in a factory, perhaps. But out here, the fields are bumpy and the winds are strong, and you need people to bring the plants to life."

Northern Utah daily runs reported Trump quotation, with a note directing reader complaints to the president

President Trump's vulgar comment about African countries and Haiti forced news organizations to decide whether they would report the verbatim quotation reported by Democratic Sen. Dick Durbin of Illinois, and if so, how they would handle it. Perhaps the most interesting approach was taken by The Herald Journal of Logan, Utah, which ran the Associated Press story with a headline that used the verbatim quotation and followed it with an editor's note:

"Since President Donald Trump's statement about immigrants from certain areas of the world is taking over the story on the immigration deal being negotiated in Washington, we will be using the president's language verbatim in print and online. Feel free to direct your complaints about the president's choice of language via postal service to 1600 Pennsylvania Ave NW, Washington, DC 20500, online at https://www.whitehouse.gov/contact/ or via Twitter @realDonaldTrump."

Readers' limited comments on the story were favorable. One called it "priceless."

The Herald Journal is published by Seattle-based Pioneer News Group, which also has papers in Washington, Oregon, Idaho and Montana. Some of its larger papers, such as the Idaho State Journal in Pocatello and the Bozeman Daily Chronicle in Montana, ran the story with the headline but without an editor's note.

Jan. 30 is deadline to seek Hillman Prizes, which recognize journalism that advances social and economic justice

Jan. 30 is the deadline for nominations for the 2018 Hillman Prizes, which honor investigative journalism and commentary that advance social and economic justice. "Winners exemplify reportorial excellence, storytelling skill, and public service impact," says the Sidney Hillman Foundation, named for a pioneer of the labor movement.

The categories for work published or premiered in 2017 are newspaper reporting, magazine reporting, nonfiction book, web journalism (material that appeared online but not in print), broadcast journalism, (at least 20 minutes in total package length) and opinion and analysis journalism in any medium. Each carries a $5,000 prize.

There is no fee to enter. A cover letter and the nominated material are the only requirements. View the entry form and instructions. See previous winners here. Winners will be announced in April 2018. Each honoree is awarded travel to New York City for the awards ceremony on May 8.

Saturday, January 13, 2018

Work requirements, likely coming to Medicaid in several states, will be problematic in rural areas short of jobs

The Trump administration gave Kentucky the power to impose work requirements on Medicaid beneficiaries Friday, granting the first of what are expected to be many "waivers" of normal Medicaid rules under a new policy the administration declared days earlier.

Kentucky has many rural areas that are short of jobs, so state officials say they plan to phase in the program, reaching such areas last, under federal rules that "allow states to account for local conditions, such as high unemployment in certain areas or other factors, to provide exemptions from a work requirement," Dylan Scott reports for Vox.

Rural areas could have "less robust transportation, and fewer social support services, all things that might lead a state to provide an exemption from the work requirement," Scott writes. Because rural areas are "more likely to be white . . . the result, intentional or not, is that black people on Medicaid — because they are more likely to live in urban areas, where those grounds for exemption are less likely to be found — could face a higher burden under these waivers."

UPDATE, Jan. 15: Phil Galewitz and Pauline Batrolone of Kaiser Health News explain why implementing work requirements will be complicated.

The Kentucky plan will require Medicaid members to report changes in their income, employment or volunteer status, and require them to pay small, income-based premiums, or be dropped from the program for six months. They could re-enroll more quickly by taking a health- or financial-literacy course, but critics of the plan say the reporting and payment system (to be handled by managed-care companies) will be a bureaucratic obstacle that will keep some people from getting health care.

“Documenting compliance will often not be trivial, and even small hassle costs can discourage people from signing up for insurance coverage,” Matt Fiedler, who covers health care policy for the Brookings Institution, told Scott. “Higher hassle costs will likely cause meaningful reductions in Medicaid coverage even among people who are working.” Kentucky's waiver proposal predicted that without it, the state's Medicaid rolls in five years would have about 95,000 more people than with it, the only reasons given being "program non-compliance" and "participants are expected to transition to commercial coverage," but doesn't explain how they will be able to afford that.

