Trump's budget calls for major cuts in Appalachia, where he won most counties by large margins

Appalachian Region Commission map

President Trump's proposed budget calls for major cuts in Appalachia, especially coal country, a region where he won big at the polls.

Cuts would be made to the Appalachian Region Commission (ARC) and the U.S. Economic Development Administration, which "are charged with diversifying the economies of states like West Virginia and Kentucky to help them recover from coal’s decline," Valerie Volcovici reports for Reuters. ARC covers all of West Virginia and parts of Kentucky, Alabama, Georgia, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee and Virginia.

Bill Estep, of the Lexington Herald-Leader, notes that ARC has spent more than $23 billion in Appalachia since being founded in 1965 after President Lyndon B. Johnson visited the region and declared a "War on Poverty."

Trump won 400 of the 420 counties that ARC operates in, Volcovici writes. "The 52-year old agency has run more than 650 projects in Appalachia's 13 states between 2011 and 2015 costing hundreds of millions of dollars. Its programs, some launched under Democratic former President Barack Obama, are expected to create or retain more than 23,670 jobs and train and educate over 49,000 students and workers, the organization."

For example, in Eastern Kentucky from October 2015 to January 2017 ARC said it supported 63 projects in Kentucky totaling $31.9 million," Estep writes. "That spending, which has been matched by more than $65 million in other aid, is projected to create or retain more than 1,200 jobs and provide education or workforce training to more than 2,300 people in the state’s 54 ARC counties, the agency said." Ben Hale, the Democratic judge-executive in Flod County told Estep, “We’re already down. There’s no need for them to step on our neck."

"ARC has been targeted before, with critics citing it as an example of wasteful, inefficient or politicized government spending," Estep writes. "President Ronald Reagan tried repeatedly to kill it, saying in his 1985 budget statement that such regional development programs 'serve no national economic purpose but instead cater, at taxpayer’s expense, to local and regional political interests,' The New York Times reported then. With the backing of local officials and members of Congress spread across 13 states, however, the agency has survived, albeit with significant cuts at times."

Lawmakers from the region, such Rep. as Hal Rogers of Kentucky's 5th District, one of the nation's poorest and most rural, believe ARC won't be cut, Estep writes. While he said "that many cuts proposed in Trump’s budget 'are draconian, careless and counterproductive'... he said he was optimistic Congress will work with Trump to 'responsibly' fund the government, including agencies that serve as 'vital economic lifelines' in struggling rural areas."

Senate Majority Leader Mitch McConnell, also a Republican from Kentucky, avoided answering questions about the future of ARC's budget, Estep writes. Instead he said, “I’m pleased to see an increased focus on our national security and veterans budgets. These are positive steps in the right direction. I look forward to reviewing this and the full budget when it is released later this spring. While this is only the first step in the budget process, I will work with the delegation to protect essential Kentucky priorities in the final budget.”

CDC study says rural suicide rates outpacing urban ones, suggests possible link to rise in opioid use

U.S. suicide rates are growing faster in rural areas than urban ones, says a study by the Centers for Disease Control and Prevention. The study, which used annual county-level mortality data from the National Vital Statistics System and U.S. Census Bureau to analyze suicide rate trends from 1999-2015, found that after declining since 1986, the U.S. suicide rate increased from 2000-15, with 600,000 suicides during the study period.

Researchers wrote: "Geographic disparities in suicide rates might be associated with suicide risk factors known to be highly prevalent in less urban areas, such as limited access to mental health care, made worse by shortages in behavioral health care providers in these areas, and greater social isolation. Such disparities might also reflect the influence of the opioid overdose epidemic. This epidemic is known to have disproportionately affected less urban areas during the earlier part of the study period and opioid misuse is associated with increased risk for suicide."

The study found that "it's also possible that economic pressures may have played a role," Margaret Farley Steele reports for HealthDay News. "The biggest increase in the suicide gap occurred beginning in 2007-2008, when the U.S. economy was experiencing a severe recession." Researchers also noted a lack of health care providers in rural areas. (CDC graphic: Suicide rates from 1999-2015)

Democrats see Trump's budget cuts as a way to win over rural areas, but budget has little GOP support

Proposed changes; click on image to enlarge (Washington Post)

Democrats, who have been trying to find ways to win over rural voters after getting crushed at the polls in those areas in November, see President Trump's proposed budget as a way to get a foot in the door in rural America. The budget calls for cutting or killing many programs that benefit rural areas.

"With an eye toward winning back Trump voters from Appalachia to the Midwest, Democrats slammed rank-and-file Republicans on the White House’s pitch to slash everything from Pell Grants to the Environmental Protection Agency to the Meals on Wheels program that’s a lifeline to homebound seniors," Heather Caygle and Elana Schor report for Politico. "Democrats repeatedly cast Trump as gouging middle-class and lower-income voters with his budget, pairing it with similar arguments against the GOP’s troubled Obamacare repeal bill."

House Minority Leader Nancy Pelosi (D-Calif.) told reporters Thursday: “The Republicans in Congress and this White House, as we’re seeing now just in a few weeks, never miss an opportunity to suck up money from the middle class. We see that in the health care bill. We see that in how they establish their budget priorities.”

The problem with that Democratic strategy is that Trump's budget hasn't won over many Republicans, Kelsey Snell and Karoun Demirjian report for The Washington Post. "Some of President Trump’s best friends in Congress sharply criticized his first budget Thursday, with defense hawks saying the proposed hike in Pentagon spending wasn’t big enough, while rural conservatives and others attacked plans to cut a wide range of federal agencies and programs."

House Agriculture Committee Chairman K. Michael Conaway (R-Tex.) "raised concerns that farmers could be hit hard at a time when farm income is already down 50 percent compared with four years ago," reports the Post. "Agriculture cuts are a particularly sensitive issue because periodically lawmakers spend months, if not years, hammering out the details of a comprehensive farm bill." Conaway said in a statement: “Agriculture has done more than its fair share. The bottom line is this is the start of a longer, larger process. It is a proposal, not THE budget.”

The Post reports, "It is not uncommon for Congress to disagree with some priorities in a White House budget. But the blueprint risks putting GOP lawmakers on a collision course with Trump over demands for spending cuts they cannot deliver. Even those fiscal conservatives who do want to cut spending don’t necessarily think slashing major domestic programs is the answer."

Agriculture leaders criticize proposed budget cuts

Agriculture leaders slammed President Trump's proposed budget, which calls for 21 percent cuts to the U.S. Department of Agriculture, "saying it could take a toll on the rural communities that helped elect him last November," Karl Plume and P.J. Huffstutter report for Reuters.

