Lack of doctors and insurers, hospital closures and more make rural health outlook 'grim,' writer says

"In many rural counties, due to a range of contributing factors — including a shortage of doctors, a sicker-than-anticipated population, lack of competition in the marketplace, the closing of hospitals and a raging opioid crisis — the outlook is grim" for health care under the Patient Protection and Affordable Care Act, John Collins writes for the liberal magazine In These Times.

Collins points to the demise of more than half of the state-based health cooperatives that provide price competition for traditional, for-profit insurers; and UnitedHealth Group's recent decision to pull out of most state Obamacare exchanges next year, coming after "other insurance providers have abandoned their less profitable rural exchanges." He notes the Kaiser Family Foundation estimate that 11 percent of policyholders will be in counties with only one insurer, and 18 percent will be in counties with two — up from 2 percent and 13 percent, respectively.

"By early 2017, The Wall Street Journal reports, it is estimated that in more than 650 counties — 70 percent of which consist of rural populations — only one option for health care coverage will be offered on the ACA exchanges," Collins writes. "According to Inovalon, the health-care information and technology firm . . . cited in the WSJ piece, rural exchanges are having trouble realizing a profit for two reasons—people are requiring more care (they’re sicker) than anticipated and the cost of that care is significantly more than it is in urban areas."

At the end of his story, Collins looks ahead and then puts his tongue in cheek: "The next administration will ultimately decide whether this six-year-old law gets put into therapy, replaced by a single-payer healthcare system for all Americans, or triumphantly repealed and replaced with something so fantastic that you can’t even imagine how good it is going to be."

Congress reaches agreement to overhaul U.S. chemical safety laws for first time in 40 years

UPDATE, May 27: The House passed the bill 403-12 but Sen. Rand Paul (R-Ky.) has delayed a Senate vote on the bill, calling it "rushed."

"Congress has reached agreement on the most sweeping overhaul of U.S. chemical safety laws in 40 years, a rare bipartisan accord that has won the backing of both industry officials and some of the Hill’s most liberal lawmakers," Juliet Eilperin and Darryl Fears report for The Washington Post. "The compromise, which lawmakers unveiled Thursday, will provide the industry with greater certainty while empowering the Environmental Protection Agency to obtain more information about a chemical before approving its use. And because the laws involved regulate thousands of chemicals in products as diverse as detergents, paint thinners and permanent-press clothing, the result also will have a profound effect on Americans’ everyday lives."

The measure, which has the tacit approval of the Obama administration and the top Democrat on the Senate Environment and Public Works Committee, Barbara Boxer (D-Calif.), "could come up for a vote in both chambers as soon as next week," Eilperin and Fears write. "After passage, the EPA must start reviewing at least 10 toxic chemicals that permeate communities across the country, a list that is likely to include asbestos, formaldehyde and flame retardants. Many are interwoven into people’s experience with everyday products, including the ink on their morning newspaper and the fabric protector on their family’s sofa."

The deal "gives the EPA the power to require companies to provide health and safety data for untested chemicals and to prevent substances from reaching the market if they have not been determined to be safe," Eilperin and Fears write. "Under current law, the agency must prove that a chemical poses a potential risk before it can demand data or require testing, and that substance can automatically enter the marketplace after 90 days. In the past four decades, the EPA has required testing for just 200 of thousands of chemicals, and it has issued regulations to control only five of them. More than 8,000 chemicals are produced in the U.S. at an annual rate of more than 25,000 pounds each, according to the agency. Under the bill, instead of going through a lengthy rulemaking process to trigger product testing, the EPA can order companies to test their new products. The measure also imposes user fees on industry to help expand the testing of chemicals."

"In return, chemical manufacturers will be subject to a single regulatory system, although states will still have the right to seek a federal waiver to impose their rules on a given chemical," Eilperin and Fears write. "Currently, California, Maine, Maryland, Minnesota, New York, Oregon, Vermont and Washington have placed their own restrictions on some chemicals in the face of federal regulatory inaction.The bill’s provisions include prioritizing the review of chemicals stored near drinking water as well as those that are human carcinogens and highly toxic with chronic exposure. House Democrats were still seeking to insert language that would allow some states in the midst of regulating chemicals the chance to finalize those actions before the EPA starts reviewing its first batch of chemicals under the law." (Read more)

Coal bankruptcies leaving many states with IOUs that could make taxpayers fund mine cleanup

The widespread practice of "self-bonding" in the coal industry could end up leaving taxpayers footing the bill for cleaning up an increasing number of abandoned mines, Mead Gruver reports for The Associated Press. Self-bonding allows companies with certain assets "to promise to eventually cover the cost of cleaning up abandoned mines without first setting aside the necessary money. Because of self-bonding, billions of dollars in legally required reclamation funding exist only as IOUs, without dedicated assets or bonds backed by third-party investors. Nationwide, self-bonding in the coal-mining industry tops $3.3 billion. That includes $2.3 billion in IOUs that the three biggest bankrupt coal companies—Alpha Natural Resources, Arch Coal and Peabody—owe in five states, according to an Associated Press analysis of bonding obligations in the top 16 coal-mining states." 

"The dilemma for state and federal regulators got even bleaker when the nation's largest coal producer, Peabody, filed for Chapter 11 protection from its creditors in April," Gruver writes. "Peabody alone holds more than $1.1 billion in self-bonding obligations for mines in Illinois, Indiana, New Mexico and Wyoming, where its North Antelope Rochelle mine produces almost 12 percent of the nation's coal. ...Wyoming, which produces almost 40 percent of the nation's coal, has more than $2 billion in self-bonded coal mining, almost two-thirds of the nationwide total."

"The 1977 Surface Mining and Reclamation Act enabled companies to open strip mines on the condition that assets be set aside to contain any pollution and return the mines to something resembling the pre-existing landscape," Gruver writes. "But companies with debts no greater than 2.5 times their net worth were allowed to avoid tying up capital by "self-bonding" instead. Self-bonding has grown to represent more than a third of the industry's cleanup costs. With several companies now in bankruptcy, states have reached agreements to secure pennies on the dollar for reclamation should Chapter 11 reorganization proceed to Chapter 7 liquidation."

Drones will be the future of collecting agricultural data, says Agriculture Dept. technology officer

Drones are the future of advanced agriculture data, said Michael Valivullah, chief technology officer at the National Agricultural Statistics Service, which is housed at the Department of Agriculture, Corinne Lestch reports for FedScoop. Valivullah, who was speaking Wednesday in Washington D.C. at the MarkLogic Data Innovation Summit, said, “Farmers are going to be more dependent on drones. Drones are a lot cheaper and can gather high-resolution, sensitive data. So a farmer or rancher will be able to understand what they have in their operation.”

