An essay from 1942 says all of America loses when small towns struggle; modern essayist says that warning is just as relevant today

In 1942, The Atlantic published an essay by Arthur Morgan about why all Americans should care when small towns struggle; modern Atlantic writer Brian Alexander looks back on that essay with a melancholy eye and discovers that "at a time when many small towns are in crisis—facing economic decline, drug addiction, despair—when economists and pundits recommend giving up on small towns, telling their populations to abandon their homes to find economic opportunity elsewhere, Morgan’s 75-year-old plea remains a trenchant warning."

Morgan said that big-city dwellers should worry about the fate of small towns because "controlling factors of civilization are not art, business, science, government. These are its fruits. The roots of civilization are elemental traits—good will, neighborliness, fair play, courage, tolerance, open-minded inquiry, patience." Those traits are best passed on to future generations in small towns, and from there outward. "To erode small-town culture was to erode the culture of the nation," Alexander summarizes.

Morgan, the Tennessee Valley Authority's first chief and former president of Antioch College, believed the nation's salvation lay in small communities with regional industries, sustainable agriculture, and free enterprise that benefit the common man. And though some of his essay's predictions didn't pan out, he got a lot right. It's a fascinating read worth your time.

Officials scramble to draft opioid plan after Trump says emergency declaration to come next week

On July 31 a bipartisan commission asked President Trump to declare the opioid crisis a national emergency. Such a declaration would allow the U.S. Public Health Service to target highly affected areas, free up funding to fight the epidemic and would allow Congress to negotiate with drug companies for lower prices on naloxone, used by first responders to revive overdose victims. At first Trump demurred, but amid mounting pressure, on Aug. 11 he abruptly announced that he would do so. He has not declared a state of emergency as of today, but on Oct. 16 told reporters he will sign the declaration next week.

But his off-script Oct. 16 statement "blindsided" top agency officials, who say there's no consensus on how to implement an emergency declaration.  When he first announced his support for the declaration in August, "the commitment quickly got bogged down in White House infighting and concerns about the order’s scope and cost," Politico reports. "Members of Trump’s Domestic Policy Council, budget director Mick Mulvaney and former HHS Secretary Tom Price opposed the plan for months because of the multibillion-dollar price tag, legal issues and questions about how it would be implemented."

Multiple sources interviewed by Politico said that agency heads hadn't been asked to create response plans at any time since Trump's promise in August. But staffers are now scrambling to draw up plans in response to Monday's announcement. That will be more difficult since four key agencies in the effort have no leader: Health and Human Services Sec. Tom Price resigned in September; Acting Director of the Drug Enforcement Agency Chuck Rosenburg resigned in September; the nominee to lead the Office of National Drug Control Policy, Rep. Tom Marino, withdrew his nomination a few days ago, and the nominee to lead the Deptartment of Homeland Security, Kirstjen Nielsen, hasn't been confirmed yet.

"It is very difficult to make a big change in direction when the heads of almost every relevant agency are either not appointed or been forced to quit," said Peter Lurie, most recently the associate commissioner for public health strategy and analysis at the Food and Drug Administration.

End of Obamacare subsidies could lead to free insurance for some, at a price for taxpayers

"If President Donald Trump prevails in shutting down a major Obamacare health insurance subsidy, it would have the unintended consequence of making free basic coverage available to more people, and making upper-tier plans more affordable," Ricardo Alonso-Zaldivar reports for The Associated Press. It means an aggregate increase in federal spending on health care though.

Sens. Patty Murray and Lamar Alexander (AP photo: Susan Walsh)

Policy experts say killing the subsidies that reimburse insurers for discounts would cause an increase in tax credits for plans covering people with low-to-moderate incomes.

How does that work? "If the subsidy for copays and deductibles gets erased, insurers would raise premiums to recoup the money, since by law they have to keep offering reduced copays and deductibles to consumers with modest incomes," Alonso-Zaldivar reports. "The subsidy for premiums is designed to increase with the rising price of insurance. So government spending to subsidize premiums would jump."

