Rural fire departments struggle to fill aging ranks, deploy new recruiting strategies for volunteers

Russel Prince volunteered for 50 years
in Winside, Neb. (World-Herald photo)

Small-town and rural fire departments are short on volunteers and struggling to keep the ranks full. Populations in most small towns are aging, "and that’s reflected in those who serve some of the most important public safety chores: fighting fires and answering rescue calls, from highway accidents to heart attacks and slips and falls," reports Paul Hammel of the Omaha World-Herald.

Nationally, about 31 percent of firefighters in towns under 2,500 in population are 50 or older, and probably older the the smallest towns, officials told Hammel. The average age in most rural counties is rising. "About half of Nebraska’s 93 counties had median ages of 45 and above in 2010, compared with only two counties in 2000," Hammel reports.

Officials told Hammel that demands of children, school and family make it difficult to persuade young people to volunteer, and population decline makes it harder to find volunteers. “The fact is we have an aging workforce and we don’t have that rush into the fire service,”  Michael Dwyer, secretary-treasurer of the Nebraska State Volunteer Firefighters Association, told Hammel.

Small-town departments in Nebraska and Iowa have used several strategies to help fill the ranks, such as recruiting high-school-age "cadets" as helpers and reimbursing training costs and paying a small stipend to answer calls, Hammel reports. "As an incentive to volunteer, the Nebraska Legislature passed a law this year granting a $250-a-year income-tax credit for those who volunteer for fire and ambulance services. In Iowa, a similar law went into effect in 2013."

The main example in Hammel's story is Winside Fire and Rescue, in a town of 427 with 34 volunteers, and former member Russel Prince, 79, one of five volunteer firefighters in Nebraska honored this year for 50 years of service. "He quit taking rescue calls three decades ago due to the time-consuming training required and, because of his age, cut back his role on fire calls in recent years mostly to driving pumper trucks and helping with equipment," Hammel reports.

“I told them if they needed help to holler,” said Prince, who retired in October after staying a few months to reach the 50-year milestone. Prince told Hammel he remembers when volunteers wore raincoats to fires, not the fire-protective bunker gear now used. He recalls when the Winside department got its first ambulance in 1974 -- a federal surplus 1964 Ford station wagon.

"The numbers of volunteer firefighters in both Nebraska and Iowa have slowly dwindled over recent decades, and with rural populations projected to continue to fall, it’s prompting concern," Hammel reports. "In Nebraska, an estimated 12,000 volunteers answer fire and rescue calls over 72 percent of the state, from suburbs like Gretna and Waverly to rural areas like Winside."

Trump over-performed Romney most in places with high substance-abuse mortality and suicide rates

Donald Trump improved the Republican presidential vote "in counties with the highest drug, alcohol and suicide mortality rates," says a study by rural sociologist and demographer Shannon Monnat of Penn State, which compared Trump's vote with that of Mitt Romney in 2012.

"Much of this relationship is accounted for by economic distress and the proportion of working-class residents," Monnat writes. "Trump performed best in counties with high economic distress and a large working class. Drug, alcohol and suicide mortality rates are higher in counties with more economic distress and a larger working class. Many of the counties with high mortality rates where Trump did the best have experienced significant employment losses in manufacturing over the past several decades," mainly the industrial Midwest, Appalachia and New England.

"People often (but not always) turn to pills, syringes, the bottle and other self-destructive behaviors when they lose hope, when they don’t have the means to live comfortably or when they don’t get the dignity that comes from work," writes James Hohmann of The Washington Post, citing counties in Ohio, West Virginia and New Hampshire as examples in the study.

"Alcoholism, overdoses and suicide are symptoms of the deeper social decay that was caused by deindustrialization. This decay led to the fears and anxieties which Trump so effectively capitalized on," Hohmann reports. "I saw this firsthand on the campaign trail all year, in countless interviews with folks who were down in the dumps and struggling to get ahead (or, quite frankly, just get by). Many supported Barack Obama eight years ago because they were desperate for hope and change. They’re still desperate, and now they’re hopeful Trump can bring the change they’re looking for."

Trump pick for Labor likes immigrant labor, and E-Verify to block employment of undocumented

Trump, VP-elect Mike Pence and Puzder (AP photo)

President-elect Donald Trump's choice for labor secretary is a fast-food executive who "has argued for the need for low-skilled immigrant workers in his industry and others," Philip Brasher reports for Agri-Pulse, a Washington, D.C., newsletter. Andy Puzder, 66, is CEO of CKE Restaurants, which operates the Hardee's and Carl's Jr. chains.

Craig Regelbrugge, former co-chairman of the Agriculture Coalition for Immigration Reform, said Puzder's nomination was a good sign that industry will see fewer regulations and streamlined guest worker programs," Brasher reports. "One issue that will give some in agriculture pause is that he supports the E-Verify system and says it has helped ensure that workers in his restaurants are legal. Growers have been fighting mandatory E-Verify bills in Congress, saying they won't be able to hire enough legal workers until Congress acts on broader immigration reform. There are also differences in the restaurant industry over E-Verify."

Puzder and Trump have not been on the same page when it comes to immigration. "He was a strong supporter of the Senate's 2013 comprehensive immigration reform bill that would have offered illegal immigrants a path to citizenship and expanded access to low-skilled guest workers," Brasher notes. "His one gripe about the bill was the amount of spending it would have devoted to border security, a central priority of the Trump campaign."