"Any approved waivers are expected to be swiftly met with legal challenges," Scott writes. "The issue hinges on whether requiring work for Medicaid can be construed as furthering the goals of the Medicaid program, which contains no explicit reference to encouraging work." Most Medicaid beneficiaries work. Among those who don't, here are the reasons they give:

At a rural GOP listening post, Trump's fitness is questioned, but Minn. poll shows majority support in largely rural areas

Grassley listens (Register photo by Zach Boyden-Holmes)
In a reliably Republican county in southwest Iowa, Republican Sen. Chuck Grassley "faced relentless questioning about President Donald Trump’s fitness for office and his own handling of the investigation into Russian election meddling," Jason Noble reports for the Des Moines Register.

Asked in the Harrison County seat of Logan, population 1,500, if he was concerned about Trump's behavior, Grassley said "he wasn’t qualified to make a psychiatric assessment," Noble reports. “I’m not president of the United States,” Grassley said. “I’m a check on the president of the United States. That’s my constitutional responsibility. I’m going to do what I can under our constitution to make sure that nothing bad happens to our country.”

The town meeting was Grassley’s first on his annual tour of all 99 Iowa counties, "was a striking scene, not least because of where it was playing out: in a rural western Iowa county where Republicans outnumber Democrats nearly 2-1 and where Trump carried 65 percent of the vote in 2016," Noble notes. "And in contrast to the crowds that packed into lawmakers’ town meetings last year, the anti-Trump contingent was not obviously organized. . . . They appeared, by and large, to be from Logan and the small communities immediately surrounding."

While the questions were mainly anti-Trump, the crowd was more evenly divided. When one woman stood and said “I just love our wonderful President Trump,” she drew "a chorus of mocking laughter mixed with sincere applause," Noble reports. The woman told onlookers, Nejedly said, “I don’t know you, but don’t hate so much. We’ve got to come together and stop hating so much.” Another woman replied, “We’re not hating. It’s not that we hate Trump.We are recognizing behavior that’s not normal. We’re not psychiatrists, but we can see abnormal behavior when we see it.”

Noble reports, "Grassley largely remained above the fray, answering specific questions as they were asked of him but declining to engage in the more open-ended critiques of his conduct or the president’s behavior." The senator said comments attributed to Trump, questioning immigration from "shithole countries," “detracts from the very important issue we’ve got to get solved by March 5,” the deadline for Congress to preserve protections for immigrants brought to the country as minors.

UPDATE, Jan. 15: In adjoining Minnesota, which Trump narrowly lost in 2016, he still had a 60 percent approval rating in the southern part of the state, and 59 percent in the north, "a region hit hard by the steel slump and layoffs in the iron mines, [where] 70 percent approved of the way Trump is handling the economy and job policy," Jennifer Brooks reports for the Minneapolis Star Tribune, which sponsored the poll, taken Jan. 8-10, before the latest controversy.

Friday, January 12, 2018

Weekly kicked off new year with a front page all about health

The week or two after Christmas is a slack time for weekly newspapers; some still take a week off. But the Adair County Community Voice in Columbia, Ky., took the period as an opportunity to spotlight personal stories about local residents' efforts to improve their health.

"We try to be prepared for slow weeks during the holidays by making sure we have options, but it really would have taken something pretty massive to kick these stories off the front," Editor-Publisher Sharon Burton said in an email to Kentucky Health News.

"A lot of people refocus on their health during the new year, so we knew these articles would be timely and draw interest," Burton wrote. "My assistant editor made a major healthy lifestyle change in his life several years ago and is passionate about this topic. I think it shows in these articles."

To read the stories, click here. For the jump page where the articles are continued, click here.

For an editorial by Burton that was also a good way to begin the year, with her sharing some philosophies of life, click here.

Republicans in Congress promise action on rural broadband

Democratic officials from 8 rural heartland states, 6 carried by Trump, tell their national party, 'You're killing us'

Indiana Rep. Terry Goodin (Politico photo by Patrick Brown)
Democrats have a rural problem. Most of them know it, and at least some care about it. Though they have won recent off-year and special elections, "The number of Democrats holding office across the nation is at its lowest point since the 1920s and the decline has been especially severe in rural America." That's from a recent report by U.S. Rep. Cheri Bustos, who was re-elected in her blue-collar northwestern Illinois district by a 20-point landslide last November.

Bustos knew Democrats needed to gain ground in rural areas, so she commissioned a study to see what rural Democratic politicians in heartland states had to say. The report, Hope from the Heartland: How Democrats Can Better Serve the Midwest by Bringing Rural, Working Class Wisdom to Washington, was just released, and will be distributed to local and regional party leaders and Democratic leaders on Capitol Hill. It's based on interviews with 72 current or former local Democratic officials from mostly rural areas of Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Ohio and Wisconsin. All voted for Trump but Minnesota (which was close) and Illinois.