In practical terms, "It means many more Californians and people across the country will get a zero-premium bronze plan," Peter Lee told Alonso-Zaldivar. Lee is the executive director of the state health insurance marketplace Covered California. Bronze plans are the most basic plans on the marketplace. "Other states where consumers could see zero-premium bronze plans include Florida, Georgia, Illinois, Mississippi, Pennsylvania, Utah and Wyoming, according to an industry estimate," Alonso-Zaldivar reports.

But the death of the cost-sharing subsidies is by no means a done deal. Republican Sen. Lamar Alexander of Tennessee and Democratic Senator Patty Murray of Washington announced a proposal to save the subsidies, backed by 12 Democrat and 12 Republican co-sponsors. "The short-term deal would extend CSR payments for the next two years and would eliminate the question about whether paying them is legal. The agreement would permanently amend Obamacare to give new flexibility for states to create insurance policies that have a larger variety and lower costs and it also would continue CSRs during 2018 and 2019," CBS News reports. Trump has been ambivalent about supporting the measure.

Also, the attorneys general from 19 states filed a federal lawsuit saying that the Trump administration is legally obligated to pay the cost-sharing subsidies, Maria Castellucci reports for Modern Healthcare.

Bankers say increased farm loan foreclosures expected for next five years

Creighton University's latest Rural Mainstreet Index predicted a slumping agriculture economy with increased farm loan foreclosures. The RMI is a monthly survey of small bank presidents and CEOs in rural areas of 10 states with agriculture and energy-dependent economies. The 10 states are Colorado, Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota, and Wyoming.

Creighton University graphic; click on it to view larger version

 "As a result of weak farm income and low agriculture commodity prices, approximately 9.5 percent of bank CEOs expect farm loan foreclosures to pose the greatest threat to banking operations over the next five years," said Creighton economist Ernie Goss, who authors the study.

The bankers' outlook was pessimistic overall. "Concerns about trade, especially current NAFTA  negotiations, and low agriculture commodity prices impaired bankers’ economic outlook for the month," Goss said. In general, average farmland prices declined for the 47th straight month, and for the 50th consecutive month, farm equipment sales were well below growth neutral. And almost half of the bankers surveyed said that corn prices are too low for some farmers in their area to break even farming. Meanwhile, the hiring index for non-agriculture jobs increased to 57.3 from September's 55.9.

Creighton University graphic; click on it to view larger version

What ACA repeal would mean for hospital workers' jobs in one rural Arkansas town

Many rural Americans worry that repealing the Affordable Care And Patient Protection Act could cause them to lose not just their health care, but also their jobs. "Funding that began flowing in 2012 as a result of the Affordable Care Act created at least a half-million jobs, according to an analysis by Goldman Sachs," Patricia Cohen reports for The New York Times.

In northern Arkansas, for example, Baxter Regional Medical Center is the town's largest employer, providing 1,600 jobs to a population of 41,000. Since the Affordable Care Act passed, the hospital has added 221 employees. "Without our hospital, I’d probably be working at McDonald’s," hospital employee Beverly Green told Cohen. Her husband, daughter, son, and daughter-in-law all work there too.

Baxter County and most other rural areas of the country voted heavily for President Trump, who campaigned on promises to repeal the ACA. Green and some of her co-workers told Cohen that "the law needed to be fixed, not scrapped. And they primarily blamed a corrupt Washington establishment — not Mr. Trump — for failing to do so."

The law has had a complicated impact on rural hospitals. Arkansas was one of 31 states to extend Medicaid coverage, which made its adult uninsured rate drop 12.3 percent. But Medicare reimbursements were reduced, which meant Baxter gained $4 million in Medicaid payments but lost $12 million through Medicare payments. So Baxter has struggled financially because of the ACA, but would struggle more under proposed Republican remakes, which sought to decrease Medicaid payments without restoring Medicare cuts, Cohen reports. Under the Republican proposals, Baxter Regional would likely have to merge with a larger hospital system, cut back services, and lay off up to 500 employees.