"Trump has proposed slashing the USDA's discretionary budget by $4.7 billion to $17.9 billion by halting funding for rural clean water initiatives and rural business services, reducing some USDA statistical services and cutting county-level staff," reports Reuters. He "has already vowed to alter trade deals that have largely boosted farm incomes and targeted health care policies that have particularly benefited the rural poor." (Washington Post graphic: Proposed changes to USDA budget)

The American Farm Bureau Federation, the country's largest organization representing farmers, "said county-level USDA staffing cuts and reduced statistical services could hurt members," reports Reuters. John Newton, AFBF director of market intelligence, told reporters, "A lot of farmers and growers rely on USDA's statistical capabilities to make a lot of marketing and risk management decisions and planting decisions."

House Agriculture Committee Chairman Michael Conaway (R-Texas), told reporters, "America's farmers and ranchers are struggling, and we need to be extremely careful not to exacerbate these conditions." Debbie Stabenow (D-Mich), ranking member of the Senate Agriculture Committee, told reporters, "I strongly oppose the Trump administration's proposed budget cuts to programs that are critical to farmers, ranchers and families in small towns across America."

Rural Mainstreet Index in heartland remains negative for 19th straight month

The Rural Mainstreet Index in March remained below 50, on a 0-100 scale, for the 19th straight month, indicating economic weakness in the 10-state region that stretches from Illinois to Wyoming and is dependent on agriculture and energy. Creighton University economist Ernie Goss surveys bank CEOs in rural areas of Colorado, Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, Wyoming and the Dakotas.

The index was 45.3 in March, down slightly from 45.8 in February, which was the highest since it reached 49 in September 2015. CEOs said the average annual cash rents for crop acreage was $211 per acre, down 16 percent from last year. More than seven of 10 CEOs said they expect farm loan defaults to rise over the next 12 months, almost one in six expect such defaults to expand by more than 10 percent and almost one-third report that property taxes are a major economic problem for farmers in their area.

Goss said, "Weak farm commodity prices continue to squeeze Rural Mainstreet economies. Over the last 12 months, livestock commodity prices have tumbled by 6.6 percent and grain commodity prices have slumped by 0.9 percent. Thus, year over year price changes remain negative, but are now less negative than several months ago.” (Creighton graphic: Rural Mainstreet Index)

In Nevada, where recreational pot is now legal, rural police officers learning to spot stoned drivers

Since recreational marijuana has been legalized in Nevada, the state's rural police officers are learning how to spot stoned drivers, Jerry Kane reports for the Reno Gazette-Journal. Attorney General Adam Laxa told Kane, "In general, marijuana DUI space is new. This has existed, but now that we've legalized marijuana, we can anticipate, like in Colorado and many other states, that there will be an uptick in drugged driving." Residents voted in November to legalize marijuana. The law went into effect Jan. 1.

The Colorado Department of Transportation reports that DUI fatalities caused by a driver under the influence of only cannabis increased from 39 in 2013 to 68 in 2015, Kane writes. In Washington state, "the percentage of drivers involved in fatal crashes who recently used marijuana more than doubled, from eight to 17 percent between 2013 and 2014," according to the AAA Foundation for Traffic Safety, a nonprofit focused on traffic-safety research and education.

To help police officers in Nevada's 15 rural counties, former Colorado prosecutor Chris Halsor will spend the next year teaching about the state's laws, which allow anyone 21 and older to possess up to an ounce of marijuana and an eighth of an ounce of cannabis concentrate, Kane writes. "In Nevada, current DUI law establishes a 2-nanogram limit for THC, the psychoactive element in marijuana."

"Marijuana blood tests have been criticized since there is no science showing that drivers reliably become impaired at a specific level of marijuana in the blood," Kane writes. "Additionally, high levels of THC often drop below legal thresholds before a test is administered to a suspected impaired driver."

Halsor's focus will be to teach law enforcement "to take extensive notes on the probable cause that allowed them to pull over a driver, to be familiar with the signs of someone who is stoned and to be familiar with the terminology that cannabis consumers use," Kane writes. Halsor said, "with detailed information, it is much easier to prove impairment" in court.

Trump's proposed federal budget calls for cutting or killing many programs that benefit rural areas

Proposed changes; click on image to enlarge (Washington Post)

Many federal programs that help rural areas would be eliminated or reduced under President Trump's proposed budget.

Some losers "may be some of the very constituencies that have been most supportive of the new president during his improbable rise to power," writes Peter Baker of The New York Times. If the cuts are enacted, "Rural communities will lose grants and loans to build water facilities and financing to keep their airports open." Federal support for long-distance Amtrak service, public broadcasting and the arts would also go away. So would the Appalachian Regional Commission and its smaller counterparts, such as the Delta Regional Authority and the Denali Commission.

Rogers with a Trump button at the
Republican National Convention.

Such ideas drew objection from Rep. Hal Rogers of Kentucky's 5th District, one of the nation's poorest and most rural. “I am disappointed that many of the reductions and eliminations proposed in the President’s skinny budget are draconian, careless and counterproductive," said Rogers, chair of the House Appropriations Committee in 2011-16. "In particular, the Appalachian Regional Commission has a longstanding history of bipartisan support in Congress because of its proven ability to help reduce poverty rates and extend basic necessities to communities across the Appalachian region.” He concluded, “I am optimistic that we can work with the administration to responsibly fund the federal government, including those agencies which serve as vital economic lifelines in rural parts of the country that are still working to overcome substantial challenges.”

The plan, which covers only discretionary spending, calls for a 21 percent cut—or $4.7 billion—to rural programs in the U.S. Department of Agriculture. Cuts to USDA and other programs are being made to make room for proposed $54 billion increases in defense, $2.6 billion for a border wall and $1.4 billion for school choice. The plan would not reduce the federal deficit.

Kim Soffen and Denise Lu of The Washington Post note, "Discretionary spending limits, addressed by this proposal, are set by congressional budget resolutions. Congress typically makes changes to the president’s proposal—last year, lawmakers disregarded Obama’s budget altogether. Mandatory spending, by contrast, is set by other laws and is often determined by the size of the benefit and the eligible population."

The Trump administration "plans to eliminate its water and waste-disposal loan and grant program, which helps with rural water and waste infrastructure, for a savings of nearly $500 million," Jose A. DelReal reports for the Post. "It also will seek to eliminate aspects of the Rural Business-Cooperative Service, which supports business development and job opportunities, because the administration called it 'duplicative.' That cut would save $95 million."

The budget document states: “Rural communities can be served by private sector financing or other federal investments in rural water infrastructure, such as the Environmental Protection Agency’s state revolving funds."

"The document says funding for the National Forest System will be reduced, but it does not indicate by how much; the administration is focused on 'maintaining existing forests and grasslands' rather than pursuing new land purchases," DelReal writes. The Forest Service is part of USDA. "The Agricultural Research Service might also face cuts to focus departmental research on 'the highest priority agriculture and food issues, such as increasing farm productivity, sustaining natural resources . . . and addressing food safety and nutrition priorities,' the document says. The budget also says the USDA will reduce staffing by an unspecified number at various service centers."