Of the more than 2.3 billion acres of land across the U.S., about 900 million are farmland, Valivullah said. "USDA keeps track of farmers who produce and sell products that are worth more than $1,000 in a central database. The agency once used traditional paper and pens to collect information, but it started sending out electronic forms—as well as iPads and tablets—a few years ago to researchers in the field." Valivullah said drones will be a better way of collecting data.

Bayer looks to acquire Monsanto; would make agriculture 40% of combined entity’s business

"Bayer AG has approached Monsanto Co. about a takeover that would fuse two of the world’s largest suppliers of crop seeds and pesticides, the companies said," Jacob Bunge and Dana Mattioli report for The Wall Street Journal. "Details of the offer couldn’t be learned and it was unclear whether Monsanto would be receptive to it. Should there be a deal, it could be valued at more than $42 billion, which is Monsanto’s current market capitalization. Should the bid succeed, a combination of the companies could boast $67 billion in annual sales and create the world’s largest seed and crop-chemical company."

Mergers an acquisitions are booming in the industry. Last month Sygenta struck a deal to be acquired by Chem China, a state-owned enterprise. DuPont and Dow have announced they are merging. If all the deals go through, it's estimated that three of these companies will control more than half of global seed sales, Dan Charles reports for NPR.

If Bayer absorbed St. Louis-based Monsanto, the world’s top seed company in terms of sales, it "would push Bayer far more deeply into agriculture, which currently accounts for about 22 percent of the German company’s business," Bunge and Mattioli write. "Monsanto’s $15 billion in seed and herbicide sales could make agriculture about 40 percent of the combined entity’s business, with the rest coming from pharmaceuticals and consumer health products."

"Folding Monsanto’s world-leading seed franchise and its trademark Roundup herbicide business into Bayer would create a company that could market products ranging from Aspirin pain-relief pills to crop genetics that enable plants to withstand bugs and weedkillers," Bunge and Mattioli write. "The combination would sell about 28 percent of the world’s pesticides and about 36 percent of U.S. corn seeds and 28 percent of soybean seeds, according to Morgan Stanley estimates." (Read more)

UPDATED: Newspaper lobbying group says new overtime rule will reduce jobs, news coverage

The main lobbying group for community newspapers is objecting to the Obama administration's new rule making more employees eligible for overtime pay. The rule "will create disruption at small newspapers and likely lead to more job cutbacks" and less news coverage, said National Newspaper Association President Chip Hutcheson, publisher of The Times-Leader in Princeton, Ky.

The new rule, set to take effect Dec. 1, will make employees eligible for overtime if they earn less than $913 a week or $47,476 a year. The current threshold is about $23,660.

An NNA survey suggested that the rule would force a third of community to eliminate staff positions or reduce news coverage. Many papers "are already under financial pressure from weak local economies and they can't afford to pay additional overtime," NNA said in a statement. "For them, the unintended consequences include lost jobs and less news coverage."

UPDATE, May 20: However, those surveyed apparently did not know that the Labor Department had retained an exemption for weekly newspapers with a circulation under 4,000, while limiting it to "employees in rural areas," said Richard Karpel of American Pressworks, NNA's lobbying contractor. "The entire section is a bit perplexing so we will be seeking clarification about why it was included. . . . There is an indication that group-owned newspapers must total all circulations together," meaning that "even if one or two properties fall below the 4,000 threshold, their circulation total would be included in the cumulative total and not subject to the exemption."

Hutcheson had rejected calls by small businesses to introduce a more modified and gradually-rising threshold that sets overtime-eligible employees apart from professional staff. "NNA agreed that it was past time to adjust the salary levels," he said. "The Labor Department failed to do its job for a decade by creating more graduated adjustments that small businesses could live with. Then it decided to try to force the small business economy to leap the whole chasm in a single bound. Its ruling fails to recognize the realities of a slow-growing business climate. It also ignores the big differences between costs of living and earnings potential in small towns and major cities."

NNA said that "newsrooms have difficulty managing a 40-hour week, and that legal barriers for private-sector enterprises to offer meaningful flex time meant that news and sports staff could not take advantage of time off during slow seasons to compensate for extra hours spent on breaking news and sporting events. NNA requested consideration of a regional scale and joined the Newspaper Association of America in suggesting that thresholds should be set at a level of twice the annual earnings of a minimum wage earner. The minimum wage index would have given states and cities the ability to effectively set the overtime-eligibility standard."

NNA is now backing legislation (S. 2707 and H.R. 4773) that would block the rule and require the Labor Department to do more analysis of the impact on small businesses, nonprofits and public employers.

Rural Western residents say local papers need more economic news, rigorous reporting

Only 21 percent of people in a sample of the rural West believe their local news is reliable and consistent, says a study by Solutions Journal Network for the LOR Foundation. The study consisted of a focus group (164 people) and a Google survey (1,540 people) in 10 communities in Colorado, Montana and New Mexico and analysis of a week's worth of stories—900 in all—from local and regional outlets in the targeted area, Leah Todd reports for Solutions Journal Network.

The survey found that 52 percent of respondents said "their local news is, at best, sometimes valuable, and a significant number said their local news is rarely or never relevant," Todd writes. Still, newspapers are the No. 1 source for local news, with 81.7 percent of respondents from the focus group saying they get local news from the newspaper, 63.4 percent from interactions with other people, 44.5 percent from local government and community organizations and 40.8 percent from social media. Newspapers also tied with television for top news source among rural respondents to the Google survey.

Respondents were mostly unhappy with coverage of the local economy, Todd writes. Nearly every focus group said jobs and the local economy were the biggest concerns. "Yet very little — just 8 percent — of the news coverage we analyzed focused primarily on the economy ." There was a discrepancy between coverage and perceived coverage. Respondents said they wanted more education coverage, which analysis showed to be the second most covered topic, after crime.

Many people complained that news coverage is too negative, Todd writes. In some areas, such as Española, N.M. respondents "complained bitterly about what they saw as the local paper’s relentlessly negative slant on news — but nearly all admitted they still read it religiously." Española is home to the Rio Grande Sun, whose owners won last year's Tom and Pat Gish Award for courage, tenacity and integrity in rural journalism, given by the Institute for Rural Journalism and Community Issues, which publishes The Rural Blog.