Many other rural hospitals would probably have to close. Rural hospitals have been closing at record rates in recent years, or drastically cutting services in order to stay open.

Delta authority's new boss says he's cut overhead expenses and will send communities the money

Lee Powell, left, executive director of the Delta
Grassroots Caucus, talked with Peter Kinder.

The temporary boss of the Delta Regional Authority told a regional lobbying group Thursday that he had eliminated more than $500,000 in administrative costs from the agency's $30 million budget, and "We're going to push those resources out to the communities who need them, where they need to be. . . . I think that's a pretty good start for the first two months."

Peter Kinder, who was a three-term Republican lieutenant governor of Missouri, was appointed by President Trump as alternate federal co-chairman of the DRA, which covers 252 counties and parishes in eight states: Louisiana, Mississippi, Alabama, Arkansas, Tennessee, Missouri, Illinois and Kentucky. Trump has nominated Christopher Caldwell, an aide to Sen. John Boozman of Arkansas, as federal co-chair. The top post requires Senate confirmation, which is pending.

Kinder, who lives in Cape Girardeau, Mo., said the region has "some of the greatest economic challenges of any region in the country," but also has opportunities. He said it has shown its commitment to rural areas by sending 84 percent of its awards over the last six years to places with less than 50,000 population.

Kinder spoke to the opening session of a conference held by the Delta Grassroots Caucus, a coalition of local leaders in the region. Other speakers included Mayor Chuck Espy of Clarksdale, Miss., a former congressman; and Mayor Shirley Washington of Pine Bluff, Ark. Today's speakers include Arkansas Gov. Asa Hutchinson, U.S. Sen. John Boozman and U.S. Rep. Rick Crawford of Arkansas.

Anonymous opinion page sage puts down his pen after being outed

Anonymity can bring out extreme opinions; that's why editorial pages usually require letters to the editor to be published under a real name. Steve Stewart, the publisher of the State Journal in Frankfort, Ky. was reminded of that recently when he realized a long-time editorial letter writer had been publishing under a pseudonym. "'Mark Henry' has delighted liberal--and trolled conservative--readers of this page since 2008," Stewart writes in an editorial page confession. "By his own estimate, his letters have been published 140 times by, if my math is right, six different editors."

Stewart figured it out when he realized "Mark's" latest editorial didn't have contact information. When Stewart wrote back and asked, the author provided both. A quick Google search found that Mark was somebody else entirely--and Stewart says he's not telling his real name.

Faced with the choice to either publish under his real name or give it up, Mark chose to give it up. He told Stewart he wanted to keep his government job, and didn't want to argue with neighbors in Kroger every time he published a letter.

Anonymity, Stewart muses, is fine on the internet, but reputable papers need real names. Perhaps the threat of a Kroger encounter can help us all stay more civil.

Writer says Grassley could throw a big wrench into Trump's plans if biofuels demands are not met

We reported yesterday that Republican Sen. Chuck Grassley of Iowa threatened to hold up President Trump's nominees for the Environmental Protection Agency if biofuel mandates are reduced in the Renewable Fuels Standard. But that's not the only card in Grassley's hand, and he could become a thorn in Trump's side if push comes to shove. As Philip Wegmann's opinion column in The Washington Examiner says, "When properly motivated, Chuck Grassley can crush skulls. Right now, the Iowan octogenarian is just playing around."

That's because, as the chairman of the Senate Judiciary Committee, Grassley has far-reaching power over Trump's judicial nominees: he controls when nominees get hearings and which nominees get voted on in the Senate floor. Trump has been frustrated by the Republican-controlled Senate's failure to pass significant legislation that he can claim as an administration win, so he's focused heavily on judicial appointments as a means for asserting his legacy. "Any slowdown in confirmations would deal a major blow to the administration," Wegmann writes. "Without judges, Trump looks even more impotent." There are about 60 judicial nominees awaiting confirmation right now.