Trump: Cut EPA 31%, decimate climate research, eliminate Great Lakes and Chesapeake projects

President Trump's proposed budget calls for a 31 percent cut—or $2.6 billion—to the Environmental Protection Agency, the largest percentage cut to any agency and higher than the estimated 25 percent cut reported last week, Evan Lehmann and Emily Holden report for Climatewire. The budget, which does not specify how many jobs would be cut, calls for eliminating former President Barack Obama's Clean Power Plan "and 'reorienting' U.S. EPA on air pollution."

"The plan now goes to Congress, where lawmakers from both parties are bound to scrap many of Trump's politically painful cuts," Climatewire reports.

Under the budget, the EPA's Office of Research and Development, which does most of the agency's science work, would be cut from $488 million to $250 million, reports Climatewire. "Categorical grants to localities would fall 45 percent, from $1.1 billion to $597 million. Enforcement of environmental infractions and crimes would also see a 24 percent cut, from $548 million to $419 million."

The budget would also "eliminate funding for popular regional programs, including the $300 million Great Lakes Restoration Initiative, which Congress authorized last year, and a large Chesapeake Bay cleanup project, which receives $73 million each year," reports Climatewire. "Geographic programs would see a total $427 million cut. Those proposed reductions are likely to spur fights on Capitol Hill."

"In all, the proposed budget would do away with 50 EPA programs that cost $347 million, including Energy Star, targeted air-pollution grants, endocrine-disrupter screening and infrastructure assistance to Alaska Native villages and the Mexico border," Climatewire reports.

U.S. leads world in opioid use, and goes easy on drug makers and distributors, U.N. agency says

Post graphic of top 25 opioid consuming countries

The opioid epidemic in the U.S. is by far the worst in the world, says a report by the United Nations International Narcotics Control Board. The opioid epidemic is a major concern in rural areas, especially in Appalachia. West Virginia had the nation's highest age-adjusted death rate for drug overdoses in 2014 and 2015, the last years for which rates have been computed. Ohio had the most overall opioid deaths in 2014.

U.N. data show that the U.S. consumes nearly twice as much opioids as any other country, Keith Humphreys reports for The Washington Post. The U.S. has a daily dose of 50,000 opioids per million people, based on standard dosages. Canada is second at just over 30,000, followed by Germany at about 26,000. When it comes to hydrocodone, the U.S. consumes 99 percent of the world's supply.

"Unlike most of the developed world, the U.S. puts minimal constraints on aggressive marketing by pharmaceutical companies," Humphreys writes. Also, "When federal drug agents began holding opioid distribution companies accountable for shipping massive numbers of opioids to pill mills, lobbyists from the industry successfully pressured the Justice Department’s leadership to curtail the investigation."

Unsealed documents raise safety concerns about Roundup; Monsanto insists it's not cancer-causing

A federal court on Tuesday unsealed documents exchanged by Monsanto and federal regulators that raised questions about safety and research practices concerning Roundup, "the world’s most widely used weed killer," Danny Hakim reports for The New York Times.

"The records suggested that Monsanto had ghostwritten research that was later attributed to academics and indicated that a senior official at the Environmental Protection Agency had worked to quash a review of Roundup’s main ingredient, glyphosate, that was to have been conducted by the U.S. Department of Health and Human Services," Hakim writes. "Documents also revealed that there was some disagreement within the EPA over its own safety assessment."

"Roundup and similar products are used around the world on everything from row crops to home gardens," Hakim writes. "It is Monsanto’s flagship product, and industry-funded research has long found it to be relatively safe. A case in federal court in San Francisco has challenged that conclusion, building on the findings of an international panel that claimed Roundup’s main ingredient might cause cancer."

Hundreds of people who contracted non-Hodgkins lymphoma "are suing Monsanto, citing a 2015 World Health Organization study that says glyphosate is 'probably carcinogenic' and damages DNA in human cells," Mireya Villarreal reports for CBS News.

Dr. Donna Farmer, a Monsanto scientist, accused WHO of cherry picking details, telling CBS last summer, "There is no data indicating that we should change any recommendations on how this product should be used. Glyphosate, the data is clear, doesn’t cause cancer." Monsanto said in a statement: “These allegations are false. Monsanto scientists did not ghostwrite the paper. No regulatory body in the world considers glyphosate to be a carcinogen.”

Trump administration to withdraw, rewrite Obama regulation on fracking on federal land

The Trump administration plans to withdraw and rewrite a 2015 Obama Administration rule "aimed at limiting hydraulic fracturing on public lands," Juliet Eilperin reports for The Washington Post. The regulation required companies that drill on federal and tribal lands to "be subject to stricter design standards for wells and for holding tanks and ponds where liquid wastes are stored. They also would be forced to report which chemicals they were pumping into the ground."

Last June a federal judge in Wyoming ruled that the Interior Department "had exceeded its congressional mandate in choosing to regulate the controversial drilling practice," Eilperin writes. "While Obama administration officials appealed that decision to the U.S. Court of Appeals for the 10th Circuit, the appeals court asked the Bureau of Land Management on March 9 if the agency’s position had changed now that Trump is in office."

"On Wednesday, Justice Department lawyers representing Interior and BLM asked the court to 'continue the oral argument and hold these appeals in abeyance pending a new rulemaking' on the issue," Eilperin writes. "The attorneys noted that Interior officials were already reviewing the regulation to mesh with Trump’s agenda."

The motion reads: “As part of this process, the department has begun reviewing the 2015 final rule (and all guidance issued pursuant thereto) for consistency with the policies and priorities of the new administration. This initial review has revealed that the 2015 final rule does not reflect those policies and priorities," Eilperin writes. It said "the department will 'soon' be issuing a notice in the Federal Register to announce it will be rescinding the rule and writing a new one."

Tennessee sues federal government over refugee resettlement, citing 10th Amendment

Tennessee is the nation's first state "to sue the federal government over refugee resettlement on the grounds of the 10th Amendment of the U.S. Constitution," Joel Ebert reports for The Tennessean. A suit filed Monday claims the feds have violated the amendment "that says the federal government possesses only the powers delegated to it by the U.S. Constitution and that all other powers are reserved for the states."

"Other states have sued the federal government over refugee resettlement but on different legal grounds," Ebert writes. "The charge that the federal government is not complying with the Refugee Act of 1980, based on the 10th Amendment, makes Tennessee's lawsuit the first of its kind."

"The lawsuit argues that the federal government has unduly forced states to pay for the refugee resettlement program," Ebert writes. "The federal refugee act was designed to create a permanent procedure for the admission of refugees into the U.S. The lawsuit asks the court to force the federal government to stop resettling refugees in Tennessee until all costs associated with the settlement are incurred by the federal government."