"People said they want more rigorous reporting that exposes the context of complex issues, and more stories about how their communities and others are responding to problems, in addition to spotlighting the problems themselves," Todd writes. One Whitefish, Mont. respondent said, “If there’s one thing that’s missing, it’s the in-depth reporting or the enterprise-type reporting that goes beyond…what was stated at last night’s council meeting or what we send out in a press release, and tries to get to the root about the issue and have impact on it." A respondent in Anaconda, Mont. said, “I get to the bottom of an article and I say, ‘Where’s the rest?’”

Oil and gas boom helps most local governments but some very rural areas struggle to keep up

The oil and gas boom has helped most local governments in the U.S., but some in very rural areas "have struggled to keep pace with rapid industry growth," says a news release about research from Duke University.

"The shale revolution has created a variety of opportunities and challenges for local governments," said Richard Newell, a professor of energy and environmental economics. His team traveled to 21 oil- and gas-producing regions in 16 states to interview more than 200 local officials and look at government finances.

While oil and gas activity generated local property taxes, state severance and sales taxes and other revenues, "industry truck traffic can cause substantial damage to local roads, and population growth can strain government services such as police, fire and emergency services," the release says. "In regions experiencing the most rapid growth (such as parts of North Dakota, Texas and Colorado), city governments have spent hundreds of millions of dollars upgrading water and wastewater infrastructure to serve their growing populations."

The recent downturn in gas and oil prices "can create substantial financial challenges for regions where the oil and gas industry is a central part of the economy. In Alaska and North Dakota, for example, a prolonged slump in oil prices could lead to longer-term fiscal challenges for state and local governments." Newell's associate, Daniel Raimi, said, "Looking forward, local governments that have become heavily dependent on the oil and gas industry may look to diversify their economies."

The study is part of a three-year Shale Public Finance project funded by the Alfred P. Sloan Foundation. The reports were released at a May 18 workshop on the local impacts of oil and gas development. To see a webcast of the workshop go to www.rff.org/live. For more on the project, including previous reports and an interactive map of findings, see http://energy.duke.edu/shalepublicfinance.

Guy Clark, a great songwriter who got much respect but not much money, dies at 74

Guy Clark (Beth Gwinn/Redferns via Getty Images)

Guy Clark, who kept drawing on his West Texas upbringing as he became one of Nashville's most respected songwriters, died Tuesday in the Tennessee city after a long illness. He was 74.

"He never got rich, but earned the admiration of countless songwriters, including Bob Dylan," Ian Crouch writes for The New Yorker. "It’s tough to pin down precisely what made his songs so distinctive. He wasn’t a poet genius like Townes Van Zandt, or a blazing, righteous performer like Steve Earle. He never enjoyed wide popularity like Willie Nelson. Mostly his songs were strong and steady, projecting a deep, indisputable, and ultimately persuasive confidence and sense of self."

Clark, a lawyer's son who preferred to be called a poet, may have been best known for "L.A. Freeway," recorded in 1973 by his friend Jerry Jeff Walker; "Heartbroke," which was a No. 1 hit for Ricky Skaggs in 1982; and "Desperados Waitin' for a Train," from his first album, "Old No. 1," in 1975. That was "perhaps his most vivid song," Tamara Sorvino writes for The Oxford American. Her biography of Clark is due out in October.

"His songwriting evinced a keen eye not just for narrative detail but also an unerring ear for spoken vernacular and a wry, existentialist bent akin to that of Kris Kristofferson or John Prine," Bill Friskics-Warren writes for The New York Times. "A laconic though riveting storyteller, Mr. Clark was adept at getting at the heart of an experience or event."

Visiting consulting clinics reduce rural orthopedic doctor shortages, says Iowa study

Visiting consulting clinics greatly reduce rural orthopedic doctor shortages and drive times for patients, says a survey by the University of Iowa. Only 35 of the state's 99 counties have a full-time orthopedist, reports Tom Snee for Iowa Now. However, when VCCS are factored in, 88 counties are covered by an orthopedist. That's good news, considering orthopedic patients are "more likely to be older, overweight and less physically active," making it harder for them to travel long distances to seek care. Many end up delaying treatment rather than travelling.

"VCCs are outreach sites regularly visited by an orthopedic surgeon, typically a rural hospital located in a community too small to support a full-time specialist," Snee writes. "Patients meet with doctors in person and receive diagnostic services and some outpatient procedures. More complex procedures are usually referred to larger hospitals with the appropriate resources to support them. The researchers used data from 2014 to estimate average trip length for participating orthopedic surgeons and patients in all of Iowa’s census tracts."

Researchers found that VCCs reduced the average distance rural patients drove to see an orthpedist by 50 percent, from 19.2 miles to 8.4 miles, Snee writes. The survey found that 45 percent of all Iowa-based orthopedists visited at least one VCC since 2014. Lead author Thomas Gruca said, "Orthopedic surgeons in Iowa have been invested in rural outreach for more than 25 years. By traveling to 80 different sites every month, these physicians from Iowa and surrounding states reduced patient travel time and improved access to orthopedic care."

Income inequality brings rise in rural child poverty

Income inequality has led to a rise in rural child poverty, says a report by the Economic Research Service of the U.S. Department of Agriculture. From 2003 to 2012 rural child poverty increased by 6.6 percent, while incomes among rural families with children declined 6.5 percent, compared to a decline of 3.8 percent among urban families with children. The report says that was "partly due to the fact that average incomes for rural families with children did not rise during the economic expansion of 2003-07, and fell during the recession and the early years of the recovery."

"Roughly two-thirds of the rise in rural child poverty and three-quarters of the rise in urban child poverty between 2003 and 2012 resulted not from declining average incomes but rather from changes in the distribution of income around that average," says the report. "Child poverty rose more than might be expected, given average income changes, because income declines were especially large for families with children that were close to the poverty line." (USDA graphic)

"The poorest one-quarter of American families saw a bigger decrease in their incomes before and during the Great Recession than families in higher income brackets," Tim Marema reports for the Daily Yonder. "And the earnings of these low-income families didn’t bounce back as quickly or as much following the recession. Child poverty in rural America dropped by 3 points from 2012-2014. Though this was a bigger drop than urban children experienced, the overall rural child-poverty rate remained higher during the period (23.7 percent for rural vs. 20.7 for urban)."

GMO foods safe for humans, but could be bad for agriculture, National Academy study finds

A report by the National Academy of Sciences, Engineering and Medicine found no evidence that genetically modified foods are harmful to people, animals or the environment, Adam Darby reports for The Kansas City Star. "However, it is unclear whether genetically modified organisms, or GMOs, have increased crop yields, the study says, and the evolution of resistance in insects and weeds is a problem." The study's author said "evolved resistance to current GE characteristics in crops is a major agricultural problem.”

