Critics of Senate health bill call it 'anti-rural'

Senate Majority Leader Mitch McConnell (Associated Press photo)

Critics of the Senate's newly released Better Care Reconciliation Act, the potential replacement of the Patient Protection and Affordable Care Act, say the bill will hit rural America especially hard, writes Tim Marema of The Daily Yonder.

Alan Morgan, chief executive officer of the National Rural Health Association, told Marema that the organization will oppose the Senate bill because the legislation will hurt rural America. "In its current form, this bill is anti-rural," Morgan said. The bill contains several provisions that would hit especially hard in rural areas, Marema says. "Among these are deep cuts in Medicaid spending and an end to Medicaid expansion. About 45 percent of rural children use Medicaid, compared with 38 percent in metropolitan areas, according to a Georgetown University study. The bill would reduce funding for treatment of opioid addiction, another issue for rural America," Marema writes.

The rate of opioid overdose deaths is 45 percent higher in rural counties, according to the NRHA. The Senate bill provides $2 billion to fight opioid addiction in 2018, while the House version of the bill would have provided $45 billion over 10 years.

Rural hospitals will continue to be at risk of closure under the new bill, Marema writes. One analysis finds that 673 rural hospitals are vulnerable to closure. Since 2010, 79 rural hospitals have closed, according to tracking by the University of North Carolina.

"Morgan also noted one part of the bill that probably won’t attract much attention but ought to," Marema writes. "The bill zeroes out the Public Health and Prevention Fund, which has been used to fight the zika virus, a mosquito-borne disease that can cause severe birth defects. " Morgan said, "There is a real concern that zika is going to reemerge this summer in rural communities along the southern border. From a rural public health standpoint it’s a real problem."

"This bill is going to hit rural America like a wrecking ball," Sen. Ron Wyden (D-Ore.) said at a hearing Wednesday.

The Washington Post has a side-by-side comparison of the two bills and the Patient Protection and Affordable Care Act.

Medicaid cuts would hit rural hospitals hardest

Pemiscot Memorial Hospital in one of Missouri's
poorest counties (Side Effects Public Media photo)

For the hundreds of rural hospitals struggling to stay in business, health-policy decisions made in Washington, D.C., could make survival a lot tougher, Bram Sable-Smith reports for NPR.

"Since 2010, at least 79 rural hospitals have closed across the country, and nearly 700 more are at risk of closing," Sable-Smith notes. "These hospitals serve a largely older, poorer and sicker population than most hospitals, making them particularly vulnerable to changes made to Medicaid funding."

House Republicans' bill would cut Medicaid — the public insurance program for many low-income families, children and elderly Americans, as well as people with disabilities — by as much as $834 billion, Sable-Smith reports. "The Congressional Budget Office has said that would result in 23 million more people being uninsured in the next 10 years. Even more could lose coverage under the budget proposed by President Trump, which suggests an additional $610 billion in cuts to the program."

The House bill would end the Medicaid expansion in 2020; the Senate bill revealed Thursday would phase it out by 2024, but after that would tighten the funding formula in a way that would likely force states to limit eligibility or cut benefits, or both. All those would be problems for small rural hospitals that depend on Medicaid. A rural hospital closure goes beyond people losing health care, Sable-Smith explains. Jobs, property values and local schools can suffer.

"Relief for rural hospitals is not what is being debated in Washington right now." he says. "Under the GOP House plan, even states like Missouri that did not expand Medicaid could see tens of thousands of residents losing their Medicaid coverage."

Wendell Berry documentary opens Friday in NYC

Wendell Berry in middle age (University of Kentucky photo)

A film documenting the shifting values of rural America through the eyes of writer, farmer and activist Wendell Berry is set to premiere at the IFC Center in New York on June 30, reports Whitney Hale of the University of Kentucky.

"Look and See: A Portrait of Wendell Berry" is the first documentary about Berry, one of America's most prominent living writers. It was filmed in and around Henry County, Kentucky, where Berry has lived and farmed since the mid-1960s, Hale reports.

"Often called 'a prophet for rural America,' Berry has long been a voice for the communities that are so often overlooked by the media. 'Look and See' subverts biopic conventions and immerses audiences into Berry's world, providing a space for talking about the land and those who sustain it," Hale writes. "Filmed across four seasons in the farming cycle, 'Look and See' blends observational scenes of farming life and interviews with farmers and community members with evocative, carefully framed shots of the surrounding landscape. Thus, in the spirit of Berry’s agrarian philosophy, Henry County emerges as a character in the film — a place and a landscape that is deeply interdependent with the people who inhabit it. 'Look and See' frames a conversation that is more urgent now than ever, as we face a deeply divided nation where so many Americans are disconnected from the farmers who feed them."

Robert Redford, Terrence Malick and Nick Offerman produced the film alongside Kentuckians Gill Holland, Owsley Brown III and Elaine "Cissy" Musselman. "Following the documentary’s award-winning premiere at the SXSW Film Festival, it was retitled and updated to reflect the conversations that have emerged since the election. Local audiences may remember the film by its previous name, 'The Seer,' which was screened last July at the Kentucky Theatre" in Lexington, Hale explains. It has been updated and renamed since the presidential election. In addition to the New York premiere, the documentary will also be shown in Austin, Texas, this summer.