One-fifth of rural youth are not in school or the workforce; the label is 'disconnected'

More than one-fifth of rural youth are disconnected,  meaning they are not in school or the workforce, says a study by Measure of America, a non-partisan, non-profit initiative of the Social Science Research Council. The study found that among youth 16-24 in 2015, 4.9 million—12.3 percent—were disconnected, and the numbers were much higher in rural areas, at 20.3 percent, and even higher in the rural South, at 24 percent. (U.S. News & World Report graphic)

Overall numbers varied widely by ethnicity. Among Native Americans more than one-fourth—25.4 percent are disconnected. Among black youth the number is 18.9 percent, followed by Latino (14.3), white (10.1) and Asian (7.2). New Mexico had the highest rate, at 17.4 percent, followed by West Virginia (17) and Mississippi (16.7). The lowest rates were in New Hampshire, Nebraska, North Dakota, Vermont, Minnesota, and Iowa, which were all under 8 percent.

The overall 12.3 percent rate is down from 16 percent "from 2010's post-recessionary peak and is slightly lower than the 12.6 percent reading seen in 2008, before the recession pushed the national unemployment rate into double-digits," Andrew Soergel reports for U.S. News & World Report. The report states: "Just as the Great Recession swelled the ranks of disconnected young people, the economic recovery reduced them; at least part of the drop in youth disconnection is due to the nationwide decline in the unemployment rate for workers of all ages between 2010 and 2015."

Kristen Lewis, co-director of Measure of America, said rural high schools tend to offer fewer educational options, such as career training, "resulting in less engaging curricula," Michael Walsh reports for Yahoo News. "Sparsely populated areas have fewer schools to choose from and fewer businesses to apply to for jobs," which leads to a growing number of young people migrating to cities.

Lewis told Walsh, “There was a real disconnect with the way more urban and suburban people feel about the future and the direction the country is going in. Kids in those areas are much more likely to find a way to be engaged in school, and they’re working more. It really does reflect a difference in the lived experience of these of rural areas versus metropolitan America... In the past, a young person with just a high school degree could probably find a way to make a living in a rural area. Whereas now, there aren’t many sort of jobs that pay a wage where a young person could really get a good start."

Critic of Medicaid confirmed to lead program; urges governors to alter program along her lines

Seema Verma at Senate hearing
(Getty Images)

The newly confirmed director of the Medicaid program quickly served notice that she wants states to make changes like those she has helped make in Indiana, her home state and that of Vice President Pence, including work requirements.

The Senate by a 55-43 vote on Monday confirmed Seema Verma, an Indiana health care consultant and Pence protégé, to run the Center for Medicare and Medicaid Services. Verma, a first-generation American whose parents emigrated from India, will lead "a $1 trillion agency that oversees health insurance programs for more than 130 million people, from elderly nursing home residents to newborns," Ricardo Alonso-Zaldivar reports for The Associated Press.

On Tuesday Verma and Health and Human Services Secretary Tom Price sent a letter to governors, "urging states to alter the insurance program for poor and disabled people by charging them insurance premiums, requiring them to pay part of emergency room bills and prodding them to get jobs," Amy Goldstein reports for The Washington Post. The letter "also derides the Medicaid expansion that 31 states and the District of Columbia adopted under the Affordable Care Act."

The letter says "the expansion, which has extended Medicaid to 11 million people with incomes of up to about $16,000 for a single person or nearly $34,000 for a family of four, 'was a clear departure from the core, historical mission of the program," Goldstein writes. "By giving states greater help with these new beneficiaries, it contends the ACA has 'provided states with an incentive to de-prioritize the most vulnerable populations.' The three-page letter does not mention that, for the first three years, the federal government paid the entire cost of covering the expansion group and still pays nearly all of that," 95 percent this year, and scheduled to decline to 90 percent by 2020.

Beginning in 2020, the House Republican health-care bill backed by President Trump "would limit overall federal financing for Medicaid in the future. Taken together, those changes could leave 24 million more people uninsured by 2026, the Congressional Budget Office said Monday in an assessment." The impact would be greater in rural areas, The Wall Street Journal reports. To see a Democratic-compiled rundown of how CBO thinks the bill would affect each of the 435 congressional districts, click here.

"In Indiana, Verma designed a Medicaid expansion along conservative lines for Pence. Most beneficiaries are required to pay modest premiums. And the program uses financial rewards and penalties to steer patients to primary care providers instead of the emergency room. Critics say the plan has been confusing for beneficiaries and some have incurred penalties through no fault of their own," AP reports. "At her Senate confirmation hearing, Verma defended her approach by saying that low-income people are fully capable of making health care decisions based on rational incentives."

Verma also helped design a similar plan that Kentucky has asked the agency she now heads to approve.

Citing increased digital readership, Hattiesburg paper cuts print editions to 3 days a week

The Hattiesburg American, a Gannett Co. newspaper in southern Mississippi, announced last week that increased digital readership is leading the paper to reduce its print schedule from daily to three time per week, effective April 5. The newspaper will be printed on Wednesday, Friday and Sunday.

"The shift, driven by our consumers and advertisers, enables us to invest in new ways of doing business and better position ourselves for the future," writes Nathan Edwards, president of the American. "Our research shows subscribers are increasingly choosing to access the American online via our website, mobile and tablet devices, with the Hattiesburg American having 8X more digital readers than print readers. In 2016, we had 2.3 million unique visitors and 13.8 million page views. Audiences watched our videos 251,000 times—and another 774,000 times on Facebook. And the average time you spent on our stories went up 2 percent."

"This change is a strategic decision based on marketplace demand," he wrote. "Our three-day-a-week print products will be as robust as ever, if not more so, and contain all of the great content you have come to rely on and enjoy. We are taking every step to ensure our most popular features and columns find new homes in print. In addition, the majority of our businesses have already opted for a 3-day model in print, with the Sunday, Wednesday and Friday editions currently containing the majority of the American’s print advertising."

"While the frequency of the print edition is changing, our commitment to covering the news, sports, events and stories that define our community remains a 24/7 priority for our staff and journalists," he wrote. "But our mission isn’t just to be a news source—we want to help improve the community and shine a spotlight on what makes it a great place to call home. As audience and advertiser preferences evolve—from print to digital, from desktop to mobile, from words to video—we’re evolving too."

EPA chief freezes safety regulations inspired by Texas fertilizer plant explosion that killed 15

West, Texas chemical plant explosion
(U.S. Chemical Safety and Hazard
Investigation Board photo)

Environmental Protection Agency Administrator Scott Pruitt "has frozen implementation of updated safety regulations for thousands of chemical plants, oil refineries and other industrial facilities, saying the delay is needed to consider an industry coalition's petition to scrap the new rules," Sean Reilly reports for Greenwire.

The regulations were in response "to a 2013 Obama administration executive order after an explosion at a West, Texas, fertilizer storage and distribution facility killed 15 people, most of them firefighters," Reilly writes. Regulations, which were published in January and supposed to go into effect Tuesday, will now be effective June 19.

The regulations "are intended to strengthen efforts to head off accidents, better protect first responders from chemical exposure and do more to keep the public informed of potential risks at plants," Reilly writes. "They would apply to as many as 12,500 facilities that have to file risk management plans (RMPs) under the Clean Air Act."