Researchers say "that new techniques, like a way to make small genetic changes in plants using genome-editing, are blurring the distinction between genetic engineering and conventional plant breeding, making the existing regulatory system untenable," Andrew Pollack reports for The New York Times. They call "for a new system that pays more attention to the attributes of the crop, as opposed to the way in which it was created."

Calls for mandatory labeling "has steadily grown louder for mandatory labeling, as consumers and food advocates say they have a right to know what's in their food," Greg Trotter reports for the Chicago Tribune. "Meanwhile, many food companies have maintained such labeling would be misleading because there's nothing harmful about GMO ingredients."

The report was widely criticized before it even came out, Seth Borenstein reports for The Associated Press. "Food & Water Watch criticized the National Academy as taking funding from biotechnology firms and using 'pro-GMO scientists' to write its reports. The report was funded by the Burroughs Wellcome Fund, the Gordon and Betty Moore Foundation, the New Venture Fund, the U.S. Department of Agriculture and the academy itself—none of which have direct connections to the agricultural biotechnology industry. It was peer reviewed by outside experts and committee members are vetted for financial conflicts of interests, said academy spokesman William Kearney."

Study says surgeries are safer and cheaper at critical-access hospitals, which are rural

It's safer and cheaper to have surgery at a rural hospital than an urban ones, says a study by University of Michigan researchers published in The Journal of the American Medical Association. Researchers found that critical-access hospitals, which by definition are rural, had significantly lower rates of serious complications—6.4 percent to 13.9 percent. Also, "Medicare expenditures adjusted for patient factors and procedure type were lower at critical-access hospitals than non–critical access hospitals," averaging $14.450 at critical access hospitals, compared to $15,845 at larger ones. (UM graphic)

The study examined 1,631,904 Medicare beneficiary admissions to 828 critical-access hospitals and 3,600 larger non–critical access hospitals for four surgical procedures—appendectomy, cholecystectomy, colectomy and hernia—from 2009 to 2013. Researchers "compared risk-adjusted outcomes using a multivariable logistical regression that adjusted for patient factors (age, sex, race, Elixhauser comorbidities), admission type (elective, urgent, emergency), and type of operation.

The risk of dying within 30 days of the operation "was the same across all hospitals," Susan Scutti reports for Medical Daily. But researchers "discovered the risk of suffering a major complication after surgery was lower at critical access hospitals compared to larger facilities. Complications included heart attacks, pneumonia, and kidney damage. Importantly, the researchers discovered patients who had these operations at critical access hospitals checked in healthier to begin with, suggesting that surgeons in these remote hospitals are appropriately selecting patients who will do well in a small rural setting while triaging more complex patients to larger centers."

"The study’s limitations include the possibility that the research team may have overestimated complication rates at larger hospitals due to how administrative reports code data," Scutti writes. "Still, the results indicate these hospitals perform well and safely at least from a surgical standpoint. Lead author Dr. Andrew Ibrahim and his co-researchers believe the implications of their work are significant to Medicare policies."

Health-care consumers get little help resolving complaints, columnist says

Health-care consumers get little help resolving complaints about high-priced bills that customers are asked to foot, writes Trudy Lieberman of Rural Health News Service in her latest "Thinking About Health" column, distributed to several state newspaper associations.

"Who protects patients when things go wrong on healthcare’s financial side?" Lieberman asks. "What happens when you receive a bill you didn’t expect and can’t afford to pay? What happens when insurers send unintelligible explanations of benefits you can’t understand? What about questionable loan arrangements to avoid medical bankruptcy?"

She answers, "Consumers of health care are pretty much on their own. From the 1960s though the 1980s when people complained, they got action from consumer organizations, government and even businesses that set up departments to handle complaints. That consumer movement is now but a flicker."

One problem is Medicare's three-day observation rule, which left John Rutledge of Wheaton, Ill., with $15,000 in hospital bills after his wife was admitted for observation, despite the fact that he refused to sign a document concurring to that statement, Lieberman writes. "Thousands of families have been caught when hospitals decide their loved ones are admitted for 'observation,' a tactic that allows them to avoid repaying Medicare if government auditors find patients should not have been classified as 'in-patients.' Playing the 'observational' game is worth millions to hospitals but costs families tens of thousands of dollars when someone doesn’t qualify for Medicare-covered skilled nursing care."

Another problem is ambulance charges, Lieberman writes. "Kathryn Green, a college history professor who lives in Greenwood, Miss. is fighting an air-ambulance company, which transported her late husband to a Jackson hospital after he suffered a fatal fall in their home. This 'nightmare,' as she calls it, is a bill from the transport company that claims it’s outside her insurance network, and says she owes them $50,950. Green is raising a ruckus and has taken her case to state and national media, members of Congress, the state attorney general, and the Mississippi Health Advocacy Program. The company has told her it will begin collection efforts."

"In both cases there’s a legislative solution," Lieberman writes. "The three-day rule can be fixed by counting all the time a patient spends in the hospital whether they’re classified as an 'in' or as an 'observational' patient. The ambulance problem can be fixed by changing the 1978 airline deregulation law that prevents states from interfering with fares, services, and routes. But money and politics block the federal changes that would help people like Rutledge and Green."

Lieberman invites consumers who have had billing issues to contact her at trudy.lieberman@gmail.com. Her column often appears on Kentucky Health News, published by the Institute for Rural Journalism and Community Issues, which publishes The Rural Blog.

Texas oil and gas industry 'almost certainly' caused 59% of earthquakes since 1975, says study

Nearly two-thirds of Texas earthquakes over the past 40 years can be linked to the oil and gas industry, says a study by the University of Texas and Southern Methodist University, published today in the journal Seismological Research Letters. The study "concludes that activities associated with petroleum production 'almost certainly' or 'probably' set off 59 percent of earthquakes across the state between 1975 and 2015," Anna Kuchment reports for The Dallas Morning News. "Another 28 percent were 'possibly' triggered by oil and gas activities. Scientists deemed only 13 percent of the quakes to be natural." (Morning News graphic)

The Texas Railroad Commission, which regulates the state's oil and gas industry, was quick to dismiss the study as arbitrary, Kuchment writes. "In November 2014 the commission tightened its rules for disposal wells. Since then, it has received 51 disposal-well applications. Of these, 22 permits were issued with special conditions, such as requirements to reduce daily maximum injection volumes and pressure and to record volumes and pressures daily as opposed to monthly. Nine permits were issued without special conditions. The rest were either withdrawn, returned to the applicant for more information, protested and sent to a hearing, or are still pending."

