Rural hospitals alarmed at Graham-Cassidy bill; interactive map shows Medicaid impact by county

UPDATE, 2:08 p.m.: Arizona Sen. John McCain announced that he would vote against the Graham-Cassidy bill, dealing it "a potentially decisive blow," The Washington Post reports. That puts the focus on Alaska Sen. Lisa Murkowski and Maine Sen. Susan Collins, the other Republicans who voted against the last bill, and Sen. Rand Paul of Kentucky, who voted for it but says he will oppose this one.

"Leaders of cash-strapped rural hospitals worry that the latest proposal to repeal and replace the Affordable Care Act could destroy them," Dave Barkholz reports for Modern Healthcare. Many rural hospitals are already on the ropes. "Of the nation's 1,160 rural hospitals, 41 percent are operating at a financial loss. Eighty-two have already closed since 2010. And one in three of the survivors is considered at risk of closing," Barkholz reports.

"If you want to watch a rural community die, kill its hospital," Lauren Weber and Andy Miller report for the Huffington Post from three counties in rural Georgia that are struggling to keep their hospitals alive. Georgia is one of the 15 states that did not expand Medicaid under the ACA, which has generally boosted rural hospitals elsewhere. The bill would end the Medicaid expansion in 2020. Because rural areas have far higher rates of Medicaid patients, rural hospitals would be disproportionately hurt and many might have to close. The Daily Yonder reports on an analysis of that by Headwaters Economics, which includes an interactive map showing how much of each county's personal income is Medicaid benefits. Here's a screenshot of the version showing counties at 10 percent or more (click image for larger version):

The bill also doesn't address the federal cost-sharing subsidies that help insurers offer cheaper plans for people with low incomes. President Trump has threatened to withhold those payments, sparking concern -- and withdrawal from rural markets -- by many insurers. Maggie Elehwany, vice president of governmental affairs at the National Rural Health Association, said that rural hospitals would be hit especially hard by legislation that "increases the uninsured, boosts deductibles for patients or threatens already shrinking Medicare payments."

Under the Graham-Cassidy bill, the individual and employer insurance mandates would be repealed, states would be given more leeway to change rules, and nearly $1.2 trillion in ACA subsidies would be distributed to states through block grants. "If state block grants end up cutting funding to health care, patients who can afford insurance may end up with higher deductibles, leaving hospitals struggling to collect payments," said Megan Neuberger, team head for health care at Fitch U.S. Corporate Ratings.

EPA inspector general says agency has failed for 11 years to set standards on animal feeding operations

Photo of large cattle feedlot from MeetingLunch.WordPress.com

Arthur Elkins, the Environmental Protection Agency's auditor general, just released a report slamming the agency for not keeping tabs on emissions from large-scale animal feedlots, as it promised to do 11 years ago. EPA was supposed to publish reliable methods of estimating pollutants from feedlots, but didn't. Without that yardstick, feedlots can't provide meaningful data on their output of ammonia and other pollutants. And because the EPA doesn't have that data, it can't decide whether to put pollution controls in place or report the feedlots to emergency responders if the pollution is an immediate threat.

"Until EPA officials finish work on the estimating methods, they are refusing to act on citizen petitions to regulate emissions from animal feeding operations . . . on the grounds that the methods "are needed to inform the agency's decision-making," the report said," Sean Reilly reports for Environment & Energy News. Meanwhile, pollution has continued during the administrations of George W. Bush, Barack Obama and Donald Trump, and the acronym for animal feeding operations has evolved to "AFOs," dropping the "C" that stands for "confined" or "concentrated."

Large feedlots can generate air pollution from decaying manure and animal feed, but figuring out a straightforward way to measure that pollution can be tricky. EPA said in 2005 that it would use data from an industry-funded study to develop methods to estimate emissions. The agency was hoping to publish the methods in 2009, but the timetable was "wildly optimistic," Reilly writes. "The industry monitoring study took two years longer than originally expected; EPA had also not accounted for the time needed to get approval from an in-house board for agreements to protect individual producers from lawsuits or other enforcement actions for alleged violations until the new system was in place. Yet another hang-up emerged when EPA's Science Advisory Board, a body of independent experts, found in 2013 that a draft version of the estimating methods for some pollutants and sources wouldn't provide an accurate gauge of overall emissions. The board urged more work. Since then, the entire enterprise has essentially been dead in the water, the inspector general's report suggested."

Lack of inertia and the retirement of key members of the project means the effort has also suffered from lack of expertise in "agricultural emissions, air quality and statistical analysis," the report said. Acting EPA air chief Sarah Dunham said she agreed with the report and said the agency plans to announce in the spring a schedule for issuing the new estimating methods.

Rural Mainstreet Index at lowest level since Dec. 2016; half of bankers have restructured farm loans

The latest monthly Rural Mainstreet Index indicates a drop in the financial situations of farmers in a 10-state region where agriculture and energy are critical to the economy, "sinking to the lowest level since December 2016," AgWeb reports. "The index remained below growth neutral, a sign that shows financial pressure continues to prevail on farms and ranches." The RMI is calculated by Omaha's Creighton University by surveying rural bank CEOs in Colorado, Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, Wyoming and the Dakotas.; more than half of the bankers reported that they have restructured farmers' loans.

Creighton University graphic; click on it to view a larger version.

The 2017 corn crop looks to have the third-highest yield ever at 170 bushels per acre, but drought is sapping yields of other crops. Scarcity often drives up prices, but that's not happening this time due to a ready supply of commodities on the global market. That is keeping American farmers from rallying, said Ernie Goss, who does the RMI: "A lot of farmers have grain in the bins. If prices go up, you get some unloading that sort of limits any growth until we get rid of that old-crop corn." A weakened dollar could help American crops look more attractive to international buyers in the long run, but for now farmers are still struggling.