"But industry organizations question whether they're even needed," Reilly writes. "In its reconsideration petition to EPA, the RMP Coalition—which includes the American Fuel & Petrochemical Manufacturers, the American Chemistry Council and five other industry groups—sought the stay and asked EPA to rescind the final rule."

While labor organizations and safety advocates had backed stricter requirements, and in some cases wanted EPA to go further, Rep. Markwayne Mullin (R-Okla.) and Sen. Jim Inhofe (R-Okla.) "have both introduced resolutions to repeal them under the Congressional Review Act," Reilly writes. "Pruitt, also a Republican, was previously Oklahoma's attorney general and has hired several former Inhofe staffers for top jobs at EPA."

Methane emissions from power plants much higher than EPA estimates, researchers find

More methane is emitted from natural gas-fired power plants and oil refineries than previously thought, says a study by researchers at Purdue University and the Environmental Defense Fund published in the journal Environmental Science & Technology. Methane is a much more powerful greenhouse gas than carbon dioxide, but breaks down in the atmosphere much more quickly. (Purdue University graphic)

Researchers "estimated that emissions from power plants fueled by natural gas could be 21 to 120 times higher than figures in the Environmental Protection Agency's most recent final greenhouse gas inventory," Hannah Hess reports for Greenwire. "For oil refineries, emissions may be 11 to 90 times higher than EPA estimates." Researchers "used Purdue's flying atmospheric chemistry lab—a Beechcraft Duchess light twin-engine airplane equipped with an airflow measurement probe—to collect daily samples at three natural gas power plants and three refineries from July 30 to Oct. 1, 2015."

Paul Shepson, director of Purdue's Climate Change Research Center, said "EPA's greenhouse gas reporting program focuses on how much escapes from belching power stacks, without considering that methane could be leaking from compressors, valves and industrial hardware," Hess writes. He told Hess, "The good news from our study is that while emissions are greater than anticipated, natural gas-burning power plants are still cleaner, relative to burning coal."

Shepson said "The amount of methane escaping from the plants in the pilot study, combined with previous estimates of methane leakage in the supply chain, is still below the 'breaking point at which it would cancel out the positive climate impacts of switching from coal to natural gas," Hess writes.

Are text messages between public officials public? It depends on the state, or maybe the judge

Are text messages between public officials on their private phones subject to disclosure under your state open-records law? It depends on what state you're in, and the answer could change, a lawyer who has researched the issue told open-government advocates in Washington, D.C., Tuesday night.

Helen Vera, a associate with the firm of Ropes & Gray, was among the presenters at a Sunshine Week event of the D.C. Open Government Coalition at the National Press Club. Just like us, Vera said, "State and local officials are texting all the time." And, she added, making new law as they go along.

Some states consider text messages "transitory" and not subject to records laws in the same way that emails are. Vera cited a court case in Colorado, in which a judge found that the Basalt Mayor Jacque Whitsitt didn't violate the law by erasing text messages between her and Town Manager Mike Scanlon. "The lawsuit targeted Whitsitt for not turning over texts that she exchanged with Scanlon, and that Scanlon provided as part of the open-records request," Scott Condon of The Aspen Times reported. "The DA determined that no criminal charges were warranted."

Vera noted new apps that can automatically delete text messages.

Vera said "the vast majority" of state laws clearly provide access to text messages, and in other states, attorneys general have issued opinions to that effect, some of them binding. But in practice, she said, laws and policies don't guarantee access. Prolonged litigation can examine retention policies and issues such as use of personal devices and the definition of "possession" in a records law. She said some states are requiring public officials to forward to the government any text messages they have regarding public business.

"It's a very sort-of-ripe issue and we expect to continue to see that this is an issue that's litigated," Vera said. She warned that new applications such as Telegram give texters the ability to have their messages automatically deleted. One, Confide, uses the slogan "Your off the record messenger."

Budget office says 24 million could lose coverage; rural counties would be hit hardest

The Congressional Budget Office predicted Monday "that 24 million fewer people would have coverage a decade from now than if the Affordable Care Act remains intact, nearly doubling the share of Americans who are uninsured from 10 percent to 19 percent," Amy Goldstein, Elise Viebeck, Kelsey Snell and Mike DeBonis report for The Washington Post.

The impact would be greater in rural areas, The Wall Street Journal reports. To see a Democratic-compiled rundown of how CBO thinks the bill would affect each of the 435 congressional districts, click here.

"The report predicted that premiums would be 15 percent to 20 percent higher in the first year compared with those under the Affordable Care Act but 10 percent lower on average after 2026," reports the Post. "By and large, older Americans would pay 'substantially' more and younger Americans less. But the GOP legislation, which has been speeding through House committees since it was introduced a week ago, would lower the deficit by $337 billion during that time, primarily by lessening spending on Medicaid and government aid for people buying health plans on their own." (Post graphic: The fall and projected rise in the uninsured ranks)

Losses would be particularly bad in rural areas, Anna Wilde Mathews and Dante Chinni report for The Wall Street Journal. Nationwide, "a rural 45-year-old making around $18,000 a year would pay about $2,291 a year more on average from his own wallet under the Republican bill than under the ACA, according to the analysis—compared with a $1,588 increase for a 45-year-old urban resident. For 62-year-olds earning about $18,000, the average increases in cost under the Republican bill's setup were far greater: $9,075 for rural and $6,954 for urban consumers."

"In extreme cases, the amount a consumer might owe for a plan could exceed that person's annual income," the Journal reports. "In Nebraska's Chase County, a 62-year-old currently earning about $18,000 a year could pay nearly $20,000 annually to get health-insurance coverage under the House GOP plan—compared with about $760 a year that person would owe toward premiums under the ACA," according to an analysis from consulting firm Oliver Wyman.

"The Oliver Wyman analysis highlights how rural areas, where individual insurance premiums are often higher, could see a major effect from the shift to flat-sum tax credits," reports the Journal. "Compounding that, rural populations are often older and poorer, so the proportion of those doing worse under the new subsidy setup may be higher. Of the 100 counties where 62-year-olds earning around $36,000 would see the biggest jump in annual costs, 97 were rural."

"People with higher incomes could see their costs go down under the Republican proposal," reports the Journal. "For instance, a rural 62-year-old making about $54,000 would spend about $2,588 less per year for a plan on average under the Republican bill's subsidy structure, which gives tax credits to people at higher income levels than the ACA does. The urban 62-year-old at that income level would spend $2,856 less."

Among President Trump's best 25 counties, mostly rural, 24 counties would suffer under the plan, the Post's Jeff Guo reports.

Tax-credits in Trump's top 25 counties (Washington Post graphic; click on it to enlarge)

A Post analysis also looked at the 35 counties that could lose the most under the plan, most of which Trump carried, and the 25 counties, mostly urban, where he got the lowest percentage of votes and how many of those counties would be better off under the new plan.