The study links man-made earthquakes back to the early days of the oil and gas industry, Kuchment writes. "The first man-made quake struck in 1925 in the Goose Creek oil field along the Gulf Coast east of Houston. Humble Oil, a precursor of Exxon, had extracted so much oil that the ground sank and caused houses to shake and dishes to crash to the floor. Over the years, different petroleum production methods have triggered quakes, including oil and gas extraction and enhanced recovery, in which operators pump water or carbon dioxide into reservoirs to boost the flow of oil. Each method can, in rare cases, raise or lower pressure on faults and cause them to rupture."

Employer drug tests increasingly positive; county-level maps show rise in overdose deaths

U.S. employers are finding it increasingly difficult to hire workers who can pass a drug test, Jackie Calmes reports for The New York Times. "That hurdle partly stems from the growing ubiquity of drug testing, at corporations with big human-resources departments, in industries like trucking where testing is mandated by federal law for safety reasons, and increasingly at smaller companies. But data suggest employers’ difficulties also reflect an increase in the use of drugs, especially marijuana—employers’ main gripe—and also heroin and other opioid drugs much in the news."

In 2014, 4.7 percent of Americans tested positive for illicit drug use, up from 4.3 percent in 2013, according to Quest Diagnostics, which has compiled employer-testing data since 1988. "The National Survey on Drug Use and Health reported in September that one in 10 Americans ages 12 and older reported in 2014 that they had used illicit drugs within the last month—the largest share since 2001." (NYT graphic: Drug overdose deaths by county from 2003 to 2014)

Drug overdose deaths increased in nearly every county in the U.S. from 2003 to 2014, Haeyoun Park and Matthew Bloch report for NYT. During 2014 a total of 47,055 drug overdose deaths—of about 125 people every day—occurred, says the Centers for Disease Control and Prevention. Drug overdose death rates have increased from nine deaths per every 100,000 people in 2003 to 15 deaths per every 100,000 people in 2014.

"The trend is now similar to that of the human immunodeficiency virus, or H.I.V., epidemic in the late 1980s and early 1990s, said Robert Anderson, the CDC’s chief of mortality statistics," Park and Bloch write. "Some of the largest concentrations of overdose deaths were in Appalachia and the Southwest, according to county-level estimates released by CDC.

Knight Foundation, Columbia launch $60M initiative to help journalists fight for open records

The John S. and James L. Knight Foundation and Columbia University today announced the formation of the $60 million Knight First Amendment Institute at Columbia. A Knight press release says one of the main goals is to help financially challenged newspapers fight for freedom of information by providing funds for legal work. The foundation and the university will contribute $5 million each in operating funds and $25 million each in endowment funds, which should generate about $1 million a year.

"A recent Knight Foundation poll of leading newsroom editors revealed that they believe the news industry is less able to pursue legal cases around free speech and freedom of the press issues than it was 10 years ago, with most also agreeing that First Amendment law has not kept pace with new digital-age demands," the release noted.

Jennifer Preston, Knight’s vice president for journalism, said “Digital journalism has created exciting, unprecedented opportunities for how we report and receive the news. Today’s reporters and news outlets have access to innovative platforms, fresh perspectives and a level of immediacy like never before. But it is also creating First Amendment challenges. Without sustained advocacy dedicated to defending uninhibited expression and a free press, we are at risk of experiencing a steady erosion of these bedrock freedoms. This is a precarious moment for the First Amendment, and with this Institute we hope to establish a primary, permanent, influential advocate of free expression.” (Read more)

Commodity groups want to exclude checkoff funds from federal Freedom of Information Act

The House Appropriations Committee's 2017 Agriculture Appropriations bill says that checkoff programs are not agencies of the federal government, meaning they don't fall under Freedom of Information Act requests, Marion Nestle reports for Food Politics. Checkoff programs are research and promotion programs run by boards and overseen by the U.S. Department of Agriculture. "Checkoffs mainly do generic marketing. They are not supposed to lobby. The USDA is supposed to manage the boards—but not with federal money. So are checkoffs government programs or not? The checkoffs like to say they are government when convenient, but not government when inconvenient. This is one of those times."

On April 11 a group of 14 trade associations—not the checkoff programs themselves—"sent a letter to Rep. Robert Aderholt (R-Ala.) chairman of the House Appropriations agriculture subcommittee, and Rep. Sam Farr (D-Calif.) the subcommittee's top Democrat, asking them to urge USDA to recognize that the promotional programs are not subject to public records requests," Candice Choi and Mary Clare Jalonick report for The Associated Press. "The rationale was that the programs are funded by producers. The House Appropriations Committee approved the legislation on April 19, including the report language urging USDA to recognize the programs are not subject to FOIA."

While checkoff programs do not receive federal funds "it's the government's backing that enables them to collect money from producers," opines Urban Lehner, editor emeritus for DTN The Progressive Farmer. "In a 2005 case involving the beef checkoff, the Supreme Court rejected a challenge from ranchers who didn't want to pay the assessment. They said being forced to subsidize promotional messages with which they disagreed (because the messages promoted generic beef, not particular types of beef) violated their First Amendment rights."

"The court replied that citizens have no First Amendment right not to fund "government speech"—and checkoff messages are government speech," Lehner writes. "Writing for the court, the late Justice Antonin Scalia declared, 'The message of the (beef) promotional campaigns is effectively controlled by the Federal Government itself" Checkoff boards liked the decision. They like the governmental aura when it enables mandatory fee collections. They don't like it when it allows embarrassing information about their operations to come to light. That's the real reason 14 commodity organizations (not the checkoff boards themselves, which aren't allowed to lobby) sought the exemption."

States' challenge to CO2 limits gets big appeals panel and is delayed; ruling will come post-election

"A U.S. appeals court on Monday delayed consideration of a challenge by 27 states to President Obama's federal regulations to curb carbon dioxide emissions mainly from coal-fired plants, meaning a decision will not come until after the November presidential election," Lawrence Hurley reports for Reuters. "The U.S. Court of Appeals for the District of Columbia Circuit will now hear the case on Sept. 27. The court was originally due to hear the case on June 2. The change appeared to be made so that a larger group of nine judges will hear the case instead of the normal three-judge panel."