Border security will not be in Pudzer's portfolio at the Department of Labor, which "investigates violations of minimum wage, overtime and worker safety laws and regulations," The New York Times notes. The paper quoted AFL-CIO President Rich Trumka as calling Puzder "a man whose business record is defined by fighting against working people."

"Puzder has criticized the Affordable Care Act and argued against raising the federal minimum wage higher than $9 an hour," The Wall Street Journal notes. The Washington Post notes that he also "opposes the recently-delayed Labor Department rule that aimed to make millions more workers eligible for overtime pay," which the National Newspaper Association opposes.

Big new health law includes money to fight opioid abuse; Vilsack says much needed in rural areas

Congress passed legislation Wednesday that will, among other things, increase funding for medical research and speed up the federal approval of new drugs and medical devices. It now heads to President Barack Obama's desk for his signature.

Obama said in a statement, "We are now one step closer to ending cancer as we know it, unlocking cures for diseases like Alzheimer’s, and helping people seeking treatment for opioid addiction finally get the help they need. . . . This bill will make a big difference."

The legislation provides $1 billion for the heroin and opioid epidemic, $1.8 billion for Vice President Joe Biden's "moonshot" initiative to cure cancer and nearly $3 billion for the BRAIN and Precision Medicine Initiatives, which targets diseases like Alzheimer's. It also has measures to improve mental-health treatment and to speed up the federal approval process for drugs and medical devices.

The $1 billion for opioid prevention efforts and expanded access to treatment for substance use disorders is to be spent over the next two years in $500 million allotments. The money will be allocated through need-based grants.

Agriculture Secretary Tom Vilsack

"These additional resources are particularly critical in rural areas, where rates of opioid misuse and overdose are high, access to treatment is limited, and patients who seek treatment are often met with waitlists that can mean the difference between life and death," Agriculture Secretary Tom Vilsack said in a statement.

NPR reports that the bill is "the most significant piece of mental health legislation since the 2008 law requiring equal insurance coverage for mental and physical health," called parity.

Among other things, the measure strengthens the enforcement of requirements to treat behavioral disorders like other diseases, includes grants to increase the number of mental-health providers, works to promote early intervention for psychosis and creates a new position to oversee the Substance Abuse and Mental Health Services Administration. It also eliminates the Medicaid "same day" exclusion, which prohibits separate payment for mental health and primary care services to a Medicaid enrollee on the same day.

But not everyone loves the bill. Sens. Elizabeth Warren, D-Mass., Bernie Sanders, I-Vt., and Jeff Merkley, D-Ore., warned that the bill is a giveaway to pharmaceutical companies, will weaken regulatory standards on drugs, doesn't provide enough money for medical research and does nothing to address the rising cost of medications, Fortune. Other senators voting against the bill were Ron Wyden, D-Ore. and Mike Lee, R-Utah.

A small town and the local college team up for major renovations to revive the community

Residents of Albion, Michigan, are rallying with their small-town college to renovate the dilapidated homes in the Harrington neighborhood next to campus. Albion College President Mauri Ditzler says the plan is to sell the renovated homes to staff and faculty at half price, as a first effort to reverse the college's fleeting enrollment, Lorin Ditzler reports for the Daily Yonder. “We only have one rule: you have to keep your porch light on,” says Ditzler, who was hired as the college's president just before renovation plans took off. The college offers a free, four-year education to residents who meet admission requirements.

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The "porch light" project seems like the perfect slogan for the former steel town, which lost a third of its population after steel jobs disappeared, "shrinking from about 12,500 people in 1960 to around 8,500 today," Ditzler notes. "Residents grappled with declining job prospects, the city struggled to maintain infrastructure and services (with a dwindling tax base), Albion College was facing declining enrollment, and construction had all but stopped."

When the first home broke ground in Harrington after the project began, it was the first new home built in Albion in eight years, the college president told Ditzler. The targeted neighborhood has grown to six square blocks, including properties purchased from the Michigan land bank.

While the lights of new homes in the Harrington neighborhood were being kept on, construction in downtown Albion restored one of the town's cultural icons. The Albion Community Foundation raised $4 million to restore the Bohm Theatre, signaling to residents that community leaders were indeed taking change seriously, Ditzler writes. “If it wasn’t for the Bohm getting done, a lot of (recent community improvements) wouldn’t have even been thought of,” Samuel Shaheen, an alum of the college and one of the primary real estate developers in Albion’s renaissance, told Ditzler.

Groundbreaking for Albion hotel (Daily Yonder photo)

The college and community filled vacant storefronts with classes, administrative offices and restaurants. Ditzler reports that the biggest accomplishment is a $10 million downtown Courtyard by Marriott hotel. "The size of the project was unprecedented for the town, and was made possible by funding from the college, the state of Michigan, and private investors, including Shaheen, who is developing the project at cost." Skeptics of the hotel idea were convinced by the college’s promises to fill up the new hotel several times a year during multi-state horse shows in the school's newly expanded equestrian arena, Ditzler reports.

W.Va. coal county thrilled with Trump, but not with his Commerce choice, who owned deadly mine

Donald Trump and Wilbur Ross

West Virginians concerned about the decline of the coal industry say they're thrilled with the election of Donald Trump, but are casting a wary eye toward some of his personnel choices, including a businessman who owned a Mountain State coal mine where 12 people died in 2006, Marc Fisher reports for The Washington Post.

Wilbur Ross, Trump's choice for commerce secretary, was the primary owner of the Sago Mine, having bought it only two months before the disaster. "I always felt the company was responsible" for the deaths, Vickie Boni told Fisher, who writes: "Boni’s ex-husband, John Boni, was the fire boss, in charge of checking safety at the Sago Mine. Five days before the explosion, he alerted superiors to a leak of dangerous methane gas. A freak lightning strike ignited the methane, investigators later said. Right after the explosion, John Boni retired, after 36 years in the mines. A few months later, he put a bullet in his head."