The report features advice from people like Indiana state Rep. Terry Goodin, a pro-gun, anti-abortion, Pentecostal cattle farmer who is the last Democrat in the state to represent an entirely rural area. His district went heavily for Trump in 2016, but many Trump voters voted for Goodin, at 17-year legislative veteran, partially because of his pragmatic relatability, Michael Kruse reports for Politico.

In the report, "The quotes from the 72 rural Democrats . . . read like a pent-up primal scream. And Terry Goodin’s comments pop out in particular," Kruse reports. "In the report, he says the Democratic Party is 'lazy,' 'out of touch with mainstream America,' relying on 'too much identity politics' where 'winners and losers are picked by their labels.' The Democrats in his district, he laments, 'feel abandoned'."

His success, Goodin told Kruse, comes from his ability to focus on the things he agrees with his constituents about instead of writing off people who disagree with him about a few things. "In a nutshell, this is the advice of Bustos’ report: Widen the definition of Democrat." Kruse reports. Bustos told him, "If we call ourselves a big tent party, then we should act like it."

Official forecast: Coal will keep losing out to natural gas; pro-drilling policies don't help coal

"Just a day after federal regulators nixed a major Trump administration proposal to shore up the struggling coal industry, the nation’s top energy forecaster predicted continuing, slow declines in U.S. coal production and in the burning of coal for electricity in 2018 and 2019, thanks to cheap natural gas and coal plant retirements," Chris Mooney reports for The Washington Post.

The Energy Information Administration's monthly report projected that coal production will decline from 773 million short tons in 2017 to 759 million in 2018 and 741 million in 2019. Burning coal for electricity, its main use in the U.S., will also decline steadily. By 2019, the report predicts that gas will generate 34 percent of electricity in the U.S. and coal will produce 28 percent. In 2003, coal accounted for 51 percent and gas 17 percent.

"The report offers the latest evidence that while the Trump administration’s focus on energy production may advantage some fossil fuels — the report also predicts a record U.S. crude oil production of 10.3 million barrels a day in 2018, followed by 10.8 million in 2019 — it’s proving more difficult to change the trajectory for coal," Mooney reports. "That’s because it’s a carbon-intensive fuel that faces not only adverse policies but also market forces, such as the booming production of natural gas thanks to fracking."

Christopher Knittel, a professor of applied economics at the Massachusetts Institute of Technology, told Mooney that cheap natural gas, not Obama-era regulation, is killing coal: "If anything, the policies of the current administration are going to exacerbate that, in the sense that they’re opening up lands for more drilling, which is likely to generate more oil, but can also generate more natural gas — which might be the final nail in the coal coffin, if you will."

Tariffs on Canadian newsprint will raise prices

The price of newsprint likely go up soon, though not as much as newspapers originally feared. The Department of Commerce announced Jan. 8 the first of a new round of countervailing duties on uncoated groundwood paper that range from 4.42 percent to 9.93 percent. The new duties will begin affecting Canadian paper producers on Jan. 16, and will give American producers room to raise prices.

Countervailing duties are a kind of tariff levied on imported goods to offset subsidies given to producers in the exporting country. "This is the first of two announcements on duties, as the Department of Commerce is also expected to release a preliminary decision on anti-dumping duties on March 8. Anti-dumping duties are described as a 'protectionist tariff' that is imposed on imported goods that a domestic government believes are priced below fair market value," the Wisconsin Newspaper Association reports.

The National Newspaper Association and the News Media Alliance are encouraging newspapers to contact their congressional representatives to protest the tariffs. The U.S. International Trade Commission will conduct a final investigation on the case in late spring and is expected to reach a final decision by September. The tariffs will be essentially permanent, barring a separate agreement under the North American Free Trade Agreement that eliminates them, which is not likely.

The petitioner for the new duties is the North Pacific Paper Co., which is owned by a New York hedge fund operator and has a single paper mill in Washington state. "We are stunned that a single U.S. mill in Longview, Wash., has been able to manipulate the trade laws to their gain, while potentially wreaking financial havoc on newspapers and other commercial publishers across the country," said David Chavern, president and CEO of NMA. "This decision and its associated duties likely will lead to job losses in U.S. publishing, commercial printing and paper industries."