Chief Judge Merrick Garland—Obama's nominee for Supreme Court—and Judge Cornelia Pillard recused themselves from hearing arguments on the Clean Power Plan, Michael Biesecker reports for The Associated Press. Of the nine remaining judges, five were appointed by Democratic presidents. "The Supreme Court voted 5-4 earlier this year to delay implementation of the plan until the legal challenges are resolved," but that vote was taken before the death of Justice Antonin Scalia, who voted to delay implementation of the plan until legal challenges were resolved. (IBEW Media Center map)

Hawaii biodiesel refinery is first U.S. biofuels plant to be certified as sustainable by industry group

A Hawaii plant that turns 13,000 gallons a day of waste cooking oils, animal fats, fruit and seeds into diesel fuel has been certified the nation's first sustainable biodiesel plant by the Sustainable Biodiesel Alliance, a non-profit industry group, Diane Cardwell reports for The New York Times. "The certification is intended to help clean fuel producers distinguish themselves to customers seeking green products—a kind of Good Housekeeping Seal of Approval for the environmentally conscious." (NYT photo by Kent Nishimura: Refinery in Kea’au)

"For biofuels, the environmental benefits of which have fallen under increasing scrutiny in recent years, that differentiation is ever more important, executives and advocates say," Cardwell writes. Jeff Plowman, chairman of the alliance’s certification committee, told her, “There are lots of different ways of making biodiesel—lots of different feedstocks—and some have been more sustainable than others. Much like the organic labeling or non-G.M.O. labeling, it gives consumers some information to make a choice."

"Climate change specialists say there may simply not be enough agricultural waste to produce significant quantities of biofuel without causing other environmental problems, and it is important to account for what would have happened to the waste material had it not been funneled into fuel," Cardwell writes. John M. DeCicco, a research professor at the University of Michigan Energy Institute, told her, “You can’t just automatically make assumptions that, say, waste-based fuel is O.K. If you have a waste that was otherwise not going to decay, then that carbon is already being kept out of the air with respect to the atmosphere, and at that point you’re as ahead of the game as you’re ever going to be.” (Read more)

Legalizing pot all over U.S. could generate $28 billion in federal, state and local taxes, says study

Legalizing marijuana in the U.S. could "generate up to $28 billion in tax revenues for federal, state, and local governments, including $7 billion in federal revenue: $5.5 billion from business taxes and $1.5 billion from income and payroll taxes," says a study by the Tax Foundation. "A federal tax of $23 per pound of product, similar to the federal tax on tobacco, could generate $500 million per year. Alternatively, a 10 percent sales surtax could generate $5.3 billion per year, with higher tax rates collecting proportionately more." (Post graphic)

In states that have legalized marijuana revenue collections have exceeded initial estimates, says the study. Colorado, which anticipated $70 million in marijuana tax collections per year, will likely exceed $140 million this year. In Washington, sales are averaging more than $2 million a day with revenue potentially reaching $270 million per year. "If all states legalized and taxed marijuana, states could collectively expect to raise between $5 billion and $18 billion per year."

The study points out that large numbers of people are using marijuana, regardless of whether or not it is legal, Christopher Ingraham reports for The Washington Post. More than "13 percent of Americans 12 and older—35 million people—used marijuana in 2014. And 4.2 million of them met criteria for substance abuse or dependence," according to a National Survey on Drug Use and Health. "We're already paying the social cost of marijuana abuse, in other words. Increased tax revenues could help offset those costs."

70-plus volunteers from several states help restore home where Hatfield-McCoy feud ended

Photo by Josh Little, Appalachian News-Express

In what the main expert called "the largest volunteer historic preservation event in the history of America," 70 or more volunteers from several states are restoring a historic home in Pikeville, Ky., in the heart of the Central Appalachian coalfield.

"Pikeville is one of the most amazing towns I have worked in anywhere across the country," preservation expert Bob Yapp told the Appalachian News-Express, the town's thrice-weekly newspaper.

The York House was built in 1874, when Pike County was still a land of timbering and subsistence farming and the notorious Hatfield-McCoy feud was still only brewing. John Dils gave the property to his daughter, Augusta, and her husband James York, a lawyer who at one time or another represented both leaders of the feud that erupted in 1878: his neighbor, Randolph McCoy, during the latter phase, and earlier Anderson "Devil Anse" Hatfield. The end of the feud was negotiated in the parlor of the home, which sits next to the home of feud figure Perry Cline, which is next to the McCoy home, says the project website.

"Once complete, the building will house the Dils-York Cultural Heritage Center," Alix Casper-Peak reports for WYMT-TV in Hazard.

More than 650 mostly rural counties will have only one Obamacare exchange option in 2017

Residents in more than 650 counties, mainly rural, will only have one insurance option when shopping for Affordable Care Act health insurance in 2017, Anna Wilde Mathews and Stephanie Armour report for The Wall Street Journal. "The entire states of Alaska and Alabama are expected to have only one insurer on the health law’s signature online marketplaces next year, according to state regulators. The same is expected to be true in parts of several other states, including Kentucky, Tennessee, Mississippi, Arizona and Oklahoma, state regulators said."

In 2016 the number of counties with only one option was 225, "when the state of Wyoming, among other areas, already had just one ACA marketplace competitor," Mathews and Armour write. "Of the counties in jeopardy of having only a single exchange insurer next year, 70 percent have populations that are mostly rural," according to Cynthia Cox of the Kaiser Family Foundation. She said "disclosures of new market entries or further pullbacks will change the totals in coming months. Filings in many states aren’t yet public, and insurers can tweak their approaches until September." (WSJ graphic)

"UnitedHealth Group Inc. said last month it would leave all but a handful of the 34 states where it sold exchange plans this year amid losses; Humana Inc. is also pulling out of some areas," Mathews and Armour write. "Others are sticking around: Anthem Inc. has said it would continue selling exchange plans in its current 14 states. Aetna Inc. will remain in its 15 states and has said it may enter more, and Cigna Corp. plans to extend beyond the seven states where it currently sells exchange plans. Premera Blue Cross said all of its subsidiaries would stop selling ACA marketplace plans in a dozen largely rural counties in its home state of Washington. It will also pull out of Oregon, where it has used the LifeWise brand."

Insurance companies say rural areas have "fewer, less-competitive health-care providers that weren’t willing to strike the payment deals the insurer sought," Mathews and Armour write. "A new analysis by Inovalon Inc., a health-technology firm, shows why rural areas are often less inviting for insurers. Using a health-insurance claims database that includes about two million exchange enrollees, Inovalon found that rural residents racked up significantly higher medical costs than urban enrollees in 2015." (Read more)

Medical schools opening locations in under-served areas to help local areas grow their own doctors

To help fill doctor shortages in rural areas 84 percent of U.S. medical schools "have, or plan to establish, programs to recruit diverse students interested in working with underserved populations," Ellen Wexler reports for Inside Higher Ed. "Sometimes that means creating new locations in rural areas, in states at the bottom of the Association of American Medical Colleges’ lists. When students study in under-served locations, the hope is that they'll stick around." AAMC predicts that over the next nine years the U.S. will be short 61,700 to 94,700 doctors.