Creighton University graphic; click on it to view a larger version.

The financial stress is reflected in the RMI's figures on farm loans: "51.2 percent of bank CEOs reported restructuring farm loans; 18.6 percent of that same group also indicated they had to increase collateral requirements," AgWeb notes. Farm loan delinquencies are up 4.1 percent too. The good news is that despite four straight years of declining farm income, farm loan defaults only increased 2.1 percent this past year.

Broadcast meteorologists can play a big role in educating the public about climate change

Hurricane Harvey, from International Space Station. (Photo by Randy Bresnik, NASA)

A broad consensus of scientists agree that the extreme weather of recent years--hurricanes, flooding, heat waves and wildfires--is somehow related to climate change, but broadcast meteorologists are often reluctant to talk about it on the air, and some are outright skeptical of the science. "The reasons are complicated, ranging from what meteorologists are taught in college to not wanting to upset their viewers. But they are increasingly changing. I’ve spoken to many former colleagues who want to start having these conversations on air and doing what they can to inform the public about the issue," Sean Sublette writes for Vox.

Sublette writes that he worked for 19 years as a TV weathernan in the Roanoke-Lynchburg, Va., market, and became more and more concerned about climate change as he learned more about it. In 2013, when he was chief meteorologist at the local ABC affiliate, he decided it was time to "speak up about how our planet was changing. This was science, not policy," he writes. He worried that his audience might not want to hear it, but he believed it was important. So, one evening he discussed recent scientific findings about the rising average global temperature and sea levels, and said that they were primarily a result of greenhouse gases from burning fossil fuels. He posted a blog item sharing the same facts. Then he sat back and waited for the storm. To his surprise, it never came. "No hate mail came; no fussing from my news managers ensued," he writes. He received one comment on his blog post that said, "I don't really like the news, but people need to hear it." He still had to be careful not to go too far to repel his conservative viewers, but he began more confidently including facts about climate change in his broadcasts.

That experience helped him realize other meteorologists might need help talking about climate change on the air. They're in a unique position of influence: "For much of the public, meteorologists are the only scientists people see on a daily basis, so they have a unique position in the media landscape. Talking about climate change from that position could make a real difference in how the public discusses climate change and its solutions. It’s something we increasingly have a responsibility to do," Sublette writes. These days he works for the nonprofit Climate Central's Climate Matters program, which helps broadcast meteorologists talk about climate change with the public.

As the public continues to ask questions and learn about climate change, Sublette says he hopes weathercasters will keep talking about it. "Broadcast meteorologists are some of the most qualified people in the media to discuss the subject and are the liaison between the public and the research-based scientific community. Increasingly they are stepping up, and we hope to see it continue."

Quick hits: Smarter rural narrative needed; a vision for rural prosperity; FCC chair talks broadband . . .

Here's a roundup of stories with rural resonance; if you do or see similar work that should be shared on The Rural Blog, email The Rural Blog at heather.chapman@uky.edu.

The Washington Post's Chris Ingraham says the recent narrative about rural America is dominated by despair, but raw data doesn't tell us everything, and we need to take a smarter and more nuanced look at rural life. He should know: in early 2016 Ingraham moved to Red Lake Falls, Minn., pop. 4,057, after an "intense and exceedingly polite" backlash to the story he wrote about how it was the worst place in America to live. Suffice it to say, he's changed his mind on that point.

The mayor of Charles City, Iowa, shares a detailed vision for rural prosperity in The Des Moines Register. Among his ideas are eliminating unfunded mandates, develop a universal preschool program and make day care affordable, and better meet the needs of senior citizens. 

Federal Communications Commission Chair Ajit Pai in West Plains, Mo., joined a roundtable about bringing broadband service to rural areas, the West Plains Daily reports. Pai, who grew up in rural Parsons, Kan., says he believes loosening federal regulations is the key to making widespread rural broadband a reality.

Two Knoxville nurse practitioners tell NPR's StoryCorps about how they established one of the first treatment protocols in the nation for babies born addicted to opioids. They also established a program that connects opioid-addicted mothers with treatment and therapy.

Charts predict how your state's federal health-care funding would change under last-ditch repeal plan

How would your state fare under Senate Republicans' last-ditch bill to repeal the Patient Protection and Affordable Care Act, which could pass Congress next week? The Kaiser Family Foundation has some figures, and so does The New York Times. UPDATE, Sept. 21: The Trump administration released its state-by-state estimates. "The predicted loss is less than that forecast by three independent analyses of the bill’s impact in recent days, but the internal numbers show a similar checkerboard of states that would be big winners and equally big losers," The Washington Post reports.

Kaiser says in a Sept. 20 report that the Graham-Cassidy proposal would:

• Repeal the Medicaid expansion and subsidies for individual insurance—including premium tax credits, cost-sharing reductions, and the basic health program—in 2020.
• Put the money into a new block-grant program to states in 2020-26. States could use the funds "to cover the cost of high-risk patients, assist individuals with premiums and cost-sharing, pay directly for health care services, or provide health insurance to a limited extent to people eligible for Medicaid," Kaiser reports.
• Cap state-by-state federal funding of the traditional Medicaid program for the poor and disabled.
• Repeal the mandates requiring individuals to have health insurance and employers to offer it, and let states waive required benefits and community rating, which prevents insurers from charging higher premiums to people with pre-existing conditions.

The changes would reward the 15 states, controlled by Republicans, that did not expand Medicaid to people in households with incomes up to 138 percent of the federal poverty threshold. Kaiser explains the complex formula and reduces its effect to a simple chart:

State by state, Kaiser defines the extremes: "Five states would see a reduction in federal funds of 30% or more from 2020 to 2026: New York (-35%), Oregon (-32%), Connecticut (-31%), Vermont (-31%), and Minnesota (-30%). Six states would see at least 40% more in federal funds under the proposal: Tennessee (44%), South Dakota (45%), Georgia (46%), Kansas (61%), Texas (75%), and Mississippi (148%). . . . Because actual state allotments under the block grant may vary based on state-specific factors and the secretary’s authority to further adjust the formula, actual state experiences under the block grant may differ. It is uncertain how additional adjustments would be used to alter states’ allotments up or down."