The administration has been walking the fence thus far on the biofuels issue, promising lawmakers from corn-producing states that ethanol is important, but without firm assurances to support increased biodiesel requirements in the fuel mix under the RFS. Iowa Governor Kim Reynolds spoke on the phone separately to both President Trump and EPA chief Scott Pruitt yesterday. "Both of them personally committed to me their continued commitment to the renewable fuel standard,” Reynolds told Reuters, and said the call with Trump was "positive."

Study: Arsenic may contaminate private wells

Millions of Americans who get their water from private wells may be exposed to unsafe levels of arsenic, according to research published Oct. 18 in Environmental Science & Technology.

"Based on a detailed assessment of where US geology is likely to create high levels of naturally-occurring arsenic, and where private wells are located, scientists from the U.S. Geological Survey and Centers for Disease Control estimated that around 2 million people are probably drinking it at levels higher than the legal limit of 10 parts per billion," Zoe Schlanger reports for Route Fifty.

Around 15 percent of Americans--about 43 million people--use private wells, but they're mostly unregulated. Private wells aren't covered by the Federal Safe Drinking Water Act, so government officials don't test them for contamination as they do public water systems. "Arsenic can’t be removed from water with chlorine, or by boiling," Schlanger reports. "The CDC recommends private well owners distill their water or treat it with a reverse-osmosis filter. Public water utilities have a range of options for treating their water for arsenic—from reverse osmosis to a process called 'coagulation and filtration.'"

Arsenic is naturally occurring in the earth's crust, but can also seep into water from presticide run-off or coal-fired power plants. In May, Environmental Protection Agency Administrator Scott Pruitt halted an Obama-era rule meant to lower the amount of arsenic that power plants are allowed to dump in waterways, saying it was too costly, Schlanger reports.

Hepatitis C outbreaks related to opioid crisis

Christine Teague screens a patient for hepatitis C in Spencer, W.Va.
(Washington Post photo by Philip Andrews)

Health providers all over the country are seeing a rise in health problems triggered by the opioid epidemic, including increases in hepatitis B, sexually transmitted diseases like syphilis and gonorrhea, an infection of the heart called endocarditis, more emergency room visits for abcesses, hospitalizations for soft-tissue infections, and small increases in HIV. Some of those are direct consequences of needle injection, and some are "consequences of impaired judgment," says West Virginia Public Health Commissioner Rahul Gupta.

But perhaps most troubling of all is an outbreak of hepatitis C, spread by heroin users sharing needles. Though hepatitis C is spiking in urban drug users, many of the newly infected live in rural and suburban areas. Diagnosed new cases of the liver disease have almost tripled in the past few years, from 853 in 2010 to 2,436 in 2015, according to the Centers for Disease Control and Prevention. Hepatitis C can be asymptomatic, so tens of thousands more probably have it and don't know it, Katie Zezima reports for The Washington Post.

West Virginia has been particularly hard-hit. It has the country's highest rate of opioid overdose deaths, and new hepatitis B and C infections. The state's numbers are so high, Gupta believes, because health officials are aggressive in identifying new cases, expanding testing at the states' syringe exchanges, jails and prisons.

"Because a treatment that cures the disease costs tens of thousands of dollars, is limited by insurance and Medicaid, and is mostly unavailable to people who are still using illicit drugs, there probably will be financial and public health ramifications for decades to come," Zezima reports.

Judith Feinberg, a professor of behavioral medicine and psychiatry at the West Virginia University School of Medicine, told Zezima: "If we don’t cure a significant number of the people who are injecting, in 20 years from now, the hospitals in this part of the world will be flooded with these people with end-stage liver disease, which has no cure."

Officials are also worried that infected pregnant women may be unknowingly spreading the disease to their babies, since hepatitis C is not a routine test administered to pregnant women. "The prevalence of hepatitis C among women who gave birth from 2009 to 2014 increased 89 percent, according to a study by Vanderbilt University and the Tennessee Department of Health. West Virginia has the highest rate of births to infected mothers, with 22.6 per 1,000 live births. The disease can be passed to an infant during birth, and about 6 percent of babies born to infected mothers contract the disease," Zezima reports. There is no treatment for the disease during pregnancy, and children can't be tested for hepatitis C until they're 18 months old.