Berry is one of the most decorated living authors, having won countless awards, including the National Humanities Medal, the Richard C. Holbrooke Distinguished Achievement Award, the Roosevelt Institute's Freedom Medal and the Cleanth Brooks Medal for Lifetime Achievement, according to Hale. Berry is also a fellow of the American Academy of Arts and Sciences, and in 2015 became the first living writer named to the Kentucky Writers Hall of Fame.

Coal magnate sues satirist John Oliver for defamation over Sunday segment on mining

Robert Murray

Coal magnate Robert Murray is suing John Oliver, the writers of his show Last Week Tonight, Home Box Office and Time Warner for defamation over a segment of Sunday's episode in which Oliver allegedly singled out Murray for failing to protect the safety of his miners.

One of Murray's mines in Utah recently collapsed, killing nine workers, Elias Leight of Rolling Stone notes.

The lawsuit, filed Wednesday, alleges that Oliver "executed a meticulously planned attempt to assassinate the character of and reputation of Mr. Robert E. Murray and his companies." Murray sued for one count each of defamation, false light invasion of privacy and intentional infliction of emotional distress, Leight reports.

"Oliver predicted that this would happen during his Last Week Tonight segment, noting that Murray has a history of suing media outlets who write unflattering stories about his business enterprises. In addition, Oliver said that when his show reached out to Murray for comment before airing Monday's episode, the coal mogul responded immediately with a cease-and-desist letter. When that failed to work, Murray – self-described as 'one of the staunchest defenders and most ardent champions of the United States coal industry and America itself' – followed with a suit," Leight explains.

Murray accuses Oliver of ignoring evidence that the Utah mine collapse was caused by an earthquake, though a government report determined the cause to be unauthorized mining practices, Leight writes. An HBO spokesperson seemed unconcerned by Murray's suit: "While we have not seen the complaint, we have confidence in the staff of Last Week Tonight and do not believe anything in the show this week violated Mr. Murray's or Murray Energy's rights."

Survey finds relatively few patients have used tele-health, which offers opportunities to rural areas

Most Americans are willing to consider using remote access telecommunications for medical appointments, but only a fraction have actually utilized "tele-health" services, according to a recent survey.

"The Advisory Board Co.'s Virtual Visits Consumer Choice Survey reported more than three-quarters of nearly 5,000 respondents would see a doctor virtually, while less than 20 percent already have used tele-health solutions," Alex Kacik writes for Modern Healthcare.

Researchers found that the health-care industry is not meeting consumer interest in virtual care, which can make medical appointments easier and more accessible for rural Americans who live far from their providers, particularly medical-specialty practitioners.

"Many providers are investing in a big way in tele-health, which was valued as a $18.2 billion global market in 2016 and is estimated to reach $38 billion by 2022, according to a Zion Market Research study. Patients can download apps that will immediately connect them with a physician and have a prescription routed to the pharmacy in minutes, which can be ideal for minor issues such as rashes or colds and chronic matters that require frequent checkups. Virtual direct-to-consumer health-care delivery has been touted as a means to increase access, improve outcomes and lower costs, which satisfies value-based payment reforms. Yet, whether there are actual cost savings has been debated. While tele-health is cheaper than traditional doctor or hospital visits, more people may seek care because it is easier to use, driving up health-care costs, according to a recent study from the RAND Corp. Integrating these tools can also be costly," Kacik explains.

Nearly 20 percent of people in the poll said they were worried that the health-care provider would not be able to diagnose or treat them virtually and that they would have to go to a clinic anyway. Nearly 40 percent of parents surveyed said they had used virtual checkups for their children, Kacik writes. Nearly all of the patients who said they had used tele-health were younger than 50, while privately insured, higher-income patients were far more likely to use virtual visits than Medicaid or Medicare patients in lower-income brackets.

Where doctors have a high rate of privately insured patients who abuse painkillers, county-by-county

After analyzing hundreds of millions of commercial health insurance claims, researchers have found that diagnoses increased six-fold from 2012 to 2016, from 241,000 patients to 1.4 million, and have released a county-by-county map of areas in which doctors see the most patients for opioid use.

Map by Amino; click on it to view a larger version

Researchers for Amino, a healthcare data company that focuses on transparency, released their findings on Sunday, according to Sohan Murthy, a researcher for the company.

Murthy and others analyzed 205 million private health-insurance claims involving patients diagnosed with "opioid use disorder," a newly updated classification that considers severity of addiction and removes the distinction between "abuse" and "dependence," Murthy writes.

The team also looked at 808,000 Medicare Part D claims involving prescriptions of buprenorphine, a drug used to treat opioid use disorder, as well as data from the U.S. Centers for Disease Control and Prevention on overdose deaths related to opioids.

Map by Amino; click on it to view a larger version

The records examined were for patients with private insurance, a demonstration of how pervasive the opioid problem has become. "Opioid use isn’t just a problem for Medicaid—many of these 1.4 million patients are on health insurance plans sponsored by their employers," Murthy notes.

"In 2005, the CDC reported that 14,918 Americans died of drug overdoses related to opioids. In 2015, 33,091 opioid overdose deaths were recorded—more than double over 10 years. In fact, the New York Times recently estimated that overdose deaths involving all types of drugs likely exceeded 59,000 in 2016—the largest annual jump in overdose deaths ever recorded (there were 52,404 in 2015)," he writes.