Buckhannon Mayor David McCauley told Fisher he was taken aback when Trump named Ross: “The whole history of West Virginia is exploitation by outside influences. Now the guy 80 percent of us voted for turns around and nominates one of the least favorite names in Upshur County. If he brings in more billionaires and Mitt Romney is secretary of state, people will say, ‘Well, wait a minute now.’ But if the economy turns around, he’ll get the credit.”

Fisher reports, "Ross told ABC that he knew the mine had been cited with 208 violations, that he accepted responsibility for the disaster, that he had not made a personal contribution toward a fund for the miners’ families, and that his company 'never scrimped on safety expenditures.' Several investigations concluded that the mine’s owner, International Coal Group, was responsible for the safety violations, but that the violations did not cause the explosion."

Helen Winans, who lost a son at Sago, told Fisher that she didn't blame Ross and thinks Trump will be good for coal. McCauley said Trump’s appeal in West Virginia "is stylistic as well as policy-driven," Fisher writes. "It’s about coal, but also about being ornery and oppositional." It’s about coal, but also about being ornery and oppositional. “Trump was just what people here have always been — skeptical of government, almost libertarian,” McCauley said. “He’s a West Virginia pipe dream: He’s going to undo the damage to the coal industry and bring back the jobs, and all of our kids down there in North Carolina are going to come home.”

Two Tennessee teenagers charged with igniting fire in Great Smoky Mountains and Gatlinburg

National Guard video of fire damage around Gatlinburg, via Knoxville News-Sentinel

Tennessee officials have charged two teenagers with starting the fire that burned 17,000 acres in and near the Great Smoky Mountains National Park, killed 14 people, injured nearly 150 others and destroyed more than 1,700 2,174 structures and affected almost 300 more.

The pair are in custody, charged with aggravated arson, and could be tried as adults, said Jimmy Dunn, the district attorney general. Dunn "refused to give any details about the case, including the teens' ages or genders, except that 'They are not from Sevier County … they are residents of Tennessee'," Tyler Whetstone reports for the Knoxville News-Sentinel.

"Agents of the Tennessee Bureau of Investigation and of the U.S. Bureau of Alcohol, Tobacco, Firearms and Explosives have worked around the clock since last week on the case," Whetstone writes. The National Park Service, which said all along that the fire appeared to have been "human-caused," set up a tip line that helped break the case, said Steve Kloster, the park's chief ranger.

“I want to thank everyone who responded to the National Park Service’s tip line. The public was critical in responding to that tip line and giving the investigators something to work with,” Kloster said.

The fire started near the Chimney Tops in the park and was swept into Gatlinburg by winds that sometimes exceeded 80 miles per hour after months of drought had turned the forest into a tinderbox. The city is allowing residents and property owners to re-enter permanently tomorrow and will be open to the public Friday.

Trump picks Oklahoma attorney general Pruitt, foe of EPA on three fronts, to lead the agency

Scott Pruitt (AP photo)

"In a move signaling an assault on President Obama’s climate change and environmental legacy, President-elect Donald Trump is expected to nominate Scott Pruitt, the attorney general of the oil-and-gas-intensive state of Oklahoma, to head the Environmental Protection Agency," The Washington Post reports. "Pruitt has spent much of his energy as attorney general fighting the very agency he is being nominated to lead. . . . On his Linked In page, Pruitt boasts of being “a leading advocate against the EPA’s activist agenda."

Pruitt has said the debate on climate change is “far from settled.” He is a leader of the largely Republican group of attorneys general suing to block EPA's Clean Power Plan to cut greenhouse-gas emissions from power plants, arguing that it is not authorized by law; to block the agency's bid to limit the emissions of methane by oil and gas operations; and against its re-interpretation of the phrase "waters of the United States" in the Clean Water Act.

"Environmental groups reacted with alarm Wednesday at the nomination. And New York state attorney general Eric Schneiderman vowed to 'use the full power' of his office to wage a legal battle to 'compel' enforcement of environmental laws under Trump," report Chris Mooney, Brady Dennis and Stephen Mufson of the Post. Sen. Edward J. Markey (D-Mass.), told the newspaper, “Scott Pruitt would have EPA stand for Every Polluter’s Ally.” Meanwhile, "Industry groups expressed satisfaction with the choice," the Post reports.

Feds ban strip mining on 75,000 acres of ridgetops in Cumberlands of East Tennessee

Mountaintop mining, in process and reclaimed (knoxnews.com)

"The federal government on Wednesday banned mountaintop coal mining from more than 500 miles of ridges in East Tennessee’s Cumberland Mountains, handing a victory to the state and to conservationists who have long sought to protect the region’s forests and streams," Michael Collins reports for the USA Today Network.

The 1977 federal strip-mine law allows the Department of the Interior to designate land as unsuitable for mining, "in essence barring a controversial form of mining known as mountaintop removal," Collins notes.

A petition for the declaration was filed in 2010 by Democratic Gov. Phil Bredesen, three months before his last term ended. He said mining would damage to cultural, scientific and aesthetic values or natural systems. "The area is an important wildlife corridor, providing habitat for black bear, elk and numerous songbirds like the cerulean warbler, the Interior Department said. The New and Emory rivers also run through the designated area and provide clean drinking water to thousands of Tennesseans," Collins reports. It includes a wildlife management area and a conservation easement.