Climate change costs billions in extra road repairs

Photo by Jesse Collins, Unsplash

A recent paper in Nature Climate Change says climate change is costing the U.S. billions of dollars in unnecessary road repairs each year. Most road miles in the U.S. are in rural areas, meaning states, counties and small towns are making repairs that some of them can ill afford.

The problem is old data. Engineers consult weather models to see what kind of pavement can best withstand the local climate. But the temperature data for those models runs from 1964 to 1995, and local weather is often different now.

"Using data from the Bureau of Transportation Statistics, Shane Underwood of Arizona State University and his colleagues show that road engineers have selected materials inappropriate for current temperatures 35 percent of the time over the past two decades," David Trilling reports for Journalist's Resource, a service of the Shorenstein Center at Harvard University. Other findings from the study:

• Failing to adapt to warmer temperatures is adding 3 to 9 percent to the cost of building and maintaining a road over 30 years.

• The authors use two models of predicted warmer temperatures, which suggest between $13.6 and $35.8 billion in extra or earlier-than-normal repairs will be required for roads being built under the current models. In the lower-temperature warming model, this translates to an annual extra cost of between $0.8 billion and $1.3 billion; in the higher-temperature warming model, it is an annual extra cost of between $0.8 billion and $2.1 billion.

• A road built to last 20 years will require repairs after 14 to 17 years under these models.

• In some cases, government transportation agencies are paying too much for materials to withstand cold temperatures that do not currently (and perhaps no longer) exist.

• Because municipal governments in the United States work on tighter road-maintenance budgets than state and federal transportation departments, the extra financial strain will largely impact cities and towns.

Trump gives mixed signals on ACA subsidy deal

"Yet another last-ditch effort to tackle the nation’s health-care system stalled within hours of its release by a bipartisan pair of senators Tuesday, with President Trump sending mixed signals and Republicans either declining to endorse the proposal or outright opposing it," The Washington Post reports.

Senators Lamar Alexander  (R-Tenn.) and Patty Murray (D-Wash.) reached a compromise yesterday that would authorize federal cost-sharing subsidies for the next two years while granting states more flexibility in regulating health coverage under the Patient Protection and Affordable Care Act. The subsidies help offset the cost to insurers of low-cost plans for lower- and moderate-income Americans. Because insurance companies are still required to offer those discounts even without the subsidies, critics say insurers will likely withdraw from poorer and rural areas where more people purchase low-cost plans with higher out-of-pocket costs. That could leave some counties, especially in rural areas, without any ACA insurers.

President Trump appeared to support the compromise yesterday, but in a tweet today said "I am supportive of Lamar as a person & also of the process, but I can never support bailing out ins. co's who have made a fortune w/ O'care." Actually, the payments reimburse insurers for the cost of the discounts.

"But that message may have been more of a caveat than a rejection," Robert Pear and Thomas Kaplan report for The New York Times. Alexander told the Times that the president called him today and wanted to be "encouraging" about the agreement. Trump, Alexander said, "intends to review it carefully to see if he wants to add anything to it" and "wants to reserve his options."

The deal did not get a rousing reception in the Senate or the House, but Sam Baker of Axios Vitals reports that both Democrats and Republicans interested in it "are claiming victory. That ultimately bodes well for the future of the package, which experts on both sides say is likely to help stabilize the individual market." For a more detailed roundup of the coverage, see this story on Kentucky Health News.

Sen. Grassley says he and other Corn Belt senators could hold up Trump nominees over biofuels issue

We reported last week that Republican Sen. Chuck Grassley of Iowa was outraged over President Trump's proposed rollback of the Renewable Fuel Standard. Now it appears as though he and other Corn Belt senators may be prepared to play hardball over it. At issue is the reduced requirements for ethanol in the fuel mix; Grassley and other legislators from corn-producing states say Trump is breaking a campaign promise to support ethanol.