Gary Claxton, a vice president at the Kaiser Family Foundation, told Guo, "It is simply cheaper and easier to provide health care in places with a lot of people. In urban areas, it’s all about being able to negotiate efficient, lower-cost networks. That’s why there’s much more ability to get lower-cost premiums in those areas. In a rural area there’s not really much you can do by negotiating with the few existing providers that are there.”

Public Tableau has created an interactive county-level map of tax credits under Obamacare vs. the new health care plan in 2020. This screenshot shows how the tax credit in McDowell County, West Virginia, one of the nation's poorest counties, would be about one-fourth of what it is now. Trump won 74 percent of the vote in McDowell County.

Wisconsin governor boosts open-records laws as legislators mull pulling public notices from newspapers

Wisconsin Republican Gov. Scott Walker last week issued an executive order "making it easier for the public to find state government notices and meeting minutes," Molly Beck reports for the Wisconsin State Journal. During last year's Sunshine Week, which this year runs through Saturday, Walker ordered improvements to how open records are handled, Matthew DeFour reports for the Journal.

Meanwhile, state lawmakers are considering bills "that would do-away with the newspaper publication of local-government meeting minutes," reports The Polk County Sun. "Assembly Bill 70 and its companion bill, Senate Bill 42, would give school boards, city councils, village boards, county boards and technical college boards the option to post meeting minutes and proceedings on their own websites to fulfill publication requirements instead of printing them in a local newspaper, which is currently required by state law."

Walker on Thursday "asked state agencies to post the most commonly requested documents online to be readily available to the public, and to post how quickly their officials respond to records requests under the state’s open records law," Beck writes. "Walker’s order requires the Department of Administration to improve the state’s public notice website by requiring all state government public notices and meeting minutes to be uploaded to the site."

"The order also requires each agency to post the total number of public records requests received, the total number of requests the agency responded to and the average time it took to fulfill the request," Beck writes. "State officials also will create and manage a single email address for agencies to use to send their meeting notices and minutes and all agency public records email addresses will be posted" online.

On March 11, 2016, Walker issued an "executive order directing state agencies to respond to requests promptly, update requesters on the status of their requests, track all requests and facilitate access to electronic records whenever possible," DeFour writes. "In the 14 months prior to the order, the average response time to fill 8,448 requests was 13 workdays. The average response time to fulfill 10,395 requests since has been nine workdays, a 30 percent improvement."

FDA says it's exempt from FOIA when it comes to naming groceries that carry contaminated food

If you want to know if your local grocery store carries items reported to be contaminated, you're out of luck. The Food and Drug Administration does not specify where contaminated items are located, "because that would violate its interpretation of an obscure trade secret rule," Caitlin Dewey reports for The Washington Post.

"This interpretation differs from that of other agencies in the federal food safety system, an overlapping and often illogical network of regulatory fiefdoms," Dewey writes. "The system, which is responsible for keeping food free of bacteria and other pathogens, frequently has to weigh the very real interests of private food companies against potential risks to the public. In the case of releasing retailer lists during major outbreaks, FDA has historically sided with business, ruling that such lists constitute 'confidential commercial information' and thus should not be available for public consumption."

FDA said in a statement "that it believes its disclosure measures are sufficient and blamed the lack of downstream recall information on federal disclosure rules," Dewey writes. "Federal regulations do limit the sort of information that can be released to the public. Under the Freedom of Information Act and Title 21 of the Code of Federal Regulations, government agencies—and specifically, the FDA—are told to exempt trade secrets and commercial information from any of their releases. Peter Cassell, a spokesman for FDA, said confidential consumer information "is exempt from Freedom of Information Act requests, but can be shared through certain information sharing agreements (including with other federal agencies).”

Critics say refusing to release the information poses health dangers, "particularly in cases like the current E. coli outbreak, where parents may not know if their child consumed the recalled product," Dewey writes. Also, in cases where there is a hepatitis A outbreak, which can be treated with a vaccine for a limited period after exposure, it's important for consumers who may have gotten ill to know as soon as possible.

West Virginia counties sue drug distributors for contributing to state's opioid epidemic

Two West Virginia counties are suing drug distributors for contributing to the state's opioid epidemic and five more counties are expected to file lawsuits this week, Scott Higham and Lenny Bernstein report for The Washington Post. According to the federal Centers for Disease Control and Prevention, West Virginia had the nation's highest age-adjusted death rate for drug overdoses in 2014 and 2015, the last years for which rate have been computed.

The lawsuits against McKesson Corp., Cardinal Health and AmerisourceBergen—which distribute 85 percent of the nation’s drugs—and Walgreens, CVS and other stores, "are among the first of their kind in the country," reports the Post. "They accuse the companies of creating a hazard to public health and safety by shipping inordinate quantities of opioids into the state in violation of a West Virginia law. The law was originally designed to permit the demolition of run-down buildings that posed a public nuisance and threatened the safety of a community."

The lawsuit says, “The unlawful conduct by the defendant wholesale distributors is purposeful and intentional,” reports the Post. Attorney Paul Farrell Jr., who filed the lawsuits, told the Post, "The purpose of these lawsuits is to make the economic cost of willfully violating the law so significant that we force the wholesalers to abide by the law."

AmerisourceBergen said in a statement that the company “has been and remains committed to the safe and appropriate delivery of controlled substances," reports the Post. (Post graphic: Age-adjusted overdose rate 1999-2015)

Texas seeks feral 'hog apocalypse' with pesticide that some fear could harm other animals

Feral hogs (U.S. Fish and Wildlife Service photo)

Texas officials say they have found a way to eliminate the state's feral hog problem: pesticides. Last month Agriculture Commissioner Sid Miller "announced a rule change in the Texas Administrative Code that classifies a warfarin-based compound called "Kaput Feral Hog Lure" as a state-limited-use pesticide." Miller said in a statement: “This solution is long overdue. Wild hogs have caused extensive damage to Texas lands and loss of income for many, many years. With the introduction of this first hog lure, the ‘hog apocalypse' may finally be on the horizon.”

Miller said there are about two million feral hogs in Texas that eat newborn lambs, uproot crops and "entire city parks," trampling across highways and causing more than $50 million in damage a year, Avi Selk reports for The Washington Post. When pigs eat the pesticide "it kills them slowly, often painfully and turns their innards blue. It’s already wiped out swine herds in Australia, which later banned the product as inhumane." The Environmental Protection Agency in January approved it.

Miller's rule change has already led more than 3,000 people to sign the Texas Hog Hunters Association’s petition against Miller’s chemical war, Selk writes. One concern is that other species might eat the poison, said Tyler Campbell, a former researcher with the U.S. Deparment of Agriculture who led the agency’s feral-hog studies in Kingsville, Texas, when warfarin was first tested on pigs. Campbell said the poison can paralyze chickens, make rats vomit and kill all manner of animals.

"The EPA regulations—which Texas plans to strengthen by licensing warfarin’s use—requires hogs to be fed the poison out of bins with 10-pound lids," Selk writes. "The lid tactic won’t work, Campbell said. Before retiring from government research a few years ago, he saw a study in which raccoons lifted much heavier lids in search of food."