Trump administration ends registry for evidence-based mental health and substance abuse programs

"The Trump administration has abruptly halted work on a highly regarded program to help physicians, families, state and local government agencies, and others separate effective 'evidence-based' treatments for substance abuse and behavioral health problems from worthless interventions," Sharon Begley reports for Stat, the national health-and-science website of The Boston Globe. The move has implications for rural areas because behavioral-health services are less available there.

The program, launched in 1997, is called the National Registry of Evidence-Based Programs and Practices; its website lists 453 programs aimed at helping issues including opioid addiction, depression, parenting and HIV prevention. "Mental health and addiction specialists say they rely on this database as a key source for finding appropriate and effective therapies," Lena Sun and Juliet Eilperin report for The Washington Post. "Since 2015, the registry has also included evidence that certain interventions do not work, which helps practitioners avoid wasting resources on those programs.

NREPP is run by the Substance Abuse and Mental Health Services Administration, part of the Department of Health and Human Services. During the Obama administration the maintenance of the database was hired out to independent contractor Development Services Group Inc. On Dec. 28, 2017, Development Services was notified that SAMHSA had terminated its contract. The website is still up, but no new entries or modifications are being entered.

"In an online statement, SAMHSA said future work on the registry, including vetting new applications, would be moved in house 'to reconfigure its approach to identifying and disseminating evidence-based practice and programs,'" Begley reports.

SAMHSA has provided no details about how and when it will pick up the registry work. Meanwhile, the decision could throw a monkey wrench into some state health policies, since some states require that public programs only use evidence-based interventions vetted by NREPP.

New GMOs use edited genes, not those from other organisms; countries debate whether to regulate them

Jason McHenry on his South Dakota farm.
(Photo by Antonio Regalado)
Genetically modified crops usually focus on increasing the yield per acre, but a new generation of  GMOs could turn that on its head with a different focus, different technology, and possibly different regulations.

Traditionally, genetically modified crops are created by splicing in genes from a soil bacterium to help them resist herbicides, boosting yields by suppressing weeds. The new wave of GMOs focuses on altering native characteristics of a plant using only the DNA it already has—a technology known as gene editing. The creators of these new GMOs argue that their plants are just like those produced by conventional breeding, just faster.

"To many scientists, the potential of gene editing seems nearly limitless, offering a new way to rapidly create plants that are drought-resistant, immune to disease, or improved in flavor," Antonio Regalado reports for MIT Technology Review. "A supermarket tomato that tastes good? That could happen if scientists restore the flavor-making genes that make heirloom varieties delicious. What about a corn plant with twice as many kernels? If nature allows it, scientists believe, gene editing could let them build it."

For example, Minnesota start-up Calyxt markets a soybean that creates an oil more like olive oil than typical soybean oil. That’s important because soybean oil has lost a lot of market share since the U.S. banned trans fats (which are present in partially hydrogenated soybean oil). South Dakota farmer Jason McHenry told Regalado he was persuaded to plant the Calyxt soybeans because "You have to keep your finger on what the consumer wants, and as a farmer, you have to differentiate yourself. If you are looking at a market that could be gone, you have to think about alternatives."

Some consumers and scientists are alarmed about the new GMOs, saying they might be unsafe. The U.S. Department of Agriculture ruled that the plants won’t be regulated like traditional GMOs since they don’t have foreign genes in them. That means Calyxt can get its new beans to market more quickly and cheaply, without having to go through the battery of permits, inspections and safety tests usually required of GMOs.

The question of whether gene-edited GMOs should be regulated like traditional GMOs is playing out across the world. “New Zealand decided that the new plants are GMOs after all, and so did the USDA’s own organic council. The Netherlands and Sweden don’t think they are. China hasn’t said. The European Union still has to make up its mind. Billions in global grain exports could ultimately hang in the balance,” Regalado reports.

Citing tax cut, Walmart hikes basic wage, gives bonuses, boosts childbirth leave, then closes 63 Sam's Club stores

"Walmart is boosting the minimum hourly wage for its U.S. employees to $11 and dishing out bonuses of up to $1,000, crediting President Trump's tax cut for enabling the move," Nathan Bomey reports for USA Today. The corporate tax rate will drop from 35 percent to 21 percent under the new law. Walmart is the nation's largest private employer with more than 1 million hourly employees in the U.S., and has a heavy presence in rural America.