Before an Oct. 17 meeting with Environmental Protection Agency Administrator Scott Pruitt, Grassley told reporters that he thinks "plenty" of Midwestern senators would consider holding up Trump's EPA nominees over the issue. Grassley said in a statement afterward that he "impressed upon Pruitt that supporting biofuels is 'good policy'" during the meeting, and that the message was "well-received," Ed Tibbetts reports for the Quad-City Times in Davenport, Iowa.

But after the meeting, "Sen. John Barrasso (R-Wyo.), chairman of the Senate Environment and Public Works Committee, postponed the confirmation votes of four EPA nominees scheduled for today. That suggests that senators may have not gotten the commitment they were seeking from Pruitt, and that one or both of the Midwestern Republicans on the committee, Joni Ernst (R-Iowa) and Deb Fischer (R-Neb.), were willing to buck the Trump administration on the nominees," Dino Grandoni reports for The Washington Post.

Grassley may have other leverage in the fight: he's the chair of the Senate Judiciary Committee, which is investigating Russian interference in last year's election.

Foundering NAFTA talks get an extension

Canada, the U.S. and Mexico have agreed to take a break from contentious talks to renegotiate the North American Free Trade Agreement. "Negotiators, struggling to find agreement on some of the thorniest provisions of the trade deal, will take an extended break to consult with politicians and interest groups before convening again in Mexico City for the fifth round of talks in mid-November. The trade talks, which were supposed to wrap up by year-end, have now been extended into the first quarter of 2018, the parties said," Ana Swanson reports for The New York Times.

That's not necessarily good news for pro-NAFTA parties. Upcoming elections in all three countries could influence candidates to take hard-line stances on the trade deal, making an agreement even less likely. The Mexican presidential election will take place July 1, Canada will hold provincial elections through the fall and early winter of 2018, and the U.S. will hold midterm elections Nov. 6.

Another possible wrench in the works: "In the United States, legislation will expire in July that gives the Trump administration more extensive authority to negotiate trade deals and then submit them to Congress for a simple up or down vote, without amendments," Swanson reports. If that legislation, called Trade Promotion Authority, is not renewed, Secretary of Commerce Wilbur Ross told a conference last week that he doesn't think a NAFTA deal will be possible.

"The demise of NAFTA, a deal that has knit together the North American economy over the last quarter century, would be a heavy blow to all three economies. A new study by Impactecon, an American consulting firm, found that the United States would lose 256,000 net jobs if it withdrew from NAFTA, with the most severe impact on low-wage employment. Mexico would lose 951,000 net jobs, and Canada 125,000, the report projected," Swanson reports. "The outcome could also damage the North American security relationship, straining cooperation to combat money-laundering, terrorism, the drug trade and undocumented migrants coming through Central America, the report said."

Farm Foundation Forum on Nov. 1 to explore collaborations for conservation in agriculture

A Farm Foundation Forum will discuss possible collaborations between the forces that drive conservation efforts on farms at 9 a.m. Nov. 1 at the National Press Club in Washington, D.C.

"Conservation work is not lacking in rural America today," says Farm Foundation President Constance Cullman. "Farmers and landowners use conservation practices to protect soil and water, which they consider high-value operational assets. Federal and state programs exist to help finance some of that conservation work. We also have private ventures seeking to initiate conservation or protect farm and ranch land from development for non-agricultural uses."

The forum will explore whether collaborations of those public and private efforts would yield better results for conservation goals. "We want to identify the challenges and opportunities of public-private collaboration. Who benefits? What hurdles exist? What goals could be met? What are the policy challenges?" Cullman says. "As Congress begins work on the next Farm Bill, it is a great time to examine this issue." Participating forum panelists will be:

• Jonathan Coppess, director of the Gardner Agricultural Policy Program at the University of Illinois
• John Piotti, president and CEO of American Farmland Trust
• Josette Lewis, associate vice president of ecosystems/sustainable agriculture, Environmental Defense Fund
• Laura Peterson, manager of federal government relations at Syngenta.

Cullman will moderate the discussion. After comments from the panelists, the floor will be opened for questions and discussion.