Kentucky has nine of the top 10 counties nationwide for doctors who treat the highest volume of patients for opioid use disorder. New Mexico and Florida don't fare much better. New Mexico has one of the nation’s highest drug overdose rates and recently passed a law requiring all police officers to carry overdose kits. Albuquerque has been added to a growing list of cities receiving federal aid for its opioid and heroin crisis, Murthy reports. "Counties in Florida are similarly affected," he writes. "The state is home to Palm Beach County, sometimes referred to as the 'Recovery Capital of America.' Local officials estimate that the city of Delray Beach . . . (with only 67,000 residents) has more than 800 treatment facilities."

The problem with treating opioid use disorder, Murthy explains, is that it is complicated by the fact that it often goes hand-in-hand with other medical issues, such as hepatitis C, chronic pain, depression and alcoholism.

Wind farms and new transmission lines spark conflicts in rural Missouri, farmer-columnist writes

"The growth of wind farming in Missouri creates green energy and less dependence on out-of-state- coal. But the impacts of turbines and transmission lines may also spark neighbor-to-neighbor, farmer-to-government, and rural-to-urban tensions," the Daily Yonder says over farmer Richard Oswald's latest "Letter from Langdon," a town in northwest Missouri.

Signs near Osborne, Missouri, oppose wind-turbine farms. (Daily Yonder photo)

"Here on the edge of Langdon, I see loaded Burlington Northern Santa Fe coal cars heading south with an equal number of empties going back north night and day, a few hours apart round the clock," supplying rural electric cooperatives, Oswald writes. "As far as they’re concerned, it’s cheap as dirt. That’s why Missouri REC boards opposed Obama administration efforts toward more renewable energy and a reduction in the use of coal for electrical generation. But we have a growing number of wind farms in Missouri, some owned by foreign corporations. Modern wind turbines have almost doubled in size. Some can be as tall as 500 feet. Residents living nearby say they light up the house at night with red aviation avoidance lights. They say turbines are noisy, an eyesore, and destroy beneficial populations of bats and birds. Their huge 1,000-ton concrete bases buried deep in into the earth render that spot unusable for anything else – forever. But with more towers going up every day, leaseholders are becoming savvier and are negotiating stricter terms, like removal of both the tower and its base, and access roads, should the lease be terminated."

Such concerns extend far beyond wind-power sites, Oswald writes: "More wind turbines means more power transmission lines. As more wind towers go up, more lines materialize across rolling, treeless parts of rural Missouri. Farmers and property owners hosting those lines aren’t treated nearly as well as turbine leaseholders. Farmers hate power lines. That’s why being part of private industry instead of a public utility with right of eminent domain makes locating those power lines challenging."

Oswald notes that rural Missourians have successfully resisted the Grainbelt Express Line proposed by Cleanline, a private power-line company. "For now, in Missouri, the Cleanline project is on indefinite hold."

Trump's pro-coal policies don't include transition help for workers like Obama's anti-coal policy did

Coal towns suffering from changes in the energy market might get some help from President Trump's policies, but they are not going to get the transition help they were promised by then-President Obama, reports Nathan Rott of NPR.

Rott reports from Colstrip, Montana, where the two older units at the town's coal-fired electric plant (the second largest in the West) are being shut down in settlement of a lawsuit by environmental groups alleging that the plant "hadn't updated its technology to meet air quality requirements," Rott reports. "On top of that, the two biggest customers for Colstrip's power — Washington and Oregon — announced long-term commitments to get off coal."

Rex Rogers (NPR photo by Nathan Rott)

The units would have also been shut down under Obama's "Clean Power Plan," which Trump has scuttled. But the Obama plan also said it would "assist communities and workers that have been affected by job losses in coal mining, coal power plant operations, and coal-related supply chain industries due to the changing economics of America's energy sector," Rott notes.

Rex Rogers, business manager of the International Brotherhood of Electrical Workers at the plant, told Rott, "Even though we won the 'war on coal,' it doesn't appear that there was anything in that for the workers."

Rott reports, "Rogers' opinion of the Clean Power Plan is not widely shared in Colstrip. Most people in the town are happy to see it, and other Obama-era regulations on the coal industry, gone or on their way out.

"With Trump in there doing some of the things that he's doing to eliminate some of those needless regulations, I think it's going to make a positive impact here," Colstrip Mayor John Williams told Rott, who adds: "If nothing else, he says, it's nice to have a president who supports coal."

Horizontal hydraulic fracturing for oil is running into old-style oil wells and damaging them

A hydraulically fractured oil well near Stillwater, Oklahoma
(Photo by J. Pat Carter, Getty Images)

Supersized new oil wells are sometimes running into existing wells, a little-noticed consequence of the shale-oil boom that has triggered complaints and lawsuits, reports Erin Ailworth of The Wall Street Journal.

The emerging problem is known as a "frack hit," and it's popped up in Oklahoma, where a group of small oil and gas producers say more than 100 of their wells have been damaged by hydraulic-fracturing jobs done for larger companies, Ailworth reports.

"In hydraulic fracturing, or 'fracking,' firms pump sand and water deep underground at high pressure to break oil and gas from rock," Ailworth explains. "Some owners of older wells have filed reports with state regulators claiming their wells were flooded with water. In some cases, the wells became so full that the water rose to the surface and spilled over. Others have claimed that they had to shut in wells due to the damage. A few cases have ended up in court. While newer wells damaging older ones is a longstanding problem, the issue is gaining attention as shale companies employ new technologies to drill wells horizontally."