Republican Sen. Lamar Alexander, "an opponent of mountaintop removal mining, said the decision will help safeguard the state’s mountains without affecting mining operations in other parts of the impacted counties or elsewhere in Tennessee," Collins reports. "The National Mining Association, however, called the Interior Department’s announcement 'another unwarranted blow to our ability to responsibly utilize this nation’s domestic resources'." The NMA said those who wrote the law didn't contemplate such large areas being designated unsuitable for mining.

The designation "makes a limited exception for re-mining activities, which will be restricted to proposals that will provide environmental benefits, such as reclaiming abandoned mine lands, and reducing the impacts of acid mine drainage and residual sedimentation," Collins reports.

Hospitals warn of big hit if Obamacare repeal leaves many uninsured; rural hospitals at more risk

The two big lobbies for hospitals are telling Congress and President-elect Donald Trump, who are planning to repeal and replace President Obama's health-reform law, that "the government should help hospitals avoid massive financial losses if the law is rescinded in a way that causes a surge of uninsured patients," Amy Goldstein reports for The Washington Post.

Joann Anderson (Photo by Rose
Hoban, North Carolina Health News)

Warning of "an unprecedented public health crisis," the Federation of American Hospitals, representing investor-owned facilities, and the American Hospital Association called a press conference to go with their letter, Goldstein reports. "Joann Anderson, president of Southeastern Health, "a financially fragile rural hospital in Lumberton, N.C., one of that state’s most economically depressed areas, said the prospect of repealing the health law without a replacement to keep people insured is 'gut-wrenching . . . We cannot take additional cuts.'" At least 76 rural hospitals have closed in the last seven years.

Hospitals are "the first sector of the health-care industry to speak out publicly to try to protect itself from a sharp reversal in health policy that Trump is promising and congressional Republicans have long favored," Goldstein notes. "When it was enacted in 2010, the health-care law was a product of a delicate balancing act among various parts of the health-care industry. Each essentially agreed to sacrifices in exchange for the prospect of millions of Americans gaining insurance to help cover their medical expenses."

The balancing act includes rural hospitals, which have special provisions in the law and other federal statutes. For example, the law expanded special funding for hospitals with relatively few patients, but that provision is scheduled to expire in October 2017. That would have a significant negative impact on rural hospitals, says a study just published by the Journal of Rural Health.

The exact nature of the repeal-and-replace strategy is unclear because Republicans will be in a position to make laws on their own after Trump replaces Obama Jan. 20. Until now, they have passed repeal bills with no replacement, knowing Obama would veto them. House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell have said they favor phasing out Obamacare and phasing in a replacement, but the time frame for that is uncertain.

McConnell backs temporary fix to preserve miners' health benefits; Manchin wants final, broader law

Kentuckians for the Commonwealth members
Eric Dixon, Katie Dollarhide and Brad Shepherd
brought petitions to Sen. Mitch McConnell's
London, Ky., office seeking passage of a bill
to help coalfield communities. (KFTC photo)

"After months of uncertainty, Senate Majority Leader Mitch McConnell said he wants to rescue retired union coal miner health care benefits in Congress' forthcoming stopgap spending deal," Dylan Brown reports for Environment & Energy News. "The Kentucky Republican, however, is mum on whether he supports adding a coal-mine-cleanup bill focused on Appalachian economic development."

McConnell said he has "insisted" to House Speaker Paul Ryan that the end-of-year continuing resolution to keep the government open include a provision to extend 12,500 miners' health benefits beyond Dec. 31, when they would otherwise expire. But such a move would be a temporary fix, and that doesn't satisfy Democrats and the United Mine Workers of America, which opposed McConnell's 2014 re-election.

Sen. Joe Manchin (D-W.Va.) threatened to hold up action on the resolution unless McConnell grants a floor vote to his bill to permanently guarantee pensions and retiree benefits for more than 100,000 coal workers and dependents, to be funded by fees coal companies pay to the Abandoned Mine Land Fund. "The Congressional Budget Office has said offsets, including Customs and Border Protection fees, would pay for the spending. But Sen. Mike Enzi (R-Wyo.) has called the pay-fors a 'budget gimmick'," Brown notes.

Another bill, by House Appropriations Chair Hal Rogers of Kentucky, would accelerate spending from the fund in areas that have been most hurt by the loss of coal jobs. The main roadblocks are "politicians from Wyoming who insist that their state should be able to keep building sports arenas, roads and other non-mine related projects" with money from the fund, which was created to clean up mine lands abandoned before federal strip-mine law took effect," the Lexington Herald-Leader says in an editorial.

Read more here: http://www.kentucky.com/opinion/editorials/article119280148.html#storylink=cpy

"McConnell spokesman Robert Steurer told the Herald-Leader there is no version of the bill in the Senate, but that his boss supports other funding streams for distressed coal communities," Brown reports. "When asked whether the legislation might end up in the spending bill, Rogers said yesterday: "I'd like to see that, but it may or may not happen."

Older Americans happiest in Hawaii, Ariz., least happiest in W.Va., Ky. says Gallup well-being index

Older Americans are happiest in Hawaii and least happy in West Virginia, says the annual index of well being by The Gallup Organization. Following Hawaii, other states with high well-being scores for people 55 and older were Arizona, New Hampshire, North Dakota and Colorado. At the other end of the spectrum, Kentucky was next to West Virginia, with Oklahoma, Ohio and Indiana nearby.