Big changes are also coming for Walmart employees who are welcoming a new baby. "The company is also boosting its paid maternity leave policy for full-time hourly workers to 10 weeks at full pay. Previously, birthing mothers got six to eight weeks at half pay," Bomey reports. "Walmart is also increasing its paid leave policy for new fathers and non-birthing mothers to six weeks at full pay for full-time hourly workers. Previously, the company didn't offer any paid leave for them."

The company will benefit from looking more attractive to workers, since unemployment is at a 17-year low, meaning other companies could woo away dissatisfied or potential Walmart employees. University of Michigan business professor Erik Gordon told Bomey that "Walmart would have had to go to at least $11 in many markets in order to retain reliable employees [but] the tax cut made it easier for the company to swallow."

The move shows that Walmart is betting on solid economic growth for the next few years, according to Charles Fishman, author of The Wal-Mart Effect. He also told Bomey that it meant that Walmart recognized that it needed to treat their employees better because "they can't take them for granted anymore."

The minimum-wage hike will take effect in February. The one-time bonuses will cost the company $400 million and will be based on the length of service. Most will get up to a few hundred dollars, but employees who have worked for at least 20 years will get the full $1,000.

UPDATE, Jan. 12: After announcing the wage hikes, Walmart announced hours later it will lay off thousands of workers as it closes 63 Sam's Club stores, some without advance warning to employees, who showed up for work and found the stores closed.

Thursday, January 11, 2018

Fears of undercount spur states to check census databases

"Amid fears that a lack of money will prevent an accurate count, states are gearing up to identify the people the 2020 U.S. census is most likely to miss," Tim Henderson reports for Stateline, the nonpartisan, nonprofit news service of the Pew Charitable Trusts. "The current task for state and local officials is to verify the Census Bureau’s residential address list: Starting in February, the bureau will turn over address lists to states and local governments for double-checking that must be finished within 120 days."

Checking databases like property-tax rolls and 911 records can help state governments correct errors in the bureau's databases, but small, local sources might help the most. "In New Mexico, for example, some small towns have used holiday-turkey distribution lists to prove to census officials that new addresses are real," Henderson reports.

States have good reason to make sure every citizen is counted, since $590 billion in federal funding and apportionment of Congressional seats depends on census data. People in rural areas, immigrants, minorities, migrant workers, and people who don't trust the government are among the most likely to be under-counted, especially because of the bureau's new system that will rely heavily on using the internet.

Trump order aims to reduce suicide among new veterans

Trump before signing the executive order Tuesday
(Associated Press photo by Evan Vucci)
President Trump signed an executive order Jan. 9 to expand mental health care for veterans who are transitioning from military to civilian life in an effort to reduce suicides in that group.

"The order will take effect March 9 and is expected to provide all new veterans with mental-health care for at least a year after they leave the military," Dan Lamothe reports for The Washington Post. "Trump gave the Defense Department, the Department of Homeland Security and the Department of Veterans Affairs 60 days to iron out details and develop a joint plan, Veterans Affairs Secretary David Shulkin said in phone call with reporters."

New veterans are particularly at risk of suicide, and 60 percent of the 265,000 service members who transition out of the military each year don't qualify for care until the government establishes that a medical issue is related to their military service. Shulkin told Lamothe that people who have been out of military service for less than a year are 1 1/2 to two times more likely to commit suicide than any other age group. About 20 veterans a day commit suicide.

The full details of the plan aren't yet clear, but will likely include making peer-group therapy sessions available at all VA Whole Health facilities; such sessions are now only available at 18 of the facilities. An anonymous source told Lamothe that the Defense Department will expand the services of its Military OneSource program to allow veterans to access its counseling and 24-hour call line services for a full year after leaving the military instead of the current 180 days. The source said that the Pentagon will look for ways to start the transition process for service members while they are still in uniform.

Shulkin said the program is expected to cost a few hundred million dollars a year from the Defense and VA budgets, but will be paid for with existing money.

New projection says reauthorizing CHIP will save money in the long run; lawmakers say they're close to a deal

A new projection from the Congressional Budget Office says that reauthorizing the Children's Health Insurance Program for 10 years would save the government $6 billion. CBO says a five-year extension would cost the government $800 million, down from earlier estimates of $8 billion.

CHIP provides insurance to 9 million children whose parents make too much to qualify for Medicaid but can't afford private insurance. The CBO's projection is anchored on the repeal of the Patient Protection and Affordable Care Act's individual mandate in the recently passed tax overhaul.