In Oklahoma, companies aren’t required to report frack hits unless there is a spill. "Regulators there have received fewer than 20 confirmed reports of such incidents in the last three years and are currently reviewing several more," Ailworth writes. "Oklahoma last month passed a bill that eases restrictions on where producers can drill horizontal wells more than a mile long. Vertical-well operators now worry their wells are more vulnerable than before."

Chad Warmington, president of the Oklahoma Oil & Gas Association, questioned allegations that hundreds of wells have been damaged. In some cases, he argued, frack hits can actually boost production from an affected well. "But given the potential for damage, the association supports making reporting frack hits mandatory, Mr. Warmington said, and would be open to having a mediation or arbitration process put in place. Some experts expect the situation will only get worse," Ailworth writes.

"We’ve got bigger fracks, so more chance of them reaching across, well-to-well," Jennifer Miskimins, an associate professor of petroleum engineering at the Colorado School of Mines, told Ailworth. "As we get closer and closer spacing, I think we’re going to see the occurrence go up."

Poll finds that rural Americans feel disrespected by the news media, more so than other citizens

A new poll finds that 60 percent of rural Americans think the news media respect them "only a little" or "not at all."

The Survey of Rural America, conducted by the Kaiser Family Foundation and The Washington Post, also found that "among those who answered this way and said they voted for president in 2016, 71 percent said they chose Donald Trump," Richard Prince notes in his "Journal-isms" column.

The feelings of disrespect were less among urbanites and subuirbanites, 51 and 52 percent, respectively. The poll also found that 54 percent of rural residents approve of the way Trump is doing his job. The survey results didn't surprise leaders of two news industry organizations Prince contatcted.

Stewart

Mizell Stewart III, vice president of the USA Today Network and president of the American Society of News Editors, told Prince, "I live in Ohio and work in and around Washington, so I literally spend time in both worlds. Because of that, the results of the study are not terribly surprising, particularly when people conflate ‘news media’ with national television networks, 24-hour news channels and major newspapers such as The New York Times and The Washington Post. The bubble in and around the Beltway is real, and it takes true effort to look at the world beyond the Northeast corridor and provide nuanced coverage of the attitudes of and the issues facing rural Americans."

Cavender

Mike Cavender, founder and executive director of the Radio Television Digital News Association, told Prince, "In some respects, they are positing a 'forgotten' mentality. They may feel that the media doesn’t see them or their views and concerns as important because of where they live or who they are. However, I believe that’s an ill-placed concern. I do believe, though, that media outlets need to do a better job in representing rural Americans' viewpoints by spending more time and resources in the areas of the country where they live. It is far too easy for editors, producers and news executives based in NYC and other major media centers to believe they are representing these divergent points of view from their urban bureaus rather than getting their staffs outside of the Beltway or the NYC corridor to do some actual on-the-ground reporting. We desperately need to improve in that arena . . . and Americans are making it clear we need to do so. Trump didn’t create the rural/urban divide . . . but he successfully exploited it and the media has been one of the primary targets of that exploitation."

Federal courts consider limiting remote access to records, a potential blow to rural journalism

Citing security fears surrounding an increase in deaths and threats to witnesses and informants, the federal judiciary has come up with new rules for sealing and sharing evidence, and is considering limiting remote access to court files, which would be a blow to rural journalists who live far from federal courthouses. The Public Access to Electronic Court Records system is widely used, even by urban reporters.

"Inmates determined to unmask a 'snitch' are . . . sophisticated, diving deep into court dockets and decoding sentencing motions filed by prosecutors for clues to who is talking. A proliferation of court records online on PACER . . . and smartphones have made it easier for criminal gangs to find files that could expose cooperators, according to judges and lawyers," reports Jacob Gershman of The Wall Street Journal.

U.S. District Judge Lewis Kaplan of Manhattan told the federal Judicial Conference’s criminal rules committee in April: "Anonymous remote public access to PACER is a source of much of the information that gets into prisons about who is cooperating." Federal inmates are can't access PACER themselves, but they can ask people outside the prison to search the online system and report the information back into the prison by phone, Gershman explains.

"Inmates also can ask courts for copies of their own sentencing files, and they often are pressured by other inmates to request the documents—known as paperwork—to prove they kept quiet, the judiciary survey found. In some prisons, according to judges, inmates are forcing other inmates to post the paperwork in their cells so others can come by and read them. At the moment, only the most confidential case files are treated as prison contraband, but inmates have been permitted to possess copies of other types of sensitive documents, such as sentencing minutes and plea agreements."

Close to 700 witnesses and informants believed to have cooperated with the authorities have been threatened, wounded or killed over the past three years; 61 of the murdered, according to estimates from a recent survey by the federal judiciary’s research arm.

Researchers: Corn better used as food than biofuel

Kumar and Richardson (University of Illinois photo)

Researchers at the University of Illinois have determined that the environmental costs of using corn as a biofuel rather than using it for food and animal feed are too high and the benefits are too low, perhaps even a net negative.

Praveen Kumar, a professor of civil and environmental engineering, and graduate student Meredith Richardson published the findings in the journal Earth's Future. "As part of a National Science Foundation project that is studying the environmental impact of agriculture in the U.S., the Illinois group introduced a comprehensive view of the agricultural system, called critical zone services, to analyze crops' impacts on the environment in monetary terms," a UI news release said.