Kaiser's report has three state-by-state tables, showing the projected differences in federal spending for ACA coverage, the total change in federal spending due to the block-grant program and the limit on Medicaid; and the projected loss of federal funds due to those factors.

The New York Times showed the funding changes per person, in charts that were color-coded: first by states that expanded Medicaid (in green), then by states (in orange) with senators who voted against one of the Obamacare repeal bills in July:

How Wisconsonites (and probably people in other states) commute across the rural-urban spectrum

We're used to thinking about populations as either rural or urban, or, if pressed, suburban and small-town too. But new research from the University of Wisconsin Applied Population Laboratory examines how seven types of communities on the rural-urban continuum are connected by the people who commute from one to the other for work. "Every day, many residents of big cities, small towns and the countryside alike travel between their homes and workplaces, sometimes within their own community, and other times traveling over long distances to places that are far apart. Their commuting patterns can help shed light on the ways these places are alike and distinct in terms of their economies and identities," Malia Jones reports for WisContext, a multimedia news and information project funded by the university. The patterns found in Wisconsin are likely echoed in other states as well.

Deciding whether a community is rural or urban can be complicated, so the Applied Population Lab used the Department of Agriculture's Rural-Urban Commuting Area Codes, which divide populations into seven categories along the rural-urban spectrum, based on census data. The results of the research can be seen on this breathtaking chord diagram (click here to use the interactive version):

Static image of interactive map by Caitlin McKown of WisContext
Click on the image to enlarge it; click here for the interactive version.

Most commuters are heading for cities, which is unsurprising, but is interesting to see quantified. And it has broader implications: "People who live in one place but work in another routinely access goods and services and make social connections across both. For example, commuters from isolated rural places may not have access to a grocery store near their home, but may have better access to one near their place of work. The lack of reliable grocery stores in sparsely settled areas is a type of food desert. This problem arises in part because many grocery stores depend on a large number of customers, which can be hard to attract in rural places where there are fewer people per square mile. For commuters from rural places, shopping at a market near work not only offers improved food options, but also creates an economic bond across places as these businesses depend on far-flung customers for their revenue," Jones reports.

Probe finds postal workers delayed lots of mail, then badly under-reported the delays

Weekly newspaper publishers have noticed that deliveries outside their home counties have slowed. Now an investigation by the Postal Service's Office of Inspector General found that postal workers deliberately slowed the delivery of more than 2 billion mailed items in the year studied. It said workers also manipulated delivery records and inaccurately reported delays.

The eight processing facilities examined "had about 1.8 million late arriving mailpieces during the week of our observations; however, the facilities only included 121,000 of them (or less than 7 percent)" in their mail-condition reports, the OIG said in the report. The centers were chosen "based on changes in their delayed mail reported" from fiscal year 2014 to 2016: Brooklyn, Dallas, Greenville, S.C.; Louisville; Mobile; Omaha; Southern Maryland; and South Suburban, a Chicago center.

Some employees said they delayed mail so workers on a slow shift would have something to do. "Investigators discovered more than 572,000 delayed mail items on land. However, postal officials were only reporting 369,000 delays, essentially hiding 36 percent of the problem," Larry Mayer reports for The Billings Gazette.

The Postal Service has struggled in recent years, with mail volume decreasing as online activity increases. And Congress has required it to set aside $5.5 billion a year to pre-fund health benefits for future employees, resulting in cuts to staffing and service. "USPS is the only government agency expected to pay for benefits decades in advance, and the cost burden has resulted in cuts to staffing and service," Mayer reports. That can mean even slower delivery times for mail, especially in rural areas.

The day the report was released, Sen. John Tester, D-Mont., called for those responsible to be fired. Tester is on the Homeland Security and Government Affairs committees, which handle Postal Service issues. "Any employee who deliberately delayed mail delivery, or who knowingly misreported mail delivery should be terminated for violating the trust of America’s hardworking taxpayers and postal ratepayers," he said.

Wireless or a hybrid with fiber-optic cable may help solve the rural broadband problem

Bringing high-speed internet service to people in far-flung rural areas is an ongoing problem, but a rural Minnesota county may have an interesting solution: a hybrid model that combines fiber-optic cables with wireless. And some wireless internet providers are already helping bridge the rural-urban broadband gap.

The problem is mainly the cost of laying the fiber. Telecommunications companies can lay a main line to a community, but rural counties can't usually afford to lay individual lines to homes that may be miles apart from the nearest neighbors. State and federal grants can help, but only go so far. This "last mile" problem is the kicker.

In Minnesota's Yellow Medicine County, a recent study estimated that laying fiber to 1,862 rural homes would cost $22 million. But Finley Engineering, which conducted the study, said using a wireless and fiber hybrid would cost only $5 million. "The hybrid proposal in Yellow Medicine County calls for laying a 52-mile fiber optic line to serve as a backbone to connect a string of towers to cover the rural areas. That compares to the 955 miles of fiber optic cable needed for a fiber-only option," Tom Cherveny reports for West Central Tribune in Willmar, Minn.

Would wireless internet in Yellow Medicine be as fast as broadband? Maybe, says Dan Richter, president of area provider MVTV Wireless. But he says providers in the region are improving internet speeds as economic conditions allow, Cherveny reports. Richter says MVTV will urge a county-appointed task force to consider the hybrid model as a solution.