"To summarize the CBO’s complicated line of reasoning that led to this outcome, no mandate means fewer people will enroll in the Obamacare marketplaces, meaning fewer low-income folks will get federal subsidies," Paige Cunningham reports for The Washington Post. "Some of those people leaving the marketplaces would instead enroll their kids in CHIP. And on the federal government’s end, paying for CHIP coverage is actually cheaper overall than funding subsidies for private marketplace plans. So the government, the argument goes, would actually save money on CHIP in the future."

With such a projection, Cunningham writes that it would be "truly shocking" if Congress doesn't renew CHIP soon. Lawmakers in both parties say they've almost resolved the disagreement and could reauthorize the popular, bipartisan law as soon as next week. The measure could be attached to a short-term government funding bill that must pass before Jan. 19, Peter Sullivan reports for The Hill.

House Energy Committee Chairman Greg Walden (R-Ore.) told reporters he didn't think paying for the five-year extension would be a problem, but said whether CHIP is added to the spending bill next week is up to the leaders who are negotiating what goes in it, Sullivan reports.

The deal will come not a moment too soon. The Centers for Medicare and Medicaid Services said the stopgap funding already provided to CHIP may not last through the end of March, Cunningham reports. Several states, such as Virginia and Alabama, have sent letters to parents warning them that the program will end soon unless Congress funds it.

Three South Dakota tribes sue opioid makers over addiction

The Rosebud Sioux Tribe, the Flandrew Santee Sioux Tribe, and the Sisseton Wahpeton Oyate Tribe in South Dakota have sued 24 drug manufacturers and distributors, alleging that the drugmakers hid and minimized the risk of addiction in tribal communities that have been hard hit by opioids.

"While 200,000 Americans died from prescription opioid overdoses from 2000 to 2016, the national epidemic has hit Indian reservations particularly hard," Sari Horwitz reports for The Washington Post. "Native Americans suffer the highest per capita rate of opioid overdoses, and one in 10 American Indian youths age 12 or older used prescription opioids for nonmedical purposes in 2012, according to the Centers for Disease Control and Prevention. That’s double the rate for white youths."

The suit accuses the defendants, including Purdue Pharma, Teva Pharmaceuticals, Allergan PLC, McKesson Corp., Cardinal Health and AmerisourceBergen Corp, of failing to comply with federal prescription drug laws meant to prevent the abuse of opioids. "The lawsuit accuses the companies of violating federal Racketeer Influenced and Corrupt Organizations laws, deceptive trade practices, and fraudulent and negligent conduct," Horwitz reports.

The case is the latest in a string of tribes filing lawsuits against opioid manufacturers and distributors. In April 2017 the Cherokee in Oklahoma was the first tribe to file suit. Three other tribes in Wisconsin, Minnesota and North Carolina have filed similar suits in the past three weeks. The South Dakota suit is the first involving multiple tribes and the first representing the Lakota Sioux.

Jurisdiction may be a sticking point in the suits. In the Cherokee case, the defendants argued that Cherokee tribal courts don't have jurisdiction over them and therefore can't sue; the judge is still deliberating on whether to keep the case in tribal court or transfer it to federal court.

Wednesday, January 10, 2018

RFD-TV to recap Trump's Farm Bureau trip; channel's site has speech analysis, interviews with state federation prexys

RFD-TV's Mark Oppold interviews Trump
RFD-TV, which got an exclusive interview with President Trump at the American Farm Bureau Federation convention, will have a special program Thursday, Jan. 11, at 10 p.m. ET with Trump's speech to the convention, "feedback from ag and commodity experts, alongside rural Americans, farmers and ranchers," RFD-TV Marketing Vice President Heather Huston says in an email.

The cable/satellite channel's interview with Trump is here; Trump’s speech is here; Agriculture Secretary Sonny Perdue’s speech is here; and interviews with state Farm Bureau presidents are here. Also, here is an analysis of the speech by Catherine Boudreau of Politico, veteran agricultural journalist Jerry Hagstrom, commodity broker and consultant Chris Swift, and RFD-TV Executive Producer Katie Dehlinger.

County-level map shows how school test scores changed

Daily Yonder map; click on the image to enlarge it. For the interactive version with county data, click here.
"A new study that examines educational progress of millions of U.S. pupils over a five-year span finds that there are few patterns for predicting how geography or socioeconomic status affect student improvement," Bill Bishop reports for The Daily Yonder. Click here for the interactive map to see how your county stacks up.