Michigan county trying to shed label as state's least healthiest with county-wide health effort

Muskegon County, Michigan
(Wikipedia map)

Muskegon County, Michigan, named the state's least healthiest county in 2011, "is trying something quietly radical: turning the small cluster of towns in the county into a multifaceted support network to help people make healthy changes that stick—like losing weight and keeping it off," David Freedman reports for Politico.

The county "has struggled with job loss, large pockets of poverty, and the raft of health challenges that afflict a disproportionate number of American towns far from the coasts," Freedman writes. "Some of the biggest of these health challenges largely boil down to obesity—a problem that vexes the entire nation and has become particularly acute throughout the Midwest and South, especially in less affluent communities that, like Muskegon, are far from big cities."

"It’s one of a handful of similarly fitness-resistant communities across the U.S. in which a new approach is slowly taking hold," Freedman writes. "With roots in evidence-based medicine rather than diet fads, it's an approach that focuses help where it's needed, is driven by a broad coalition of community members and looks to gradually grind out solutions by seeking tiny victories that can be aggregated and amplified."

"The goal is to form a web of interventions that successfully nudge, tempt, bribe and even scare people into sticking with new, healthier habits," Freedman writes. "The approach offers hope of accomplishing at the community scale what policymakers despair of getting done at the scale of an entire nation. These unflashy, slow-but-sure efforts are in their early stages and have received little attention in the press. But they are being carefully watched and nurtured by some influential national players."

Coal and UMW leaders say proposed fossil energy budget cuts would harm industry

Coal industry and labor leaders sent a letter to President Trump March 10 asking him not to cut the budget of the U.S. Department of Energy’s fossil-energy office, saying cuts would harm the industry's attempts to recover, James Osborne reports for Fuel Fix. Trump promised during his campaign to revive the coal industry.

Earlier this year the Trump administration said it would cut spending by $10.5 trillion over the next decade, "with substantial cuts coming from the Departments of Energy and Commerce," Osborne writes. "The cuts were reportedly based on a spending plan written by the the conservative Heritage Foundation, which calls for eliminating the Energy Department’s Office of Fossil Energy—along with the Office of Electricity and the Office of Energy Efficiency and Renewable Energy."

The United Mine Workers of America and CEOs of the nation's three largest coal companies—Peabody Energy, Arch Coal and Cloud Peak Energy—said in the letter: "In light of recent calls for dramatic cuts to the federal budget, we want to stress that every dollar allocated to fossil energy research is an investment in the long-term future of America’s coal and fossil fuel industry."

Southern Baptist leader will not be dismissed over criticism of Trump and his religious supporters

Russell Moore (Baptist Press photo)

Leaders of the Southern Baptist Convention, the nation’s largest Protestant denomination, said there is no truth to a Washington Post article saying that Russell Moore, president of SBC's Ethics and Religious Liberty Commission, could be forced out over his criticism of President Trump and religious leaders who publicly supported him, David Roach reports for Baptist Press. Trump was especially popular among evangelicals during the election.

The Post's Sarah Pulliam Bailey reported Monday that "more than 100 of the denomination’s 46,000 churches have threatened to cut off financial support for the SBC’s umbrella fund, according to Frank Page, president of the executive committee." Page, who met with Moore Monday, told Bailey prior to the meeting, "If the meeting doesn’t goes well, I’m fully prepared to ask him for a change in his status."

On Monday night Moore and Page issued a joint statement: "We fully support one another and look forward to working together on behalf of Southern Baptists in the years to come. We will collaborate on developing future steps to deepen connections with all Southern Baptists as we work together to advance the Great Commission of our Lord Jesus Christ.”

Roach writes, "The meeting came less than a month after the executive committee launched a study of churches' escrowing Cooperative Program money and two months after Dallas-area Prestonwood Baptist Church announced it would escrow CP funds over 'various significant positions taken by the leadership of the Ethics & Religious Liberty Commission.'" The executive committee "has received reports of similar actions by other churches. Churches have expressed concern about alleged disrespectfulness by Moore toward evangelical supporters of President Trump and about a friend of the court brief signed by the ERLC in support of a New Jersey Islamic society's right to build a mosque."

Page told Roach he called the meeting "to find bridge-building solutions to an unnecessary divide that has been created across the landscape of our Southern Baptist network of churches." Page said, "I also informed (Bailey) that I have no authority over Dr. Moore; that is vested in his board of trustees."

Oklahoma bill would give doctors a $25,000 income tax break for practicing in rural areas

Oklahoma wants to cure its rural doctor shortage by offering tax breaks to physicians who live and practice in rural areas, Dale Denwalt reports for NewsOK. A bill proposed in the state House would let medical and osteopathic doctors claim a $25,000 income tax break "for income earned in 2018 and later if they live and work in rural areas."

Rick Snyder, vice president of the Oklahoma Hospital Association, said the state "has one of the worst doctor-to-patient ratios in the country," Denwalt writes. Snyder told Denwalt, “I do know that most doctors coming out of residency, unless they're from a rural background, are not really thinking of practicing in a rural area. It gives rural communities an important tool to attract physicians they would not otherwise be able to attract. And we need all of them we can get.”

Oklahoma already has the Tobacco Settlement Endowment Trust that awarded a $3.8 million grant in 2015  to fund more than 100 osteopathic physician residents in six hospitals and rural doctors can receive scholarships and loan repayment if they meet certain criteria, Denwalt writes. Despite those incentives, "most of the state is classified by federal regulators as having a shortage of primary medical care" with nearly all of the state's 77 counties having a shortage of doctors.

Rural S.D. reporter wins 2017 Public Notice Journalism Award and a $500 prize

Amanda Fanger

A rural South Dakota reporter was named winner of the 2017 Public Notice Journalism Award, reports the Public Notice Research Center. Amanda Fanger of Reporter & Farmer, a weekly newspaper in rural Day County, "won for a story that scratched below the surface of a public notice to reveal a potential embezzlement scheme in one of the small towns within her paper’s coverage area."

Fanger, who will receive a $500 award, earns a free trip to Washington, D.C, where she will be honored Thursday at a National Newspaper Association dinner at the National Press Club, reports PNRC. For her story she "followed up on an obscure reference to 'employee dishonesty' in the minutes of a town board meeting that were published in March 2016 as a public notice in Reporter & Farmer. She discovered that a recent legislative audit of the finances of Grenville, S.D., had concluded that the town’s former financial officer might have embezzled as much as $72,000. Digging a little deeper, Fanger learned the same person was being prosecuted for using a stolen credit card."

John Suhr, co-publisher for Reporter & Farmer, told PNRC, “No newspaper, no matter how big, can make it to every public meeting in its coverage area. It is because of public notices, however, that we are able to see their actions and follow up to help explain to the taxpayers what their board is doing.” 