The forum is free to attend, but you must pre-register. Click here to register to attend the forum in person. Click here to participate in the live audiocast. After the session, audio from the session will be available to download from the Farm Foundation website.

Rural Mass. retailer under fire after posing with Trump and order undermining Affordable Care Act

Dave Ratner is second from left; Sen. Rand Paul is at right. (AP photo by Mandel Ngan)

When the owner of some rural Massachusetts pet-and-beverage stores was invited to the White House for a photo opportunity with President Trump, he thought it was a reward for his years of lobbying to get more flexibility for small businesses like his in the health-insurance market. It was, but that's not all it turned out to be. Now it is a public-relations nightmare, due to social media and the strong opinions about Trump.

Dave Ratner has owned Dave's Soda and Pet City for 42 years, a small chain with locations around small-town New England (Stafford Springs, Conn., and Agawam, Ware, Northampton, Ludlow, and Hadley, Mass.) "Ratner attended President Trump’s signing Thursday of an executive order authorizing changes to the Affordable Care Act designed to create cheaper — and less comprehensive — health insurance plans. An Associated Press photograph of the event, with Ratner smiling broadly behind Trump, has come back to haunt him," Laurie Loisel reports for The Boston Globe.

The photo brought Ratner criticism on social media, a wave of angry callers to his shops, long-time customers swearing off shopping at his stores, and some circulating petitions calling for boycotts. Ratner called it the "worst two days of my life."

Ratner, who says he is not a Trump supporter, said he was invited because he's actively lobbied Washington as member of the National Retail Federation. "For years through this federation, his company and others negotiated for cheaper group-insurance rates, giving them some of the advantages large companies have," Loisel reports. "With the 2010 passage of the Affordable Care Act, this negotiating power vanished. Since then, he has trekked to Washington, D.C., annually, talking to anyone who will listen about how unfair that is."

Two weeks ago, the federation called Ratner and invited him to a ceremony where, they said, Trump would sign an order restoring that negotiating power back to small businesses. Ratner says he was happy to hear it, but didn't realize exactly what the signing meant, and didn't dig further into it. "I absolutely abhor what he did, and I would not have been there had I known what was happening," Ratner told the Globe. He has hired a Boston public-relations firm to rebuild his company's image. "It was 42 years of building a wonderful brand, and having it destroyed in one day," he said.

Quick hits: white-nose fungus still decimating bats; the terms applied to ruralites; the Navajo's dependency on coal; Puerto Rico and Appalachia

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 us at heather.chapman@uky.edu.

White-nose fungus is still decimating bat populations, Dave Levitan reports for Earther. The population decline in Pennyslvania's bat population is over 99 percent. Experts say some bat species may go extinct because of it, and other species will be scarce for a long time to come.

The rural-urban divide is more pronounced now than it has been in generations, and the slang people use to talk about rural Americans is a symbol of that, Nora Mabie reports for In These Times. But what's behind that slang? Mabie digs into the history of derogatory terms such as "hillbilly" and "redneck" and discusses also the more positive idealized images of rural America--and how marketers have exploited them.

Much has been made of the impact of coal's decline on Appalachia, but the Navajo in Arizona are in the same boat, Ian Frisch reports for Climate Changed. The story explores coal's complicated stature in a rural reservation where people revere living in harmony with the earth, but coal is the biggest employer.

An editorial from The Roanoke Times talks about how Puerto Rico and Appalachia can help each other. Both regions are rural, and both need a "Marshall Plan" level of intervention. Proposed federal budget cuts would hurt both areas, so perhaps they should join forces in Washington D.C. to lobby for help.

Web briefing for journalists will examine landscape of Obamacare following recent announcements

A web briefing at noon ET Wednesday will examine the landscape around Patient Protection and Affordable Care Act marketplaces and the open enrollment period beginning Nov. 1, which continues to shift with the Trump administration’s announcements last week.