The Stanford University study looked at standardized test scores of the same students in the third and eighth grades. A child who has completed five years of school would ideally advance five grade levels on test scores. The results show that metro and rural schools averaged about the same at raising students' test scores over that five year period. Rich and poor districts had similarly varied results. 

Some areas stand out, though: students in much of Central Appalachia, Alabama, Mississippi, Georgia, Florida, North Carolina and rural Illinois performed below average, while students in most rural and metro Tennessee counties performed above average.

Head researcher Sean Reardon "collected some 300 million standardized reading and math test scores from 45 million students in over 11,000 school districts spanning the school years 2008-09 to 2014-15, Bishop reports. "Reardon was able to devise a national standard by comparing state test scores to the National Assessment of Educational Progress, a long-running test of students across the United States."

Study finds nutritional value of pastures has declined; could stymie trend for grass-fed beef

Iowa Beef Industry Council photo
Most beef cattle in the U.S. are finished on feedlots, bulked up with grains instead of the grass they evolved to eat. But more and more consumers are demanding grass-fed beef, saying it's healthier to eat and better for the environment. "Sales have soared from $17 million in 2012 to $272 million in 2016. And industry analysts say grass-fed beef could make up 30 percent of the market within 10 years," Alex Smith reports for NPR.

There's a problem with the growing trend of grass-fed beef though: the grass they eat is becoming less nutritious. Researchers at Texas A&M University and Boulder, Colo.-based ecology outfit Jonah Ventures studied cow manure collected from all over the country between 1994 and 2016 and found that crude protein in grass has dropped by almost 20 percent since the mid-90s. That's causing the cattle to gain less weight on grass than they would have in years past. The less-nutritious grass could hurt even conventional cattle, since many are grass-fed before finishing.

Jonah Ventures co-owner Joe Craine told Smith there are two theories on the cause for the drop. One is that rising carbon dioxide levels in the atmosphere could be the other reason, since increased CO2 levels are have been linked to fewer nutrients in other grass plants like rice and wheat. The other is cattle that are moved to feedlots don't defecate on the prairie anymore, delivering nutrients to the soil.

"Craine thinks this may be happening on a large scale in the prairie, and that it's just a matter of time before prairie grasses simply don't have enough protein to support grazing," Smith reports. The researchers studied cow manure collected from all over the country between 1994 and 2016. "Somewhere on the order of 50,000 cow pies got shipped to Texas for this study," Smith reports.

Rural women start having sex earlier, are likelier to have more kids, and use more reliable methods of birth control

Centers for Disease Control and Prevention chart
A new analysis of federal data by the National Survey of Family Growth found that women in the rural U.S. tend to have sex earlier, and have more children than their urban counterparts. They are also more likely to report choosing long-term or permanent methods of birth control because more reversible methods like condoms are less likely to be accessible. The researchers analyzed responses from in-person interviews with more than 10,000 women ages 18-44, between 2011 and 2015.

"On average, women living in rural areas said they had their first sexual encounter earlier than women living in urban areas, according to the survey. The mean age of first sexual intercourse among women living in rural areas was 16.6 years old. For women living in urban areas, the average age of first intercourse was 17.4," Patti Neighmond reports for NPR.

About 41 percent of metro-area women had no children, significantly more than the 30 percent in rural areas. And women in rural areas are slightly more likely to have two or more children than women in urban areas are.

"When asked about contraception, one in five women in both groups reported they'd had sexual intercourse without using contraception. And, notably, more women in urban areas reported using less effective birth control methods to prevent pregnancy (a condom or withdrawal, for example) than their rural counterparts, who were more likely to use one of the most effective contraceptive methods — an IUD or sterilization," Neighmond reports.

Eleanor Bimla Schwarz, a research epidemiologist at the University of California, Davis, who wasn't involved in the study, told Neighmond that the difference in birth-control methods likely stems from the fact that women in rural areas can't access reversible methods of birth control as easily. "If we really want to help young women and teens have a healthy and safe sexual life, we need to get effective resources and education to them before 16," she said.

Administration has fulfilled most of requests by nation's largest coal operator, who was a big supporter of Trump

Murray
President Trump has been famously friendly to the coal industry in his first year of office, and a confidential memo suggests coal magnate Robert Murray may be responsible.