Since 2002, 20 new M.D.-granting and 10 new D.O.-granting medical schools have been established, Wexler writes. This fall the New York Institute of Technology College of Osteopathic Medicine will open a new location at Arkansas State University. The goal is to help local students earn medical degrees to practice in Arkansas, which ranks 46th in active physicians per capita and 48th in its population's health status. Barbara Ross-Lee, dean of NYIT's new location, told Wexler, "In states that are experiencing shortages in physicians, the best way to supply more physicians is to grow your own."

Since many medical schools are already at capacity they unable to increase class sizes on their main campuses, Wexler writes. "That’s why some medical schools are operating on the campuses of other colleges instead of building their own spaces in new locations. The partnerships allow medical schools to grow enrollment while saving on expenses like infrastructure and staff support." Charles Bird, a former Ohio University administrator who now consults with colleges and universities about branch campuses, told Wexler, “This is a way to meet a real, legitimate need in a cost-effective way."

Hillary Clinton still trying to win over coal country ahead of Tuesday's primary in Kentucky

Democratic presidential candidate Hillary Clinton, who easily won Kentucky in the 2008 primary against President Obama, will have a tougher go this time around during Tuesday's primary in the Bluegrass State. The main issue is coal, with Clinton putting her foot in her mouth in March by saying "we're going to put a lot of coal miners and coal companies out of business" with rules to fight climate change. Clinton admitted that she misspoke, and has a plan to help laid-off miners, but the comment hasn't hurt her in a red state that has lost more than half its coal jobs during the Obama administration.

During speeches Sunday "Clinton touted her plan for coal country," Catherine Lucey reports for The Associated Press. "Her proposals include protecting miners' health care coverage and retirement programs, investing in infrastructure in mining communities and repurposing mines. Clinton pledged to put husband Bill Clinton—who won the state in 1992 and 1996—'in charge of revitalizing the economy.' She provided no further details, but during Bill Clinton's administration, economic growth averaged 4 percent per year, median family income rose and the budget deficit was turned into a surplus."

Vermont Sen. Bernie Sanders same to Kentucky and talked about polls showing he would do better than Clinton against Republican Donald Trump, Joseph Gerth reports for The Courier-Journal. Sanders told supporters, "We do very well with Democrats but we also do very well with independents and the Democratic leadership may not know it yet but independents are the fastest growing segment of the American political system."

Sanders was running only 5 percentage points behind Clinton in an early-March poll, before she made her coal comment, and could benefit from Trump supporters who are registered Democrats, writes Courier-Journal contributing columnist Al Cross, director of the University of Kentucky's Institute for Rural Journalism and Community Issues, which publishes The Rural Blog.

How the NRA has gone from promoting gun safety to being the biggest lobby in Washington, D.C.

The National Rifle Association has transformed itself over the past 150 years from a group promoting marksmanship and safety to being arguably the most powerful interest group in Washington, D.C., Andrew Wolfson reports for The Courier-Journal in advance of the NRA's annual meeting May 19-22 in Louisville. "With an operating budget of more than $300 million, it spent $28 million supporting and opposing candidates in the last federal election cycle and $3.6 million on 35 lobbyists last year. But 151 organizations spent more on lobbying—the American Medical Association alone spent seven times as much. And the NRA’s enemies and champions alike say its power derives more from its grass-roots support than from money."

The NRA's strength is their ability to sway voters, Wolfson writes. "In 2014 alone, the NRA spent $61 million on 'member communications,' according to its tax report, including to spread the word about the 'report cards' its Political Victory Fund compiles in every state and federal race. Richard Feldman, who worked for the NRA in the 1980s, said one of the keys to the NRA’s clout "is that it has wisely shaped the fight as a symbolic battle over freedom and liberty, after conducting tests more than 30 years ago that showed gun owners associated them with those terms."

"The result: In the three years since a heavily armed gunman walked into Sandy Hook Elementary School in Newtown, Conn., and killed 26 people—20 of them children—Congress has passed a single piece of gun control legislation—a bill to renew an expiring ban on plastic firearms that could bypass security checkpoints and be snuck on airplanes," Wolfson writes. "The NRA helped defeat a bill to extend a ban on assault weapons. It blocked a bill that would have extended background checks to gun shows despite the fact that even 79 percent of Republican voters supported it, according to a Pew Research Center poll last summer. The NRA even slipped into the language of the Affordable Care Act, known as Obamacare, restricting what doctors can ask patients about firearms in their homes." (C-J graphic)

"The NRA has been even more effective in statehouses across the U.S., pushing through 'stand-your-ground laws' in 23 states that removed the duty to retreat before using force in self-defense, and legislation in 42 states to allow residents to carry concealed firearms with a permit,' Wolfson writes. "The other eight allow that without a permit. But the NRA’s biggest victory came at the Supreme Court in 2008, when by a 5-4 vote the court struck down a District of Columbia law that had banned handguns from the home. The decision marked the first time the high court ever found that the Second Amendment protects an individual right to bear arms in self-defense. And it marked the culmination of decades of work by the NRA to redefine the amendment as a personal right—rather than one intended to maintain a 'well-regulated militia,' as the preface to the amendment says."

The NRA has been successful at the state level, in places like Kentucky, "where 81 out of 100 House members and 32 out of 38 senators earned marks of A or A+ when they were graded during their most recent elections," Wolfson writes. In Kentucky, "over the past three decades, with the NRA’s support and little opposition, the General Assembly has stripped the power of cities to enact gun control ordinances, knocking existing ones off the books," Wolfson writes. "The legislature has given motorists and homeowners the right to stand their ground and shoot first, without retreating. It has blocked police from destroying weapons confiscated from criminals to keep them from getting back on the street. It has allowed residents to carry concealed weapons, with some restrictions. Then it voted at least 12 times to loosen the regulations, including to allow concealed guns in churches."

Gun ownership is prevalent in Kentucky, "but Al Cross, director of the Institute for Rural Journalism and Community Issues at the University of Kentucky, said the NRA’s strength in Kentucky springs from more than the number of gun owners alone," Wolfson reports. "They have created the myth that people are out to get their guns," said Cross. "When you are dealing with a population that is prepared to believe the worst about politicians, it is a pretty easy message to sell." The Institute publishes The Rural Blog.

Trump and Clinton both struggle to tell the truth, rural Virginia columnist says

Curtis Seltzer

Republican Donald Trump and Democrat Hillary Clinton, who are both on verge of securing their parties' nominations for president, are incapable of telling the truth, writes Curtis Seltzer, a Highland County, Virginia, real-estate writer who often dabbles in political topics.