The data come from 115,000 interviews are are based on five categories: Purpose (liking what you do each day and being motivated to achieve your goals); Social (having supportive relationships and love in your life); Financial (managing your economic life to reduce stress and increase security); Community (liking where you live, feeling safe and having pride in your community); and Physical (having good health and enough energy to get things done daily).

Hawaii was No. 1 for Purpose, Community and Physical; Arizona was tops for Social, and North Dakota led for Financial. West Virginia was last for Purpose, Social and Physical. Mississippi had the lowest score for Financial and New Jersey was lowest in Community.

"There is one cluster of states with high rankings in a section of the Midwest, but for the most part, the high- and low-ranking states are evenly distributed," Tara Bahrampour reports for The Washington Post. Dan Witters, research director for index, told her, “The 55-and-over crowd in those top states … report always making time for regular trips and vacations with family and friends, reaching their goals in the last 12 months, using their strengths and aptitudes as a human being, in other words, doing things that are a natural right fit for them." (Post graphic showing states colored by quintiles, or fifths of 50)

Weekly editors seek entries for annual editorial-writing contest; winner gets conference trip

The International Society of Weekly Newspaper Editors is accepting entries for the 57th annual Golden Quill editorial writing contest. All newspapers published fewer than five days per week are eligible. Entries must be published in 2016. Each newspaper is allowed up to four entries; two is the maximum per person. The entry fee is $25 per person; checks should be made payable to ISWNE.

To enter, complete the PDF form at iswne.org (under Contests) and send a tearsheet with the Golden Quill entry clearly marked. Send two copies of each entry to Chad Stebbins, Missouri Southern State University, 3950 E. Newman Road, Joplin MO 64801-1595. Entries must be postmarked by Feb. 1, 2017.

Entries should reflect the purpose of ISWNE: Encouraging the writing of editorials or staff-written opinion pieces that identify local issues that are or should be of concern to the community, offer an opinion, and support a course of action.

The Golden Quill winner will receive a scholarship and travel expenses up to $500 to attend ISWNE's annual conference June 28-July 2 at College Park, Md. Runners-up (called the Golden Dozen) will receive conference scholarships if they have not previously attended an ISWNE conference. Grassroots Editor, ISWNE's quarterly journal, will reprint the Golden Quill and Golden Dozen editorials in the Summer 2017 issue. For questions, email Stebbins.

Trend seen as Austria's election mirrors U.S. and Brexit votes, with similar rural-urban divides

What do last month's U.S. presidential election, last weekend's Austrian presidential election and Britain's earlier vote to leave the European Union have in common? All three elections had a significant rural-urban divide, Jonn Elledge reports for CityMetric, part of the British political and cultural magazine The New Statesman. Map: Austria's rural voters (blue) favored the conservative presidential candidate, while urban ones (green) backed the liberal candidate, who won.

"There are no doubt all sorts of reasons for this phenomenon," Elledge writes. "Some of them will be economic (well-paid jobs are increasingly concentrated in cities). Some of them will be cultural (the countryside is more likely to be white). Indeed, these are two sides of the same coin: As young or educated people move to cities in search of opportunity, the places they leave behind will become older, less diverse and more conservative."

"Whatever the explanation, though, it looks increasingly like that is the new political fault line in western countries," Elledge writes. "If you believe in progressive politics, there's a fair chance you live in a city." Map: U.S. presidential election by county

Many rural counties that supported Trump could stand to lose from his vowed repeal of Obamacare

Many of of the counties—most of them rural—where Donald Trump scored big victories in this year's presidential election could suffer the most if he repeals federal health reform, Philip Bump reports for The Washington Post. That includes large areas of Appalachia, the Rust Belt and the upper Midwest and several longtime blue counties that this year turned red. (Post map: Change in vote margin since 2012)

Some of Trump's biggest support was from working-class white voters, a demographic helped greatly by the drop in the uninsured rate from 25 percent to 15 percent since Obamacare was launched, Bump writes. Trump scored victories in many of the states that have seen the biggest drop in rates of uninsured residents—Arkansas, Kentucky, Michigan, Ohio, Pennsylvania and West Virginia, all of which expanded Medicaid under the reform law. Trump has said he supports the longtime Republican goal of returning Medicaid management to the states and limiting federal funding through block grants. (Post map: Change in percent of uninsured from 2013-2016)

"Nationally, there's no correlation between the change in insurance coverage in a county and the results of the 2016 election," Bump writes. "But it's certainly the case that much of the swath of states around the Great Lakes that went for Trump in 2016 also had big decreases in the number of uninsured since 2013." While it's too early to speculate how Trump's plans will affect newly-insured Americans, "those places that had the biggest changes in coverage are likely to see larger increases in the number of uninsured. In many cases, those shifts will occur in places that voted for it to happen."

EPA chief: Agency hasn't done enough for rural areas; Congress should OK Obama aid for coalfields

Outgoing Environmental Protection Agency chief Gina McCarthy acknowledged Monday that the agency hasn't done enough to support rural areas, but also took a shot at Congress for not approving President Obama's proposal for more funds to coal-dependent communities, Jack Fitzpatrick reports for Morning Consult, a Washington D.C.-based research firm. McCarthy told reporters, “I think we have not done as well as we could developing a rural strategy in cooperation with other agencies and certainly have more presence in rural communities."

Despite acknowledging the agency’s shortcomings, "McCarthy said she was proud of the EPA’s controversial work on greenhouse gases, calling the Clean Power Plan 'a signature item for the United States','' Fitzpatrick writes. "She also defended the Obama administration’s attempts to shore up the economy in coal country, where Republicans including President-elect Donald Trump, have blamed environmental regulations for reducing demand for coal."