Craig Settles reports for The Daily Yonder that more than 3,000 wireless internet service providers use fixed wireless technology, in which transmitters boost and relay data back and forth from homes to a fiber-optic source. "Each one [is] usually run by a handful of people who do everything: engineering design, hanging routers, marketing, customer service, and tech support. Some WISPs are integrating fiber technology into hybrid systems that use both wireless and wired communications technology," Settles reports. And though the speed provided by WISPs isn't as fast as cable broadband, it's probably plenty fast enough for most families, according to Jimmy Carr, CEO of fixed wireless company All Points Broadband.

Webinar next Tuesday will showcase new toolkit for rural tobacco control and prevention

Tune in for a free webinar from 2-3 p.m. ET on Sept. 26 to discuss the new Rural Tobacco Control and Prevention Toolkit, just released by the Federal Office of Rural Health Policy. The toolkit provides "evidence-based examples, promising models, best practices, and resources" that rural organizations can use to implement smoking cessation and prevention program. Such programs are important because rural Americans are more likely to get--and die from--cancers related to tobacco use.

The webinar is presented by the Rural Health Information Hub and a research organization at the University of Chicago, which developed the toolkit for the government. A recording will be available on the website afterward. Click here to learn more or register.

First dataset from all states shows veterans' suicides are highest in the West and rural areas

Chart based on partial report issued in 2012
(Click on the image to view a larger version)

Military veterans living in the Western U.S. and rural America are much more likely to die by suicide, possibly because of contributing factors like social isolation, gun ownership, opioid addiction and access to health care, according to the first 50-state Department of Veterans Affairs data on suicide, Hope Yen reports for ABC News: "It shows Montana, Utah, Nevada and New Mexico had the highest rates of veteran suicide as of 2014, the most current VA data available. Veterans in big chunks of those states must drive 70 miles or more to reach the nearest VA medical center." West Virginia, Oklahoma and Kentucky have high suicide rates as well as higher rates of opioid prescriptions.

The study also breaks down gender and age disparities: female veterans are two and a half times more likely to die by suicide than their civilian counterparts. Male veterans are 19 percent more likely. Veterans 50 or older account for about 65 percent of veteran suicides.

The problem is nationwide. Rajeev Ramchard, an epidemiologist who studies suicide for the RAND Corp, told Yen that veterans in every state are at least one and a half times more likely to die by suicide than the general population. He pointed out that 70 percent of veterans who take their lives had not been connected to VA health care. "These findings are deeply concerning, which is why I made suicide prevention my top clinical priority," VA Secretary David Shulkin told ABC. "This is a national public health issue."

"Shulkin, who has worked to provide same-day mental health care at VA medical centers, recently expanded emergency mental care to veterans with other than honorable discharges," Yen reports. "The department is also boosting its suicide hotline and expanding telehealth options." Expanding private-sector care and stemming veterans' suicide are priorities of President Trump. In a statement this week as part of Suicide Prevention Month, he said the U.S. 'must do more' to help mentally troubled veterans.

Mississippi journalists accept reporting awards

Discussing the work that won them the Bill Minor Prize with moderator Rick Cleveland (from left) are Jerry Mitchell of The (Jackson) Clarion-Ledger, Ray Mosby and Natalie Perkins of the Deer Creek Pilot, Jamie Patterson of The Yazoo Herald and Tim Kalich of The Greenwood Commonwealth. (Photo by Layne Bruce, Mississippi Press Association)

Five Mississippi journalists accepted awards for their reporting and reflected on it and the state of journalism at an event in Jackson Friday. Ray Mosby and Natalie Perkins of the Deer Creek Pilot in Rolling Fork and Jerry Mitchell of The Clarion-Ledger in Jackson won the Bill Minor Prize for Investigative Journalism, and Jamie Patterson of The Yazoo Herald and Tim Kalich of The Greenwood Commonwealth won the Minor Prize for General News Reporting. Bill Minor, who died in March at 94, was a longtime Mississippi statehouse correspondent for The Times-Picayune in New Orleans and later a syndicated political columnist.

"Mosby and Perkins’ investigative coverage uncovered the dire need for renovations and repairs to the jointly owned Sharkey-Issaquena Community Hospital," Layne Bruce reports for the Mississippi Press Association. Mitchell, who has made a career of investigating unsolved murders of the civil-rights era, did a story in 2012 that led to the 2016 conviction of a man for killing his wife in 1962. “It was the oldest conviction of a suspected serial killer in U.S. history,” Mitchell said. “It took over 50 years. . . . When the trial was over, the [district attorney] told me ‘If you know any other guilty sons-of-bitches, let me know.’”

"Kalich was honored for a 2016 jailhouse interview with Edgar Ray Killen, convicted in the murders of civil-rights workers James Chaney, Andrew Goodman, and Michael Schwerner during the Freedom Summer of 1964," Bruce reports. "Kalich said the interview took place at the behest of Killen, who previously has had a not surprisingly combative relationship with the press.

“He wrote me a letter and said he liked our newspaper,” Kalich said. “I don’t know what that says about our newspaper.” His four-hour interview "was complicated by the rambling nature of Killen’s responses and the fact the state penitentiary at Parchman, where the interview was conducted does not allow any outside materials to be brought inside," not even paper.

"Patterson’s award-winning entry saw its genesis in two residents who turned to the local newspaper for help" because they had bought properties that the city had deemed a nuisance. “They later found out unpaid bills for cleanup, of $17,000 for one and $30,000 for the other, had been attached the land.” It was a complete surprise, Patterson said, adding that her investigation found “chaos” in the city’s recordkeeping.

The panel's moderator, syndicated columnist Rick Cleveland, "opened the program by discussing the challenges facing community journalists," Bruce reports, quoting him: “The best way to combat the perception that the media is the enemy is to put our heads down and do our jobs.”