"Clinton appears to have lost the ability to tell the truth about her actions when it would disadvantage her. Trump tells his version of the truth regardless of whether any evidence supports it," Seltzer writes. "Clinton is hiding whatever agenda she has by metastasizing into positions that she once rejected. In the Democratic Party’s game of political hopscotch, she’s now landed in every numbered square at the same time. Trump is obfuscating his policy plans—assuming he has some—by being inarticulate, unresponsive, inconsistent and teasingly hazy. He has raised hide-the-ball politics to a form of abstract art."

"I don’t even mind politicians changing their policies to appeal to more voters to get elected," he writes. "I do mind politicians reneging on their personal promises to the people who elect them. My congressman, Bob Goodlatte, was elected in 1992 on his oft-stated pledge that he would serve no more than six two-year terms. Twelve years after passing his promised deadline, he’s still occupyingthe office that he promised to leave. I’m waiting for Bob Goodlatte to fulfill his promise. With both Clinton and Trump, I get the feeling that all promises will be kept—out of sight and out of mind upon taking office."

"The simplest way of dealing with Big Money buying influence over politicians is to require that any elected or appointed official who accepts anything of value as a gift, fee or campaign contribution must recuse himself/herself from any vote or decision affecting that donor’s interests," Seltzer writes. "With that rule, the quid pro quo of giving money to influence a political decision would end. Donors could expect nothing for their generosity, and recipients would absent themselves from conflicts of interest."

"I take some comfort in the fact that whether it’s Clinton or Trump who wins, neither is likely to have much success in getting their programs through Congress," Seltzer concludes. "I also take some discomfort in the same fact, because it leaves us punting the issues down a field that keeps getting longer. Waiting for a President Clinton to get much of anything done will be akin to waiting for Godot. I will, however, be waiting fearfully for her next big bad judgment. Waiting for a President Trump to be other than who he has always been will also be unrewarded. I will, accordingly, be waiting for him to do something really stupid. We are facing a choice between two individuals who either don’t know who they will be or refuse to say."

Rural Va. weekly gets unprecedented community response from survey on quality of life, concerns

The weekly Rappahannock News in northern Virginia got an unprecedented 42 percent response rate (1,362 out of 3,258) from a survey sent to every household in the county asking residents about their most important qualities of life in the region and their main issues of concern. Rappahannock County (Wikipedia map) has 7,400 residents and is in the foothills of the Blue Ridge, 65 miles west of Washington, and may be a classic case of a rural place that wants to maintain its environmental qualities while having more urban conveniences. The News turned the survey, done in a partnership with a local non-profit, into a three-part series.

Many respondents said they "treasure the beauty that surrounds them, the privacy they enjoy in one of Virginia’s least populated and unspoiled places, and the spirit of volunteerism that has neighbor helping neighbor," Christopher Connell writes in the first part of the series. "But most who responded to the survey are open to some changes. They see a crying need for better cellphone and internet service, no longer frills but essentials that affect safety, children’s education and, increasingly, people’s livelihoods. As one resident put it, 'We need to catch up to Third World countries.'”

(News graphic: Respondents rated each category from 1, not important at all, to 4, very important)

"The survey, commissioned by the nonprofit, nonpartisan Foothills Forum and conducted by the University of Virginia’s Center for Survey Research, found 90 percent of respondents satisfied with living in Rappahannock and a scant 3 percent dissatisfied," Connell writes. "As much as people love the solitude and want nothing to destroy the mountain vistas, obscure the night skies or invade the hollows, more than 70 percent are open to some changes. Fewer than three in 10 believe Rappahannock should stay just as it is with no more changes. But sentiment was strong – 70 percent – in favor of limiting taxes."

"While respondents are mostly satisfied with the quality of services and amenities in the county, they also are anxious about housing affordability, the dearth of jobs, the availability of services for elders, and preserving farms," Connell writes. "Protecting the environment ranked high among concerns. Maintaining the county’s beauty, preserving the quality of its rivers and keeping the night skies shimmering were Nos. 3, 5 and 6. While it’s a point of pride that there are no fast-food outlets or big-box stores nor even a stoplight, some residents chafe at having to drive to Warrenton, Culpeper or Front Royal to shop at a supermarket or fill a prescription."

The biggest concerns were poor internet and cell phone service, Connell writes in the second part of the series. "Rappahannock residents gripe about a myriad of inconveniences from the county’s spotty cellphone service—the missed call from a doctor’s office or a teacher, the important text message that didn’t get through, the boss or a customer not being able to find them in a pinch. Mostly they grin— or grit their teeth.—and bear it. Some would prefer no service to a profusion of cell towers."

Poor cell service can be more than a nuisance, Connell notes, telling the story of maintenance worker Richard Allen Brown being struck in the leg by the blade of a trimmer, severing an artery. "His co-worker tried to fashion a tourniquet and then, because his cellphone had no reception, frantically ran a half-mile uphill to the nearest house to call for an ambulance from a land line. The Sperryville Volunteer Rescue Squad arrived eight minutes after the call. Two other companies responded as well and a medevac helicopter was called, all too late for the 67-year-old Sperryville man."

Despite lack of technology, some residents are concenthat the region is "frozen in time," Connell writes in the third part of the series. In addition to poor internet and cell phone service four of the top six concerns were "maintaining the county’s beauty, maintaining family farms, protecting the quality of rivers and keeping those remarkable views of the sky and stars at night." Rick Kohler, president of the Rappahannock League for Environmental Protection, told Connell, “It’s one of the last places on the East Coast with a view of the Milky Way. It is a treasure we must all cherish for once gone, it is gone forever.”

The region has "already has undergone significant changes in recent decades," Connell writes. "The apple and peach orchards are largely gone. There are still no stoplights or fast-food franchises, but the population grew 44 percent between 1970 and 2010, from 5,200 to 7,500. It is graying rapidly and, some fear, gentrifying in ways that could make it affordable mainly for 'come heres' at the expense of 'been heres'.”

The nonprofit Foothills Forum raises community support for research and enhanced reporting on Rappahannock County matters. Its all-volunteer directors and advisers include journalists with backgrounds at The Washington Post, The Miami Herald, The Boston Globe, America’s Morning News and American Spectator. "The countywide survey establishes a baseline to guide future reporting on key issues including a deeper dive into broadband and cell coverage where large swaths of the mountainous region lack connectivity. In this unique community engagement effort, the nonprofit is also underwriting a college intern this summer and has underwritten the expenses of a volunteer uploading public meetings to YouTube," writes Larry "Bud" Meyer, chair of the organization, in an email to The Rural Blog.