Murray, who supported Trump's campaign donated $300,000 to the inauguration, owns the country's largest coal company, Murray Energy. He sent the memo soon after the inauguration; it included a detailed list of 14 policy actions that would benefit him. Almost a year later, almost have been completed or are on track to be completed.

"The March 1 memo, which was obtained by Sen. Sheldon Whitehouse of Rhode Island and shared with The New York Times, is addressed to Vice President Mike Pence. The sweeping wish list of regulatory overhauls includes ending regulations on greenhouse gas emissions and ozone and mine safety, as well as cutting the staff of the Environmental Protection Agency 'at least in half' and overhauling the Labor Department’s office of mine safety," Lisa Friedman reports for the Times. Murray sent a similar memo to Secretary of Energy Rick Perry on March 23.

Murray wrote in the memo to Pence that his wish list is geared toward "getting America's coal miners back to work." It included requests to cut funding for carbon capture and sequestration technology and eliminate a 2009 EPA ruling that was the legal basis for most of President Obama's climate change policy.

In a recent interview with the Times, Murray said that the memo outlined measures that would help provide "reliable, low-cost electricity in America" and praised the Trump administration for "being bold, being passionate and being correct in addressing a lot of these issues that were on my list here."

Friedman reports, "The Trump administration has had an unusually close relationship with Mr. Murray. He and 10 of his miners were invited to watch the president sign an executive order to rollback President Obama’s climate change regulations. He has met with Mr. Perry to discuss the needs of coal producers. His longtime attorney, Andrew Wheeler, is awaiting Senate confirmation to the No. 2 slot at the EPA, and David Zatezalo, the nation’s new top mine safety and health regulator and previously the president of a coal mining company, told his hometown paper that Mr. Murray had encouraged him to put his hat in the ring for the job."

Despite Murray's influence, on Jan. 8 the Federal Energy Regulatory Commission rejected Perry's proposal to subsidize coal and nuclear power plants, which would have mostly benefitted Murray.

U.S. child mortality highest among wealthy nations; most deaths among infants (especially rural) and late teens

Washington Post charts; click on the image to enlarge it.
"American babies are 76 percent more likely to die before they turn a year old than babies in other rich countries, and American children who survive infancy are 57 percent more likely to die before adulthood, according to a sobering new study published in the journal Health Affairs," Christopher Ingraham reports for The Washington Post.

Ashish Thakrar, an internal-medicine resident at The Johns Hopkins Hospital in Baltimore and lead author of the study, writes that "persistently high poverty rates, poor educational outcomes, and a relatively weak social safety net have made the U.S. the most dangerous of wealthy nations for a child to be born into." U.S. policy decisions could play a big role in those conditions. Policy decisions explain at least 47 percent of the differences in life expectancy between countries, according to a 2010 study. And a 2007 study found that about 20 percent of the difference in infant mortality rates can be explained by policy decisions.

Thakrar "notes that while the U.S. spends more per capita on health care for children than other wealthy nations, it has poorer outcomes than many. In 2013, the United Nations Children's Fund ranked the U.S. 25th in a list of 29 developed countries for overall child health and safety," Ingraham reports.

In the 1960s the U.S. had a much lower childhood mortality rate than the average of 19 other wealthy countries in the Organization for Economic Co-Operation and Development, but that began to change in the 1970s and the gap widened dramatically in the 1980s (coinciding with a rise in childhood poverty). The gap today translates to about 20,000 deaths a year. Since 1961, that means about 600,000 deaths. The U.S. has ranked last in the OECD for child mortality since the 1990s, Sarah Kliff reports for Vox.

Centers for Disease Control and Prevention chart
About 90 percent of the U.S. deaths were among infants from birth to age 1 and teens 15 to 19; comparatively few deaths occurred between ages 1 and 14. Among infants, the leading causes of death are premature births (which have risen dramatically in recent years) and Sudden Infant Death Syndrome. Infant mortality has decreased since the 1960s, but declined more in other OECD countries. In the U.S., the infant mortality rate in rural areas is 25 percent higher than in urban areas.

The two leading causes of death for 15-to-19- year-olds in the U.S. were motor vehicle accidents and assault by firearm. "Teenagers were twice as likely to die from motor vehicle accidents and 82 times more likely to die from gun homicide in the U.S. than in other wealthy nations," Thakrar writes. Though overall gun ownership is higher in rural areas of the U.S., urban teens are more likely to die from shootings. But rural drivers are far more likely to die in car wrecks than their suburban and urban counterparts.