EPA may allow farmers to use the controversial herbicide dicamba, with restrictions

The Environmental Protection Agency may allow farmers to use the controversial herbicide dicamba in 2018, but with more rules aimed at making it safer to use, Tom Polansek reports for Reuters. After dicamba is sprayed on crops, it sometimes dries into a fine powder that is picked up and spread by the wind. In 2017 alone, that has damaged about 3 million acres of soybeans and other crops that aren't dicamba-tolerant.

Reuben Baris, acting chief of EPA's herbicide branch, said he wasn't sure what steps the agency would take to mitigate damage associated with dicamba use. Officials had considered banning it, as several states have already done temporarily. Now the focus has shifted to discussions with state regulators on how to prevent crop damage in the future while allowing dicamba to be used in some way. EPA has also been in talks with Monsanto and BASF, which sell dicamba, to encourage changes in how they are used.

State officials had told Reuters that EPA "was considering establishing a set date after which the spraying of dicamba weed killers on growing crops would not be allowed," Polansek reports. Arkansas is considering a statewide spray deadline of April 15, 2018. "Monsanto has said the date would amount to a ban in Arkansas because the chemical was designed to be sprayed over the genetically engineered crops during the summer growing season," Polansek reports.

Rural Idaho schools hire more unlicensed teachers to deal with teacher shortage

School districts in south-central Idaho, struggling to attract qualified teachers, are hiring an increasing number who are either unlicensed or following a nontraditional university teaching program. The Twin Falls school district, for example, issued "alternate authorizations" for 34 such teachers for this school year, Julie Wootton reports for the Twin Falls Times-News. Some new hires are licensed, but need an alternate authorization because they aren't certified to teach the age groups they're being hired for, and some are student teachers who haven't yet graduated. But an increasing number of them don't come from an education background at all.

"Some education officials say it’s not necessarily a bad thing to hire someone who has experience working in a different career, but gaining a teaching license is important," Wootton reports. "Unlicensed teachers have three years to work toward a state certificate. Plus, they receive training and mentoring to help them adapt to working in a school and managing a classroom."

Many unlicensed teachers in Idaho work toward a state certificate by taking self-paced online classes through the American Board for Certification of Teacher Excellence, a non-profit program that helps professionals switch careers. Because so many instructors are going through the ABCTE, the Twin Falls district is now providing them with specialized training in topics like classroom management and navigating teacher-student relationships -- skills they would normally learn during student teaching if they were going through a traditional program.

Rural Idaho isn't short of teachers because the state is graduating fewer of them; the number of certified teachers graduating in Idaho has held steady for the past few years. But Debbie Critchfield, vice president of the Idaho State Board of Education, said many graduates are looking for jobs in urban areas of the state. "It’s almost more of a distribution problem," Critchfield said. "We’re not getting our certified teachers into our more rural areas around the state."

Republican Governors Association has a partisan website masquerading as news, AP reports

A partial screen shot of The Free Telegraph shows an attack
 on the Democratic nominee for governor of New Jersey.

The growing field of partisan media has a new entry that tries to disguise its partisanship. “The Republican Governors Association has quietly launched an online publication that looks like a media outlet and is branded as such on social media,” Bill Barrow reports for The Associated Press. “The Free Telegraph blares headlines about the virtues of GOP governors, while framing Democrats negatively. It asks readers to sign up for breaking news alerts. It launched in the summer bearing no acknowledgement that it was a product of an official party committee whose sole purpose is to get more Republicans elected. Only after The Associated Press inquired about the site last week was a disclosure added to The Free Telegraph’s pages identifying the publication’s partisan source.”

Barrow reports that the site was registered through “a company that allows the originators of a website to shield their identities. An AP search did not find any corporate, Federal Election Commission or IRS filings establishing The Free Telegraph as an independent entity. As of early Monday afternoon, The Free Telegraph’s Twitter account and Facebook page still had no obvious identifiers tying the site to RGA. The site described itself on Twitter as 'bringing you the political news that matters outside of Washington'. The Facebook account labeled The Free Telegraph a 'Media/News Company'.”

Democrats and liberal media critics told Barrow that material from the site is likely to appear digital and television ads, masquerading as news. A leading academic in the field of political advertising, Kathleen Hall Jamieson of the University of Pennsylvania, “said The Free Telegraph commits a form of 'identity theft' by 'appropriating the integrity of news' because 'the form of news carries credibility' that blatantly partisan sites do not.”

New book illuminates challenges of family farming by following a Nebraska family for a year

The survival of traditional family farms – those large enough to financially support a family but small enough to be worked and managed almost entirely by family members – has been under pressure for several decades in the U.S.

A new book, This Blessed Earth: A Year in the Life of an American Family Farm, by journalist and poet Ted Genoways, looks at the day-to-day challenges and financial realities of farming that exists on a scale somewhere between huge corporate agriculture and smaller, specialized ventures.

Genoways wanted to explore the world of farmers who are trying to pass on their land and way of life to the next generation while dealing with a range of political and market factors that affect their ability to make a living. Recognizing changes in consumer habits, he asked, "Is all of this really helping family farmers? How do they feel about a food movement that lionizes ideologically-driven operations like Joel Salatin's Polyface Farms, the pastoral curmudgeon made famous in Omnivore's Dilemma, and vilifies generations-old operations in the middle of the country, where many farmers have no choice but to raise commodity grains - principally corn and soybeans - just to keep their families afloat?"

The book follows Nebraska farmers Rick and Heidi Hammond and their daughter, Meghan, who raise corn, soybeans and cattle. The family began farming in Nebraska in the 1860s. "I saw firsthand conversations about what to do at a particular moment on a soybean farm in rural Nebraska that was directly influenced by what was happening at that moment in China," Genoways describes.