McCarthy noted that Congress has failed to take up Obama's $3 billion aid package for coal communities affected by his climate-change policies: “I think Congress needs to take that up. If they need to do it in the next administration because they don’t want to call it an Obama initiative, I’m very happy with that.” (Read more)

Native Americans' opioid use is soaring, but many reservations lack funding for treatment

Drug addiction rates—especially use of opioids—are high among Native Americans, many of whom live in a world of poverty where "chaotic family lives, suicide, mental illness, addiction, domestic violence and other trauma are the norm," Christine Vestal reports for Stateline. "Compounding the problem, the majority of the nation’s 2.9 million Indians living on and off reservations have little to no access to health care, much less mental health and addiction services."

"Native Americans are at least twice as likely as the general population to become addicted to drugs and alcohol, and three times as likely to die of a drug overdose," she writes. A 2014 study by the National Institute on Drug Abuse found that use of heroin among Native Americans who are seniors in high school is double the national average, while 61 percent of sophomores have smoked marijuana, compared to 33 percent of the general population. (PBS graphic: Overdose deaths by race in 2014)

Some of the more affluent tribes in the Northwest, mostly near major cities, have used money from casinos and other businesses "to build world-class health care systems on their reservations that include addiction treatment program," Vestal writes. It also helps that states with large Native American populations, such as Washington—where Native Americans die of drug overdoses at a rate of 29 per every 100,000, compared to rates of 12 for whites, 11 for blacks, 3 for Hispanics and 2 for Asians—expanded Medicaid under federal health reform.

"But the lifelong nature of addiction and the increasing availability of heroin and other illicit opioids demand more investment every year, particularly for recovery housing and support services, said Dr. Anthony Dekker, an addiction specialist and expert on Indian health," Vestal writes. "He addressed a gathering of 25 tribes from Idaho, Oregon and Washington here in November to discuss the opioid crisis in Indian country." Nearly all the tribes "provide some level of addiction services, needle exchange and naloxone distribution programs, and recovery housing on their reservations, though funding is limited for many." (Read more)

Language in controversial EPA study on fracking was tempered after White House meeting

Language in a controversial 2015 Environmental Protection Agency study on horizontal hydraulic fracturing was added after a meeting with White House officials, Marketplace and American Public Media say in a jointly reported story by Scott Tong and Tom Scheck.

The executive summary of the EPA study said that while fracking has the potential to harm drinking water, researchers found no evidence of "widespread, systemic impacts" to drinking water supplies. An EPA panel in August said the report, which they called inconsistent, should be revised.

The story says the phrase "widespread, systemic" was added after the White House meeting. Originally, the summary and press release originally "made a bland but contrary point — that scientists had found 'potential vulnerabilities'," notes Mike Soraghan of Energy Wire.

"Earlier draft versions emphasized more directly that fracking has contaminated drinking water in some places," the story says. "In a conference call with reporters about the study on the day it was released, the EPA’s deputy administrator, Tom Burke, highlighted the lack of widespread, systemic impacts as the agency’s top finding. In fact, scientists had found evidence in some places that fracking activity had polluted drinking water supplies," in "more than two dozen instances."

Tong and Scheck write, "It’s not clear precisely who inserted or ordered the new phrasing. But emails acquired via the Freedom of Information Act show EPA officials, including press officers, met with key advisers to President Obama to discuss marketing strategy a month before the study’s release. The emails also show EPA public relations people exchanging a flurry of messages between 4 and 11 p.m. on the eve of the study’s release."

Moving away from agriculture-based economy hurts rural areas, says series on rural Minnesota

Of the 360 people in Milan, Minn., 28.7 percent
are Pacific islanders, mostly from Micronesia, and
11.8 percent are Hispanic. (City of Milan photo)

The biggest challenge facing rural Minnesota is not a lack of economic opportunities or young people migrating to cities, but its continued move from an agriculture-based economy, Jay Walljasper reports a series about rural Minnesota for The McKnight Foundation. The series is based on reports that Walljasper, an urban consultant and strategist, wrote after compiling reports from each region of the state.

"Ever-larger farms employ fewer people and buy fewer supplies locally. Among Minnesota farm operators, 55 percent work primarily off the farm and 93 percent depend on some off-farm income," Walljasper writes. In 1969 farming accounted for at least 20 percent of earnings in about half of Minnesota counties. By 1999, "after three decades of farm consolidation, it had shrunk to just a few spots on the map bordering the Dakotas."

Kelly Asche, program coordinator of the Center for Small Towns, based at the University of Minnesota-Morris, said "expanding livelihoods in farming to include more people means looking beyond large-scale agricultural commodities to farmers' markets, local food production and the production of prepared foods." Walljasper writes, "For example, the University of Minnesota-Morris is working to make regionally produced food a growing share of meals served on campus."

"Another change sweeping the nation is apparent in rural Minnesota: the rising percentage of Americans who are not white," Walljasper writes. "Thirteen of the 15 Minnesota counties that experienced population growth from 1990 to 2010 because of increasing numbers of people of color are outside the metro area. Mexican restaurants are becoming a staple of small-town main streets across the state."

Thursday webcast will focus on how elections have evolved recently and on the future of voting

The Pew Charitable Trusts on Thursday will conduct a day-long webcast, "Voting in America: How Have Elections Evolved?" The webcast, scheduled from 9 a.m. to 5 p.m. EDT, will focus on how U.S. elections have changed in the past four years and what the changes mean for the future of voting.