To compare the energy efficiency and environmental impacts of corn as food vs. biofuel, the researchers inventoried the resources required for corn production and processing, then determined the economic and environmental impact of using these resources, all defined in terms of energy available and expended. They found that the net social and economic worth of food corn production in the U.S. is $1,492 per hectare (about 2.47 acres], versus a $10 per hectare loss from biofuel corn production.

"One of the key factors lies in the soil," Richardson said. The assessment considered both short- and long-term effects, like nutrients and carbon storage in the soil. "We found that most of the environmental impacts came from soil nutrient fluxes. Soil's role is often overlooked in this type of assessment, and viewing the landscape as a critical zone forces us to include that," Richardson said. 

"Using corn as a fuel source seems to be an easy path to renewable energy," said Richard Yuretich, the NSF program director for Critical Zone Observatories. "However, this research shows that the environmental costs are much greater, and the benefits fewer, than using corn for food."

Ranchers sue USDA to get labeling of meat imports

Photo via Morning Ag Clips

Cattle ranchers are suing the U.S. Department of Agriculture in federal court over relaxed regulations that allow foreign-produced meat to be sold in the U.S. without labeling its country of origin.

The lawsuit, filed in Spokane, Wash., seeks to reverse the USDA's March 2016 decision to loosen regulations that required imported meat products to be labeled with the country in which they were produced, Nicholas Geranios of The Associated Press reports. The lawsuit was brought by the Ranchers-Cattlemen Action Legal Fund, United Stockgrowers of America and the Cattle Producers of Washington.

"Consumers understandably want to know where their food comes from," David Muraskin, an attorney for the non-profit legal group Public Justice, which filed the lawsuit, told Geranios. "With this suit, we're fighting policies that put multinational corporations ahead of domestic producers and shroud the origins of our food supply in secrecy."

Geranios reports, "Between 2009 and 2016, the USDA required country-of-origin labeling on meat." The lawsuit says the 2016 change violated the Meat Inspection Act, "which required that slaughtered meat from other countries be clearly marked." Multinational corporations use the newly lax regulations "to import more beef from more foreign countries, including countries with questionable food safety practices," said Bill Bullard of United Stockgrowers. Current regulations allow corporations that import beef and pork and other products into the United States to label that meat "Product of USA," Geranios explains.

Beth Terrell of Public Justice, said the U.S. imports more than 800 million pounds of foreign beef each year. Without country-of-origin labeling, "domestic ranchers and farmers tend to receive lower prices for their meat because multinational companies can import meat and misleadingly present it as homegrown," a Public Justice news release said.

Foundation says 44 counties, so far, are at risk of having no Obamacare insurers in 2018

One reason many Republicans in Congress give for repealing and replacing "Obamacare" is that the health-insurance system created by the 2010 law is collapsing as companies withdraw from the marketplaces for federally subsidized insurance, threatening to leave many Americans unable to buy such policies. "The status quo is simply unsustainable," Senate Majority Leader Mitch McConnell said today.

That threat may be overstated, but more complete information is coming, according to research by the Kaiser Family Foundation. At the precipice of the June 21 deadline for insurers to submit rates for the marketplace, the foundation released a map that will continue to track counties at risk of having no health insurers that offer plans in the 2018 marketplace.

To date, only 44 counties are at risk of having no marketplace insurers, representing 31,268 estimated enrollees, according to a foundation news release. Those counties are a mix of metropolitan and rural counties throughout Ohio (from which insurer Anthem Inc. recently withdrew) and western Missouri, plus a rural county in southern Washington.

"Compiled from a foundation analysis of insurer filings and news reports, the map charts the counties at risk of having no insurers based on current public announcements, along with the name of the 2017 participating insurer and the number of enrollees in 2017," the release says. "The map also includes a tally of the number and share of counties at risk, and the number and share of enrollees that could be affected. . . . Foundation experts will continue updating the map until insurer participation in 2018 is finalized in the fall of 2017."

If a county has no marketplace insurer, consumers would not be able to purchase plans subsidized by federal tax credits and cost-sharing reductions. "Tax credits make coverage more affordable throughout the year by lowering consumers’ monthly premium costs; cost-sharing reductions help lower out-of-pocket costs," Kaiser explains. "In 2017, 8.7 million people (84 percent of all marketplace enrollees) received tax credits to cover a share of their premium and 5.9 million people (57 percent of all marketplace enrollees) received cost-sharing reductions."

Interactive map, tables show changes by state in health coverage and financing under Obamacare

Screenshot of interactive map shows partial data for Arizona; for a larger version,
click on the image. For the actual interactive map, click on the link below.

The Kaiser Family Foundation launched an interactive map Friday that provides a look at changes in health-insurance coverage and financing in each state under the Patient Protection and Affordable Care Act.

The ACA, enacted in 2010, increased enrollment in health insurance by financing expansion of Medicaid in states that chose to do so, offering tax credits for low- and middle-income people to buy private insurance, and reforming insurance-market rules. For example, it required insurance companies to cover people with pre-existing health conditions.

Users can scroll over each state to see a detailed breakdown of ACA-related data, as described by the foundation's Katie Smith:

• The number of people enrolled in plans in the ACA marketplace, the number of enrollees receiving advance premium tax credits to help them buy insurance, and the total amount of money in the form of such credits received by marketplace enrollees in the state.
• The number of enrollees in Medicaid, with a break out of the number of Medicaid expansion enrollees in the 31 expansion states and Washington D.C., as well as total federal Medicaid spending and Medicaid expansion spending in the state;
• The reduction in the number of people without health coverage in each state between 2013 and 2015, as well as the estimated number of people in the state with pre-existing health conditions.