Jim Lockwood of The Scranton Times-Tribune in Pennsylvania won second place and Victor Parkins of The Milan Mirror-Exchange in Tennessee won third place. Lockwood won the award in 2015. (Read more)

Oil and gas beginning to show signs of recovery

Longview, Texas (Best Places map)

Oil and natural gas appear to be making a comeback, at least in Texas—the nation's leading producer and consumer—and Louisiana, Ken Hedler reports for the Longview News-Journal in northeast Texas. Texas has seen "more drilling rigs going up, more sales of supplies and more people returning to work. The signs are occurring as the price of crude oil is slowly increasing and largely stabilizing, thanks in part to OPEC's decision in November to cut production beginning in January, industry observers said."

Baker Hughes Inc., an American industrial service company, said "the total number of drilling rigs operating last week was up a dozen from a week before to 768," Hedler writes. "It was the eighth consecutive weekly increase, pushing the total to 288 more than a year ago. The monthly averages also show increases, with Baker Hughes data showing Texas averaged 336 rigs in January, up more than 10 percent from a year ago."

"As a proxy for activity in the sector, rig counts are an important indicator for the drilling industry and its suppliers—and are one of the first indicators to show a recovery is in the works," Hedler writes. Bob Davis Jr., a wholesaler who sells valves and other devices to producers, "said more rigs are going up in West Texas, while much of the newer activity in the Longview area and Louisiana is drilling for natural gas."

"Another barometer showing an industry uptick is the Texas Petro Index, which increased for a second straight month in January to 153.3," Hedler writes. "That was up from an index of 150.6 in December and 148.0 in November. Still, the January figure was about 16 percent less than in January 2016 and about 51 percent lower than the peak index of 313.5 calculated in November 2014."

NPR's Congress Tracker shows where each lawmaker stands on the health-care bill

NPR has created a tracker for the position of each senator and representative on the new health-care bill. "Our reporting finds that lawmakers' responses fall into four categories," Brett Neely reports for NPR. "Most Republicans on the record support the bill, but a large group of the most conservative members are vehemently opposed to the legislation, arguing that it's not a sufficient repeal of Obamacare. A smaller group of Republicans, primarily in the Senate, are concerned that bill will result in many residents of their states losing coverage via Medicaid. While Democrats are almost universally opposed, a small group of Democrats in districts won by Trump last November have struck a more equivocal tone."

"The bill would no longer require that Americans buy health insurance, and it would eliminate the current subsidies that are used to bring down the cost of premiums," Neely writes. "NPR's full coverage explains how those subsidies would be replaced with a fixed refundable tax credit and there would be big changes to Medicaid."

Also, the NPR Congress Tracker allows users "to submit a short quote that best summarizes the Congress member's position, such as: 'The President's executive order on refugees will harm, not enhance, our national security and marks a significant departure from our nation's proud history of welcoming people in need of protection.'"

Residents in poor counties that supported Trump could lose Medicaid coverage if he repeals ACA

McDowell County, West Virginia
(Wikipedia map)

McDowell County, West Virginia has high rates of poverty and unemployment, President Trump scored a lopsided victory in 2016 and many previously uninsured residents gained coverage from Medicaid through former President Barack Obama's Patient Protection and Affordable Care Act. If Trump repeals Obamacare, many of those same people who voted for him could stand to lose benefits. This same story could be written about countless counties across the nation.

"Before the law, most West Virginians without children or disabilities could not qualify for Medicaid, no matter how poor they were," Jessica Contrera reports for The Washington Post. "ACA expanded the program to cover more people" like Clyde Graham, a 54 year-old former coal miner who has been out of work for four years. Because of ACA, Clyde’s visit to Tug River Health Association is covered by Medicaid.

As for the other problems in his life, Graham "has put his hopes in Trump, who came to West Virginia saying he would bring back coal and put miners back to work," Contrera writes. "When Trump mentioned repealing Obamacare, Clyde wasn’t sure what that might mean for his Medicaid. But if he had a job that provided health insurance, he reasoned, he wouldn’t need Medicaid anyway, so he voted for Trump, along with 74 percent of McDowell County," which has the nation's short life expectancy.

Tug River Health Association "treats about 8,700 patients, resulting in some 20,000 visits a year to its five clinics," Contrera writes. "In 2016, 12,284 of those visits were from patients on Medicaid, up from 5,674 in 2013, before the ACA took effect here. Without the ACA, many of those patients wouldn’t be able to afford care."

"In other parts of the country, the primary impact of the ACA has been requiring people to have private health insurance, but in poor and sick communities like McDowell County, the law’s dominant effect has been the Medicaid expansion, which has given more people access to the kind of health care that wasn’t widely available or affordable to them before," Contrera writes. "With an insurance card in her pocket, the patient at Tammy’s window can venture into the realms of medical care that are typically out of reach to those without one: blood work, immunizations, specialized doctors, surgery, physical therapy."

Opioids and drug overdose deaths are beginning to plague farming communities

Roger D. Winemiller and his only living child
Roger T. Winemiller (Times photo by Ty Wright)

Drug addiction and overdose deaths are becoming a far too common occurrence in some farming communities, such as Clermont County, Ohio, where Roger Winemiller has lost two children to drug overdoses and a third has battled drug addiction for years, Jack Healy reports for The New York Times. "Overdoses are churning through agricultural pockets of America like a plow through soil, tearing at rural communities and posing a new threat to the generational ties of families like the Winemillers."

"Farm bureaus’ attention to seed, fertilizer and subsidies has been diverted to discussions of overdoses," Healy writes. "Volunteer-run heroin support groups are popping up in rural towns where clinics and drug treatment centers are an hour’s drive away, and broaching public conversations about addiction and death that close-knit neighbors and even some families of the dead would prefer to keep out of view."

Clermont County, located about an hour east of Cincinnati, has a low unemployment rate—4.1 percent—but "the economic resilience has done little to insulate the area from a cascade of cheap heroin and synthetic opiates like fentanyl and carfentanil, an elephant tranquilizer, which have sent overdose rates soaring across much of the country, but especially in rural areas like this one," where drug overdoses have nearly tripled since 1999.

Clermont County, Ohio
(Wikipedia map)

Ohio in 2014 led the nation in overdose deaths with 2,106, according to an analysis of the most recent federal data by the Kaiser Family Foundation. "In rural Wayne Township, where the Winemillers and about 4,900 other people live, the local fire department answered 18 overdose calls last year," Healy writes. "Firefighters answered three in one week this winter, and said the spikes and lulls in their overdose calls gave them a feel for when particularly noxious batches of drugs were brought out to the countryside from Cincinnati or Dayton."

The drug epidemic also has farmers, like Winemiller, concerned about who will take over the famly business when he's gone, Healy writes. "Winemiller and a cousin inherited the farm in 1993 when an uncle died, and they own and run the business together." While his remaining child has been clean for two months, and has said he wants to someday run the farm Winemiller "worries about what could happen to the business if he turned over his share of the farm and his son relapsed—or worse—a year or a decade down the line. He also keeps a pouch of overdose-treating nasal spray in the living room now, just in case."