A panel of experts will discuss: How states embraced technology in 2016 and how can it be better used; how voter-registration changes have affected the democratic process; and how better data collection and analysis can improve elections administration. For more information or to register for the webcast. click here.

Lack of regulations and training lead to 4,500 ambulance accidents, 33 deaths per year

A lack of regulations for ambulance-driver training and restraints for passengers has for years led to accidents, injuries, and sometimes death, Jenni Bergal reports for Stateline. Over the last 20 years ambulances have been involved in an annual average of 4,500 accidents, leading to about 2,600 injuries and 33 deaths, according to a 2015 report by the National Highway Traffic Safety Administration. About 54,500 ambulances were on the road in 2010, the latest figure available, says NHTSA.

The study found that only 33 percent of patients involved in serious crashes "were secured with both shoulder and lap restraints and 44 percent were ejected from their cots," Bergal writes. At the same time "84 percent of EMS workers in the patient compartments of ambulances that crashed were not using their own restraints."

The main problem is that "unlike school buses, ambulances are not regulated by the federal government," Bergal writes. "While states set minimum standards for how they operate, it’s usually up to local EMS agencies or fire departments to purchase the vehicles and decide whether to require their crew to undergo more stringent education and training. Some agencies demand that crew members in the back of an ambulance use lap and shoulder restraints for their patients and themselves, but many agencies don’t." (NHTSA graphic: Severity of injuries involving ambulances from 1992-2011)

"In some places, ambulance drivers don’t receive any special training before they get behind the wheel, even though they must speed through traffic under tremendous pressure," Bergal writes. Bruce Cheeseman, Idaho’s EMS operations manager, told her, “One agency will make them take a course before they can drive. Another will just say, ‘here are the keys.'" Many rural areas are served by volunteer EMS workers.

Bergal writes, "In the back of a traditional ambulance, which has no airbags, emergency medical technicians and paramedics can sit on one of several seats: a bench that is aligned with the stretcher or cot and faces the patient, a seat on the opposite side, or a rear-facing seat called the captain’s chair, which is in front of the patient’s head. A 5- to 8-ton ambulance filled with heavy equipment can become a deathtrap in a crash. Cots typically are not bolted to the floor. Electrocardiogram monitors, which can weigh 20 to 25 pounds, usually are not tied down, and medical equipment is often stored on countertops or in cabinets that can fly open."

Lack of after hours emergency pet care in some rural areas putting owners in tight spots

Astoria, Ore. (Best Places map)

Some rural pet owners facing an emergency are reduced to either driving to an urban center or waiting until the morning to see a local veterinarian, Erick Bengel writes for The Daily Astorian: "It takes a fairly large population center to support around-the-clock emergency clinics. On the North Coast, there simply aren’t enough pet emergencies to justify keeping an animal hospital open through the night."

Five regional vet offices in Clatsop and Pacific counties, with about 58,000 total residents, have an on-call rotation, with each office deciding its hours, Bengel writes. Some take calls all night, some until 10 p.m., but the clinics usually don't remain open all night. Dr. Brad Pope, founder and hospital director at Bayshore Animal Hospital, one of the five, told Bengel, "To have a 24-hour emergency clinic open, to pay somebody to answer the phone two times a night, would never be economically feasible." Dr. Dannell Davis, owner of Astoria Animal Hospital, added that "The people that have the skills, that are willing to work in the middle of the night—guess what—are expensive. You can’t pay them minimum wage. They won’t do it.”

That means pet owners in an emergency most likely have to drive to Portland, about 97 miles from Astoria. That doesn't work for pet owners such as Erin Anderson, who was unable to reach a vet after her cat had a late-night stroke and her night vision problems prevented her from driving to Portland, Bengel writes. The cat died. Anderson told Bengel, “I like the vets here. All the vets are very nice people. I’m not knocking any one of them. I admire what they do. I know it’s tough on a rural area. But it’s tougher on us whose pets die in our arms.” (Read more)

Experts warn of latent mental health concerns following fires like the ones in Smoky Mountains

Trevor Cates stood amid the ruins of the fellowship hall of Banner
Baptist Church, which he attends, at Gatlinburg. (Getty Images)

Survivors of fire, in addition to facing the long road to recovery from structural damage, are often in need of mental-health services, experts tell Jeff Martin of The Associated Press. "In some ways, escaping a fire-filled forest as thousands did recently in and around Gatlinburg, Tenn., can be more traumatic than hurricanes, floods or earthquakes," Martin reports. "One reason: Flames spread so rapidly that people had no time to prepare."

Becky Stoll, vice president of crisis and disaster management at Centerstone, one of the nation's largest behavioral health care providers, told Martin, "To have your life turned upside down is much more difficult than if you had time to brace for it, and in this case I don't think people had time to brace for it." Also, the visual image of seeing the flames causing damage can be hard to shake, said Valerie Cole of the American Red Cross.

Cole said that while some possessions can be salvaged from disasters such as earthquakes and tornadoes, a fire usually leaves nothing behind but ashes, Martin writes. She said after a fire survivors typically are thankful they are alive and focus on basic needs, but down the line, maybe six or nine months later, is when people begin to get frustrated or disillusioned. That can cause post-traumatic stress, leading to increased rates of suicide, depression, anger and substance abuse. (Read more)

Warming temperatures cause soil carbon loss, which increases climate change, says study

Predicted changes in soil carbon
per pixel by 2050 under the
‘no acclimatization’ scenario

"Rising temperatures will stimulate the net loss of soil carbon to the atmosphere, driving a positive land carbon–climate feedback that could accelerate climate change," says a study by worldwide researchers published in the peer-reviewed journal Nature. The study consisted of 49 field experiments in North America, Europe and Asia.