"The map also shows the political party affiliations of U.S. senators in each state," Smith adds. "Replacement legislation under consideration in Congress has the potential to affect every state’s Medicaid program and individual health insurance market."

As ocean temperatures rise, species move north and fishery management isn't keeping up

Tropical rabbitfish

Oceans are warmer now than they have been since record-keeping began in 1880, which is forcing many aquatic species toward the poles, leaving fishermen with a choice: follow the schools or pursue a different species.

As water temperatures have spiked along the East Coast, the Atlantic Ocean’s inhabitants have undergone a dramatic rearrangement, Ben Goldfarb reports for Yale Environment 360.

"According to an analysis by researchers at Rutgers University, black sea bass, once most abundant off the coast of North Carolina, have shifted two degrees of latitude north, to New Jersey, over the last half-century. Lobsters have all but vanished from Long Island Sound — where rising temperatures have made the crustaceans more susceptible to disease — and, at least for now, proliferated in the Gulf of Maine. Butterfish have supplanted herring in the Gulf, with disastrous consequences for baby puffins, which struggle to swallow the disc-shaped interlopers and starve to death. Even blue crabs, the invertebrate icon of Chesapeake and Delaware bays, have arrived in the Gulf of Maine," Goldfarb writes.

Some agencies and fishing communities have also begun considering the future of seafood. In 2016, National Oceanic and Atmospheric Administration scientists found that around half the Northeast’s fish and shellfish were highly vulnerable to climate change, especially species like shad, salmon and sturgeon, which spend part of their lives in freshwater and must contend with changing conditions in rivers as well as oceans, Goldfarb explains. "A parallel NOAA study suggested that ports whose economic fates are hitched to vulnerable species — like New Bedford, Mass., which depends on scallops for around 80 percent of its landings — face particular risk, while towns like Point Judith, R.I., whose fishermen catch the gamut from squid to monkfish to lobster, could fare better."

As fishermen are left to decide whether to follow the cash or pursue a different species, either way, Goldfarb says that larger-scale fishermen have an advantage, "spelling further trouble for beleaguered 'day boats' whose captains are already burdened by overfishing, stringent regulations, and industry consolidation."

Tom Nies, chairman of the New England Fishery Management Council, warns that small-scale fishermen will have more difficulty adapting to climate change, "because they have less ability to go longer distances, they can carry fewer fish, and they may have less familiarity with fish species in another area."

Regulators have begun incorporating climate change into their decision-making, Goldfarb explains. In 2014, NOAA used water-temperature data to set catch limits for butterfish. But Nies says such case studies have been "few and far between," and most regulations remain rigid. "As summer flounder, black sea bass, and other species migrate north, catch allocations have been slow to follow," Goldfarb writes. "Fishermen in North Carolina hold the highest black-sea-bass quota, for instance, even though the fishery has crept into New England. The absurd upshot is that North Carolinians must motor north for 10 hours to catch their share, while New Englanders often have to discard bass."

In a 2016 letter to the inspector general of the U.S. Department of Commerce, which oversees NOAA, U.S. Senators Chris Murphy and Richard Blumenthal of Connecticut warned, "The impacts of a changing climate will be far more severe if the data used — and regulation that follows — fails to keep pace with environmental changes."

Pa. and Md. districts among those awaiting Supreme Court ruling on gerrymandering

As the U.S. Supreme Court prepares to hear the Wisconsin case challenging the constitutionality of politically gerrymandered voting districts, other legal battles over redistricting continue, reports Michael Cooper of The New York Times.

Redistricting is "the once-a-decade process of drawing new election districts to reflect population changes — an event typically seized on by whichever party is in power to draw maps that favor its incumbents," Cooper notes. The Supreme Court has never struck down a voting map on the grounds that it benefited one political party over another, but the Wisconsin case offers a formula that courts could use to measure partisan skew. Here are some other states with election maps before the courts:

Pennsylvania's 7th Congressional District
(New York Times map)

Pennsylvania's 7th Congressional District:
"A Rorschach-test inkblot of a district that has been likened to 'Goofy Kicking Donald Duck,' this district meanders through five counties and is so narrow in parts that it is only the width of a restaurant in King of Prussia and of an endoscopy center in Coatesville, according to a lawsuit filed by voting rights activists last week," Cooper writes. "The suit, filed in state court, contends that Republican lawmakers crossed a line when they redrew congressional boundaries in 2011, creating a map that helped Republicans win control of 13 of the state’s 18 districts even though registered Democrats outnumber Republicans in the state."

Maryland's 6th Congressional District
(New York Times map)

Maryland's 6th Congressional District:
"Democrats in Maryland drew plenty of crazily shaped districts to help their party in 2011 — its Third District has been likened to a 'praying mantis' — but a federal lawsuit challenging the state’s last round of redistricting is focused on one: the Sixth District, which yoked Democratic voters from the Washington suburbs to Republican voters in the rural west of the state," Cooper explains. Michael Kimberly, the lawyer bringing the suit, said he had been watching the Wisconsin case. However, Kimberly said his suit was taking a somewhat different approach, arguing that the new Maryland map violated the First Amendment rights of voters.