Lorraine Boissoneault writes for Smithsonian magazine, "Genoways says farmers follow everything from trade agreements like the Trans-Pacific Partnership to the debate over NAFTA and immigration from Mexico - to which the Mexican government has suggested it might stop imports of American corn."

In the face of these geopolitical issues and more traditional farm challenges, such as harsh weather, field pests and plant diseases, the Hammonds are trying like many other farm families to make a living and preserve their most precious resource: their land.

"He's not your typical 2017 farm hero, but, as Genoways artfully illustrates, [Rick] Hammond is working hard to pass his farm on to the next generation against the odds," Twilight Greenaway writes for Civil Eats. "And the myriad challenges family farms like his face – from unstable prices to a diminishing water supply and increasingly erratic weather – are worth our attention."

Genoways is also the author of the 2014 book, The Chain: Farm, Factory and the Fate of Our Food.

FERC overrules state regulatory department that tried to halt construction of a pipeline

Pipelines may have a smoother path to approval now that a newly reconstituted Federal Energy Regulatory Commission has established a new legal precedent for its powers.

"Leaders of blue states such as New York and California have positioned themselves as bulwarks against Trump administration efforts to roll back environmental regulations. Where the federal government steps away, these governors say, states will step in," Dino Grandoni reports for The Washington Post. But FERC, which approves permits for gas and oil pipelines, has asserted federal authority over states' rights in one such case, possibly setting a precedent for expanded authority.

The New York State Department of Conservation had denied a permit needed by the Millennium Pipeline Company to begin construction on the Valley Lateral Project. But last week, FERC ruled that the state of New York could not halt construction on the pipeline, saying that New York had taken too long to issue the permit and thereby waived its authority under the Clean Water Act.

The act was the first decision under FERC's new chairman, Neil Chatterjee, and may provide a hint of how FERC will rule in future cases now that it is fully staffed. Three seats on the commission had remained unfilled since President Trump's election, meaning FERC did not have the quorum it needed to approve new projects. Chatterjee is a longtime energy adviser to Senate Majority Leader Mitch McConnell. UPDATE: The Senate Agriculture and Natural Resources Committee approved Trump's appointments to the two remaining seats, Kevin McIntyre and Rich Glick, on Tuesday.

Attorneys general put insurers on notice for possible role in opioid epidemic; a lawsuit, maybe?

A patient takes hydrocodone.
(NYT photo by Kevin Liles)

Drug companies and doctors have been accused of playing a part in the opioid crisis ravaging America, but insurers may be partly responsible too. Health-insurance plans are more likely to cover opioids that are relatively cheap, while limiting access to more expensive painkillers that carry a lower risk of addiction. That's a problem, because a study by researchers at the University of Arkansas for Medical Sciences found that 20 percent of patients who get a 10-day first-time prescription for opioids will still be using opioids after a year.

"ProPublica and The New York Times analyzed Medicare prescription drug plans covering 35.7 million people in the second quarter of this year. Only one-third of the people covered, for example, had any access to Butrans, a painkilling skin patch that contains a less-risky opioid, buprenorphine. And every drug plan that covered lidocaine patches, which are not addictive but cost more than other generic pain drugs, required that patients get prior approval for them," Katie Thomas of the Times and Charles Ornstein of ProPublica report. "In contrast, almost every plan covered common opioids and very few required any prior approval. The insurers have also erected more hurdles to approving addiction treatments than for the addictive substances themselves, the analysis found."

Officials are taking notice. The Department of Health and Human Services is studying whether insurance companies make opioids more accessible than non-opioid painkillers or non-drug therapies (early analyses say yes). And attorneys general from 35 states, the District of Columbia, and Puerto Rico co-signed a letter sent to industry trade and lobbying group America's Health Insurance Plans this week, pressuring insurance companies to take action. "The chief state legal officers are pushing for insurers to review, and potentially revise, payment and coverage policies to encourage health care providers to prioritize non-opioid pain management over opioid drugs for the treatment of chronic pain not caused by cancer," Bill Lucia reports for Route Fifty.

Kentucky's attorney general, Andy Beshear, and his West Virginia counterpart, Patrick Morrisey, held a joint press conference Sept. 18 in Huntington, W.Va., to call attention to the letter. Beth Warren reports for The Courier-Journal that Beshear didn't say what would happen if insurers don't take action, but he referred to lawsuits attorneys general brought against cigarette manufacturers for selling addictive, potentially deadly products; the companies are paying billions in settlements. "Ask the tobacco companies how that works out," Beshear said.

Cathryn Donaldson, a spokeperson for AHIP, told Lucia in an email that insurers are committed to helping solve the problem. "Many health plans have instituted new programs that are helping to dramatically reduce how much—and how often—opioids are prescribed," she said. But the data analysis by the Times and ProPublica found that there are still significant barriers in place for the prescription of less addictive painkillers and addiction treatment drugs such as Suboxone, especially in some state Medicaid programs.

Appeals court rejects theory that it doesn't matter where coal mined when it comes to carbon dioxide

Coal mining in the Powder River Basin. (Bureau of Land Management photo)

A federal appeals court ruled last week that the Bureau of Land Management did not adequately consider the environmental impact of greenlighting four large coal mines in Wyoming's Powder River Basin, and thus violated the National Environmental Policy Act. "The BLM concluded in 2010 that if companies were not allowed to mine the coal on federal land in Wyoming, the demand for coal would still be so high that it would be mined somewhere else, so the carbon-dioxide emissions would be the same whether the federal leases were approved or not. The Court of Appeals for the 10th Circuit ruled Friday that the BLM’s conclusion did not withstand scrutiny," Timothy Cama reports for The Hill.

BLM's decisions for leasing coal often hinge on the "perfect substitution" theory, which assumes that coal will be mined elsewhere if not at the tract under consideration, and that the prices the coal brings will be the same anywhere. But the court noted that Powder River Basin coal is generally cheaper than coal from other mines, Ellen Gilmer reports for Environment & Energy News.