The "feedback" researchers are referring to "involves the planet’s soils, which are a massive repository of carbon due to the plants and roots that have grown and died in them, in many cases over vast time periods (plants pull in carbon from the air through photosynthesis and use it to fuel their growth)," Chris Mooney reports for The Washington Post. "It has long been feared that as warming increases, the microorganisms living in these soils would respond by very naturally upping their rate of respiration, a process that in turn releases carbon dioxide or methane, leading greenhouse gases." Researchers said that is happening.

"Our analysis provides empirical support for the long-held concern that rising temperatures stimulate the loss of soil C [carbon] to the atmosphere, driving a positive land C-climate feedback that could accelerate planetary warming over the 21st century." Mooney notes,"This, in turn, may mean that even humans’ best efforts to cut their emissions could fall short, simply because there’s another source of emissions all around us. The very Earth itself."

Jonathan Sanderman, a climate scientist with the Woods Hole Research Center in Massachusetts, said the study gives “strong support to the hypothesis that soils will release a substantial amount of carbon in response to rising air temperatures," Mooney writes. Sanderman told Mooney, "This is really critical, because if the additional release of carbon is not counterbalanced by new uptake of carbon by plants, then it’s going to exacerbate climate change and increases the urgency to immediately reduce greenhouse gas emissions.”

But Sanderman "also noted studies have suggested that better management of agricultural soils could sequester large amounts of carbon, perhaps enough to offset the losses projected in the study."

Corps denies Dakota pipeline crossing, but builder sticks to plan, anticipating approval by Trump

InsideClimate News graphic

Native Americans protesting the Dakota Access Pipeline scored at least a temporary victory Sunday when the Army of Corps of Engineers announced it "would not approve an easement to allow the Dakota Access Pipeline to cross under the Lake Oahe section of the Missouri River," Caroline Grueskin reports for The Bismarck Tribune. The Standing Rock Sioux tribe said they feared a spill could leak into the river, their main source of water.

Despite the disapproval, Energy Transfer Partners, the project's builder, "is under no legal obligation to stop construction on the Dakota Access project and hasn’t voluntarily agreed to do so," Tim Loh writes for Bloomberg. Loh adds, "It has finished 84 percent of the project and is pushing ahead with construction wherever it’s permitted, including in Iowa."

President-elect Donald Trump, who has had stocks in Energy Transfer Partners and Phillips 66, which owns one-quarter of the pipeline, said Thursday he supports the project, reports BBC News. After his election, ETP said it expected to complete the pipeline; after the Corps announcement, it said there would be no detours. Monday, a Trump spokesman said the president-elect still supports the pipeline and after taking office "will make the appropriate determination at that time."

Army Assistant Secretary for Civil Works Jo-Ellen Darcy said the decision "merits additional analysis, more rigorous exploration and evaluation of reasonable siting alternatives and greater public and tribal participation and comments. Accordingly, the Army will not grant an easement to cross Lake Oahe at the proposed location based on the current record."

"Darcy recommended the corps conduct an environmental impact statement with 'broad public input and analysis' before determining any appropriate route," Grueskin writes. "Among the considerations would be more information on the alternative routes, including the one crossing north of Bismarck, details on potential spills and impact on the Standing Rock Sioux Tribe's water intake and the extent of the tribe's treaty rights in Lake Oahe."

While protesters applauded the decision, Republican Gov. Jacky Dalrymple called it a "serious mistake," Grueskin writes. He said in a statement: "It does nothing to resolve the issue, and worst of all it prolongs the serious problems faced by North Dakota law enforcement as they try to maintain public safety. It’s unfortunate that this project has become a political issue rather than one based on engineering science." (Read more)

In Appalachian Ohio opioid epidemic soars, while state funds for treatment remains sparse

Columbus Dispatch graphic

A report released last week by the Centers for Disease Control and Prevention found that Ohio in 2014 led the nation in most opioid overdose deaths (2,106) and was fifth in highest rate of opioid deaths, at 24.6 per every 100,000 people.

The epidemic has been especially problematic in the state's southern Appalachian region, where it has flourished in areas with high poverty, high unemployment and scant public resources, Rita Price reports for The Columbus Dispatch. Joe Gay, executive director of the Athens County-based addiction and mental-illness-treatment agency Health Recovery Services, compares the opioid epidemic in Appalachian Ohio to Ebola in Africa. He told Price, “The places where the treatment system was least adequate was where it hit. And it spread and spread and spread.”

Gay said that state budgets for counties, as recently as 2010, "show that Appalachian counties with the highest rates of overdose deaths still were receiving far less non-Medicaid treatment money per capita than suburban counties with much lower overdose rates," Price writes. Gay told her, “It’s hard to convey how much worse things were before the Medicaid expansion. The whole system was broken. Now, the system is working but still has weak spots. But a lot of damage was done.” Medicaid was expanded in Ohio in 2014.

"Still, addiction remains rampant, with supply routes for heroin now firmly established in place of 'pill mills' dispensing painkillers," Price writes. "Many county officials wonder whether they ever will be able to respond to all the need. And in communities without tax-levy funding for mental-health and addiction services, there aren’t any local dollars to be 'freed up' as a result of the Medicaid expansion, said Robin Harris, who heads the Alcohol, Drug Addiction and Mental Health Services Board for southeastern Ohio’s Gallia, Jackson and Meigs counties." (Read more)