"Several election lawyers said it was unclear how far-reaching a Supreme Court ruling in the Wisconsin case might be, given that other election maps are being challenged at federal and state levels using different legal arguments," Cooper notes.

Here's a simple explanation (the last example) of how gerrymandering can be used to give advantage to a party that doesn't deserve it. Click on the graphic to view a larger version.

How to defend journalism: calmly, factually and respectfully; Walla Walla paper sees dividends

In a challenging environment with fewer resources, greater vulnerabilities and increasing attacks from politicians and the politically motivated, how should news organizations respond? One editor-publisher's approach — a calm, respectful but strong defense of journalism and its essential role in democracy — seems to work.

Brian Hunt

Brian Hunt, editor and publisher of the Walla Walla Union-Bulletin, gave a speech at the southeast Washington city's library April 27 and boiled it down to a 2,400-word column in the May 7 edition, headlined "Community journalism in the era of fake news." He laid the ground work by explaining how the media environment, the news business and the journalism have changed. Here are some excerpts:

"Truth matters less today than reach. The largest information companies in the world today depend upon their ability to get advertising in front of our eyeballs. The content that wraps around these ads doesn’t need to be true, it just needs to be able to entice us to click. . . . Facebook and Google succeed by collecting and selling very sophisticated user information about what we like, what we don’t like, what we open, what we ignore. They know what persuades us as individuals and they can easily help us sort ourselves into very small groups of like-minded groups. What could go wrong?"

"We all gravitate to information that feels like it fits our perspective. It’s human nature. . . . As journalists, we are trained in critical thinking. In looking at all sides of an issue. In separating our personal feelings from the work of telling true and balanced stories that enable readers to make up their own mind. The rise of objective journalism had a dramatic impact on the news media – and in our world. The advent of the advertiser-funded internet particularly, and the scale at which broadcast news outlets proliferated and extended themselves, is a new wild west of information dissemination. So how do we navigate the vast amounts of information we encounter to ensure that what we read and what we share are true?" Hunt recommends the "Stop, Search, Subscribe" motto of the News Media Alliance, formerly the Newspaper Association of America, but acknowledges, "What is true or false may not be as enticing as "our desire to believe in something shared."

This sign once promoted Donald Trump.
(Photo from Walla Walla Union-Bulletin)

He gives examples: "The president of the United States declares the press the enemy of the people. In our valley, we drive by billboards that vilify our reporters and editors. Fake news accusations are now common for stories that don’t suit a particular audience, true or not. We’re increasingly intolerant about information we don’t like, for sides of the argument that disagree with our side. For community newspapers such as the U-B, this loss of collective understanding and tolerance threatens the very sense of a shared and diverse community."

After Donald Trump was elected, "I began hearing from readers who seemed confused about what was published as a news story and what was published as a personal opinion column or an editorial. Definitions that newspapers have relied on for decades are suddenly not widely understood," Hunt writes. "This became a small wave of complaints that national political coverage in the U-B did not match reader expectations — they knew things we didn’t include, and they often disbelieved what we did include."

Hunt gives examples of the extreme without being judgmental: "I’ve been challenged on why we include people of color in our newspaper. I’ve heard from readers who question why, when two-thirds of our region voted for Trump, the U-B would ever publish anything remotely critical of his presidency. I learn things in these conversations. Most notably, the people I speak with are not unaccomplished, not unintelligent, not uncaring.  We know these people. You know these people. Fake news and the isolated intolerance that can feed it gets to us all."

In an email, Hunt told The Rural Blog, "I have to believe many rural papers are in the same boat." He said reaction to his column "has, for the most part, been positive/understanding, with a fair amount of surprise around the idea that the bitterness and intolerance of our national politics does indeed have real local impact: 'Not in our Walla Walla,' etc. This may in part be because I've got my own bubble. More importantly, it's just much easier to get angry in the abstract at the person across the table from you."

But Hunt has objective, empirical yardsticks — the number of reader gripes and reasons they give for canceling subscriptions — that strongly suggests his column had a positive impact: "We've also seen a dramatic slow-down in complaints/stops based on the perception that we're too liberal. (I spoke to one last week who called to tell me they were upset because we made too many excuses for Trump's behavior -- a first from that perspective.) Stories that are perceived to reflect on Trump as a person seem to generate the most outcry. The policy actions, health care debate, etc. have not."

The Union-Bulletin has a daily circulation of 16,000 and is owned by The Seattle Times, which is owned by the family of Frank Blethen, a tenacious defender of local ownership of newspapers and public-service journalism.

New Interior secretary reassigns dozens of career officials, in an unprecedented shakeup

Ryan Zinke (Washington Post photo)

Interior Secretary Ryan Zinke, a former Montana congressman, is reassigning dozens of longtime officials, a shakeup unprecedented in size, report Juliet Eilperin and Lisa Rein of The Washington Post.

The shuffle of career employees in the federal government's Senior Executive Service personnel classification appears to be the start of a broad reorganization of the department, which manages one-fifth of all land in the U.S. A politically appointed official can reassign those with the SES classification only after he or she has been in office 120 days, and that date for Zinke is June 28. "But the letters that three dozen or more Interior officials got Thursday night . . . provides them with 15 days notice of their job change," Eilperin and Rein write. "The notice means their reassignments could take place at the earliest date that is legally permissible. An official with the Senior Executives Association, which represents 6,000 of the government’s top leaders, said the reassignments at Interior could involve as many as 50 people."