Judge Mary Beck Briscoe wrote that the BLM showed no proof that coal to be mined in the basin could be easily mined elsewhere at a comparable price. "It did not refer to the nation’s stores of coal or the rates at which those stores may be extracted. Nor did the BLM analyze the specific difference in price between [Powder River Basin] coal and other sources; such a price difference would effect substitutability."

The case marks the first time a federal appeals court has ruled on the "perfect substitution" theory for coal leasing. Jayni Hein, policy director at New York University School of Law's Institute for Policy Integrity, told Gilmer "This opinion is significant because it means that future federal agencies cannot just rest on these questionable assumptions and will have to do meaningful analysis as to the actual greenhouse gas emission effects from their leasing decisions."

The ruling could be cited as a precedent in future cases to show that federal agencies must do due diligence in predicting the environmental impacts of decisions, Cama notes.

Report for America project aims to get 1,000 more reporters at local newspapers in next five years

A new project is trying to boost the number of reporters at local newspapers that have been decimated, or worse, by layoffs. Report for America aims to put 1,000 journalists at local papers in the next five years. It's modeled on organizations such as the Peace Corps, Americorps, and Teach for America, Kristen Hare reports for the Poynter Institute.

Co-founders Charles Sennott and Steven Waldman announced the project Sept. 18 at the Google News Lab Summit. RFA is a partnership between Google News labs and the Groundtruth Project, of which Sennott is the CEO. "RFA also gets support, and its reporters will get training, from the Center for Investigative Journalism, the Lenfest Institute for Journalism, the Solutions Journalism Network and the [John S. and James L.] Knight Foundation," Hare reports.

The program will be selective, since the co-founders say the program isn't worth it unless the reporters do great work. After the reporters apply, are selected and get further training, they'll work in a newsroom for one year. For that first year, each reporter's salary will be paid 50 percent by RFA, 25 percent by the newsroom, and 25 percent by local donors. After the year is up, the paper may choose to rehire the reporter and assume more or all of the cost of his or her salary. The program will also require the reporters to do other community service, such as helping a high-school newspaper.

Waldman says "Digital start-ups, public radio stations, newspapers, TV stations and journalism schools are all possible partners. But they have to make the case that they'll use the RFA journalist for civically important local journalism that's in the public's interest, not just clickbait."

Top Ky. lawmakers propose moving Appalachian agency from D.C., focusing it on poorest areas

ARC map shows most economically distressed counties in red. Click on it to enlarge.

Two powerful Kentucky Republicans have an idea to boost the economic development agency created to help Appalachia: "Move it out of the nation’s capital," Matthew Daly reports for the Associated Press. Senate Majority Leader Mitch McConnell and Rep. Hal Rogers, a House Appropriations Committee chair and former committee chair, "are sponsoring a bill they say will refocus the Appalachian Regional Commission to invest more in the poorest communities in 13 Appalachian states." ARC is a partnership of government at the local, state and federal levels that works to boost the workforce, economies, infrastructure, communities, and natural and cultural heritage of the Appalachian regions of 13 states, spanning from Mississippi to New York.

The legislation, introduced Sept. 18 in the House and Senate, would also increase funding to the poorest counties served by the ARC's Area Development Program. Of the 82 counties the ARC classifies as economically distressed, 35, or 43 percent, are in Kentucky.

McConnell and Rogers say other regional commissions modeled after ARC are headquartered on home ground, and that such a move would reduce administrative costs and make them more accountable to their communities. The lawmakers say the location for the headquarters would be chosen after the bill becomes law.

President Trump’s proposed budget targeted ARC for elimination, "but lawmakers from both parties pledge it will remain intact," Daly reports. McConnell said he supports ARC, but wants to improve it and make it more efficient.

Rural hospitals struggle to stock expensive drugs that could save lives

Rural hospitals are having trouble keeping certain life-saving drugs in stock because the government forces them to pay far more for them than large hospitals. A provision of the Patient Protection and Affordable Care Act, added without debate at the end of the drafting process, denies rural hospitals from getting discounts on so-called "orphan drugs" that are meant to treat rare diseases, Sarah Jane Tribble reports for NPR. Large hospitals can get bulk discounts on drugs; rural hospitals try to get lower prices by participating in a federal drug discount program approved in 1992, but still end up paying far more for some drugs than large hospitals that receive the bulk discounts.

Here's why this is particularly bad news for rural hospitals: many pharmaceuticals classified as orphan drugs do not actually treat rare diseases. "The Food and Drug Administration gives the orphan drug designation to a medicine as a first step when it agrees with a drugmaker's request to study whether the medicine can be used to treat a specific rare disease. And this can happen even if a drug is already FDA-approved and on the market for use in treating a common condition," Tribble reports. So widely used drugs such as the clot-busting Activase, which must be used immediately to help stroke victims, are too expensive to keep on hand. Activase has not been approved to treat a rare disease, but the FDA granted it orphan status in 2003 and 2014 because its manufacturer, Genentech, said it is researching possible ways for Activase to treat rare diseases.

"If we don't keep this drug [in stock], people will die," hospital pharmacist Mandy Langston told Tribble. Where she works, Stone County Medical Center in Mountain View, Ark., a single dose of Activase costs $8,010. But just miles down the road, regional hospital White River Medical Center pays only $1,600 per dose.

The orphan drug clause affects cancer drugs too. At Cass County Memorial Hospital in Atlantic, Iowa, cancer patients may have to wait a few days to begin treatment so the hospital can order the medications, otherwise too expensive to keep on hand. And "in Vermont, North Country Hospital closed its infusion center this spring due to the soaring cost of medicines," Tribble reports. Cancer patients who live nearby must now drive 45 minutes for treatment.