The reassignments come just two weeks before federal agencies are to submit initial plans to the White House showing how they can streamline operations and save money. "The exact number of Interior letters sent was not immediately clear Friday, but the push appears much broader than what Republican and Democratic administrations have pursued in the past," Eilperin and Rein report. "Administrations usually wait until the Senate has confirmed appointees that oversee individual agencies within a department; at this point, Zinke remains Interior’s only Senate-confirmed appointee."

Some officials who received notices include the Interior’s top climate policy official, Joel Clement, and at least five senior officials of the Fish and Wildlife Service, nearly a quarter of that agency’s career SES staff, the authors note. "Among the Fish and Wildlife officials are the assistant director for international affairs, Bryan Arroyo; the Southwest regional director, Benjamin Tuggle; and the Southeast regional director, Cindy Dohner." Dan Ashe, who ran the Fish and Wildlife Service under the Obama administration and worked for the agency for more than two decades, told the Post that he has watched every presidential transition since Ronald Reagan took over for Jimmy Carter in 1981, and described the move as "unprecedented."

Supreme Court to hear case on constitutionality of districts drawn for partisan advantage

The Supreme Court said Monday that it will consider whether gerrymandered election maps favoring one political party over another are constitutional. The decision could potentially create a fundamental change in the way American elections are conducted, reports Robert Barnes of The Washington Post .

"The justices regularly are called to invalidate state electoral maps that have been illegally drawn to reduce the influence of racial minorities by depressing the impact of their votes," Barnes reports. "But the Supreme Court has never found a plan unconstitutional because of partisan gerrymandering. If it does, it would have a revolutionary impact on the reapportionment that comes after the 2020 election and could come at the expense of Republicans, who control the process in the majority of states."

The difference in this case is that political scientists came up with a formula to calculate just how much partisan advantage had skewed the ideally neutral redistricting of the legislature in Wisconsin. A panel of federal judges ruled 2-1 last year that Republican leader pushed through a plan in 2011 so partisan that it violated the Constitution, Barnes writes. The case will be briefed and argued in the judicial term that begins in October.

In the election after adoption of the new maps, Republicans got less than 49 percent of the statewide vote, but captured a 60-to-39 seat advantage in the State Assembly. "The threat of partisan gerrymandering isn’t a Democratic or Republican issue; it’s an issue for all American voters," said Trevor Potter, president of the Campaign Legal Center, and former Republican chairman of the Federal Election Commission. "Across the country, we’re witnessing legislators of both parties seizing power from voters in order to advance their purely partisan purposes. We’re confident that when the justices see how pervasive and damaging this practice has become, the Supreme Court will adopt a clear legal standard that will ensure our democracy functions as it should."

Barnes explains, "The Supreme Court has been reluctant to tackle partisan gerrymandering and sort through arguments about whether an electoral system is rigged or, instead, a party’s political advantage is because of changing attitudes and demographics, as Wisconsin Republicans contend."

Tenn. town known for 1925 'Monkey Trial' finds economic boost in bass fishing tournaments

Fishing on Chickamauga Lake (CBS News image)

A small town whose tourism for nearly the past century has focused around being the site of the John Scopes "Monkey Trial" over evolution in 1925 has turned to bass fishing tournaments for a recent boost in tourism dollars. And it may have helped land a factory.

When anglers compete for the biggest bass in the Tennessee Valley Authority's Chickamauga Lake, Dayton, Tenn., is cashing in, Dennis Tumlin, head of the Rhea County Economic & Tourism Council, told CBS News' Dana Jacobson. "Our statistics show us that about $14 million came into town last year," Tumlin said. That's a big deal for the southeastern Tennessee town of 7,200.

The boost comes at a crucial time for Dayton, which CBS calls one of the more economically depressed areas of Tennessee, based on statistics that include poverty rate, household income and unemployment. "When Mayor [Gary] Louallen was elected four years ago, he had a plan to turn around Dayton's economy," Jacobson reports. Louallen said went to the council and said, "Guys, if you'll just trust me and run with me on this, fishing could really make it good for us."

Dayton, Tennessee (Yahoo map)

Louallen's idea paid off. Dayton sits on an arm of Chickamauga Lake, a Tennessee River impoundment that offers some of the best bass fishing in the South, Jacobson says: "According to Tumlin, the average angler spends $1,100 in a week. One recent tournament brought in 400 anglers, and "We've been averaging 30 events per year for the last three years." That means "the local service industry has been booming," Jacobson reports.

Mary Helen Sprecher, managing editor of Sports Destination Management, a sports-tourism magazine, says you don't need to host the Olympics to become a sports-tourism destination. "She points to events like the Fat Tire Bike Race in Cable, Wisconsin; the American Birkebeiner Ski Race in nearby Hayward, Wis.; and especially the Pickleball Tournament in Naples, Florida, as success stories," Jacobson writes. "One event could have a $1.5-million economic impact, Sprecher said."

But Tumlin says the fishing tournaments are just one step toward a larger goal. "We're chasing industry as hard as we're chasing tourism," he said. "If you're an industry CEO, you're looking for quality of life. So, when you come here, we want you to feel energy, and feel a great community. And we believe it will yield great results." Days after Jacobson visited, "Tumlin announced Dayton had reeled in a really big fish: A Finnish company, Nokia Tyres, announced a $360 million investment in a new plant in the town, along with the promise of 400 new jobs," Jaconson reports."For a small town, that is a great catch."