Some drugmakers, such as Janssen Pharmaceuticals, voluntarily offer discounts to rural hospitals on all of their orphan drugs. "In contrast, drugmaker Genentech sent letters to rural hospitals on Jan. 1 listing dozens of drugs that would not qualify for discounts — including Activase and cancer drug Avastin," Tribble reports.

Wildfires costs hit new record; Perdue endorses new funding scheme; weather helps Montana

The historic Sperry Chalet in Glacier National Park. (AP photo)

The 2017 wildfire season has now cost more than $2 billion to fight, making it the most expensive in the nation's history. "The Department of Agriculture, which oversees the federal Forest Service, says it’s had to dig deeper into budgets to ward off the flames – even dipping into fire prevention funds," James Dawson reports for Boise State Public Radio in Idaho. "That leaves little to no money for prescribed burning and other forest management techniques that can prevent a manageable blaze from growing into a behemoth."

Agriculture Secretary Sonny Perdue says he wants Congress to change how the USDA pays for fighting wildfires, endorsing a bill introduced by Rep. Mike Simpson (R-Idaho) that would treat wildfires like natural disasters such as hurricanes, with money to fight them coming from special emergency relief funds, Dawson reports.

Wildfires this season have burned about 8.4 million acres, almost 3 million more than the average of the past decade, Phil McCausland reports for NBC News. As of today, the fires cover about 1.7 million acres in Western states; some seem to be slowing down due to rain, snow and ice in hard-hit Montana.

Memo reveals Interior's recommended changes to monuments, three new ones for people of color

Petroglyphs at Gold Butte National Monument in Nevada. (AP photo by Christian Lee)

A copy has been leaked of the memorandum that Department of the Interior Secretary Ryan Zinke sent to President Trump last month, in which he recommended that the size of some national monuments be reduced in order to again open up those lands for commercial use. The memo revealed that Zinke recommended modifying 10 monuments, which includes shrinking the boundaries of at least four Western sites. Zinke also recommended that local officials and affected industries be able to weigh in on the way the targeted monuments are managed, and said that "the administration should permit 'traditional uses' now restricted within the monuments’ boundaries, such as grazing, logging, coal mining and commercial fishing," Juliet Eilperin reports for The Washington Post.

The memo "does not specify exact reductions for the four protected areas Zinke would have Trump narrow — Utah’s Bears Ears and Grand Staircase-Escalante, Nevada’s Gold Butte, and Oregon’s Cascade-Siskiyou — or the two marine national monuments — the Pacific Remote Islands and Rose Atoll — for which he raised the same prospect," Eilperin reports. "The two Utah sites encompass a total of more than 3.2 million acres, part of the reason they have aroused such intense emotions since their designation."

Zinke also suggested establishing three new national monuments to recognize either African American or Native American history: Camp Nelson south of Nicholasville, Ky., where African Americans joined the Union Army and began Kentucky's change of heart in favor of the Confederacy; the Jackson, Miss., home of Medgar Evers, where he was murdered; "and the 130,000-acre Badger-Two Medicine area in Zinke’s home state of Montana, which is consider sacred by the Blackfeet Nation," Eilperin reports.

The issue may create legal precedent for a president's ability to act under the Antiquities Act, since conservation groups such as the Wilderness Society have vowed to fight Zinke's recommendations in court if they become a reality. "No other president has tried to eliminate a monument, but some have trimmed and redrawn boundaries 18 times, according to the National Park Service," Matthew Daly reports for The Associated Press. President Trump ordered Zinke's review after complaining that former presidents had misused the authority granted by the Antiquities Act to create too-large monuments that hamper important commercial activities.

All U.S. counties again have Obamacare plans after Anthem steps in to serve Va. counties left bare

Health insurer Anthem Inc. announced Sept. 15 that it will sell individual Obamacare plans next year in the parts of Virginia that were in danger of having no such coverage. So, as of now, no U.S. counties lack an individual Obamacare insurer, though an increasing number will have just one when government marketplaces open enrollment Nov. 1.

"Last week, Virginia officials said there were 48 counties and 15 cities in that state expected to be bare as a result of Optima Health's decision not to expand its footprint as much as it had earlier expected,"  Dan Mangan reports for CNBC. "Anthem had announced in August that it would stop selling its Blue Cross Blue Shield Obamacare plans in all of Virginia. Two other large insurers, Aetna and UnitedHealthcare, previously said they would exit the Obamacare market there."

Bloomberg's county-by-county map shows number of marketplace insurers as of Sept. 18. Click here for the interactive map; click on the image for a larger version.

The marketplace has been in frequent flux as insurers decide whether, or to what extent, to participate in the marketplaces created under the Patient Protection and Affordable Care Act. Insurers must submit final plans to the federal government by the end of September. Anthem is significantly scaling back its ACA plans in nine of the 14 states where it currently sells individual marketplace plans. A few weeks ago, the insurer announced it would cut in half the number of Kentucky counties in which it would offer such plans.

News to use about Farm Safety and Health Week

This is National Farm Safety and Health Week, which serves as an annual reminder that farming is one of the most dangerous occupations. This year's theme is "Putting Farm Safety into Practice," and each day has a related focus:

Monday: Tractor Safety
Tuesday: Farmer Health
Wednesday: Child/Youth Health and Safety
Thursday: Confined Spaces in Agriculture
Friday: Rural Roadway Safety

The National Education Center for Agricultural Safety has a page with informative documents for each day's topic. In addition, the AgriSafe Network will post a webinar from 12 to 1 p.m. Central Time each day this week focusing on the day's topic. Click here to learn more about and register for the webinars. And the U.S. Agricultural Centers has posted 100 safety and health videos about agriculture, forestry and fishing to its YouTube channel. The centers are funded by the National Institute for Occupational Safety and Health.