"Though the 2010 health law remains intact for now, consumers will see fundamental differences this year when it comes to signing up for 2018 marketplace plans. Premiums are increasing significantly in some states, though not all consumers will feel the impact," says the Kaiser Family Foundation, which is sponsoring the webinar.

"The enrollment period is shorter. Healthcare.gov will experience regular planned outages. And understanding plans and their true costs could be more challenging, due to steps insurers and regulators took to mitigate political uncertainty about the ACA. Additionally, fewer navigators will be available to help consumers with their questions, following deep funding cuts from the federal government."

The web briefing, which is only for news media, will examine these issues:
What are implications of a shortened open enrollment period? (Nov. 1-Dec. 15, half as long as last year)
What are trends in premium changes for 2018, and how does this compare to prior years?
Who is subject to premium increases, and which plans do the increases apply to?
Who is eligible for financial assistance, and how does this assistance affect affordability of coverage?
What can consumers expect when it comes to choice of insurers in marketplaces?
When and how can consumers renew their coverage or shop for a new plan?
Where can consumers get help signing up for coverage, and how does this differ from prior years?
What is the penalty for not having health insurance in 2018, and who is exempt?
What is the potential impact on marketplace premiums of President Trump’s decision to end cost-sharing subsidy payments to insurers?
How have other actions by the Trump administration affected marketplaces, and what is the outlook going forward?

Panelists will include Larry Levitt, senior vice president for special initiatives and co-executive director of the foundation’s Program for the Study of Health Reform and Private Insurance; Karen Pollitz, senior fellow at the foundation; and Jennifer Tolbert, director of state health reform and associate director of the foundation’s Program on Medicaid and the Uninsured. To RSVP for the briefing, click here.

Expensive wildfire season triggers proposed budget cuts that would hurt rural Montana

Proposed cuts to Montana's budget would cripple safety net services in rural Montana, Oscar Peña writes in an opinion column for the Montana Standard. Peña is the public policy coordinator of the Montana Food Bank Network.

After an expensive wildfire season, state legislators now have two choices: "accept nearly 10% cuts to every state agency, or have a special session and attempt to pass revenue-generating legislation to defray some of the cuts," Peña writes. Some rural areas are already reeling after the fires caused a reduction in recreation and tourism spending.

One proposal is to close 19 of the state's 37 Offices of Public Assistance, which provide in-person help for people applying for the Supplemental Nutrition Assistance Program (formerly known as food stamps), Temporary Assistance for Needy Families, or Medicaid. All 19 affected offices serve rural Montana, where resources are already scarce. "Despite being rural communities, these offices serve a significant number of Montanans with nearly 19,500 SNAP participants in these counties alone," Peña writes.

If the offices are closed, seniors, the poor, and rural residents would lose a critical resource, and remaining offices would be overwhelmed, he says.

Experts doubt dicamba limits will stop crop damage

Some U.S. weed experts say they don't think new federal restrictions on the controversial herbicide dicamba will keep it from damaging crops next year. That's because the Environmental Protection Agency's limits focus on application, not volatilization -- the chemical's propensity to turn into a powder after application and drift elsewhere.

"Under EPA’s guidelines, only certified pesticide applicators, or people under their supervision, will be allowed to spray dicamba formulations manufactured by Monsanto and BASF next year," Emily Flitter and Tom Polansek report for Reuters. "That restriction may not do much to reduce crop damage related to sprayings, though, because many farmers and commercial applicators are already certified, experts said."

Aaron Hager, a weed scientist and professor at the University of Illinois, told Reuters that "nothing in these new restrictions addresses volatility, and that’s still an issue." The new guidelines also limit the times and wind speeds for dicamba application, and require farmers to keep records proving they're spraying the herbicide according to instructions on the label.

The changes were proposed by Monsanto, which blamed most of the crop damage on improper application. The EPA will monitor the impact of the restrictions next year to see if further restrictions or a ban are needed later. Dicamba has recently been blamed for causing damage to oak trees and older strains of corn and soybeans.

"Jonas Oxgaard, an analyst for the investment management firm Bernstein, said the rules could slow the adoption of Monsanto’s Xtend soybean seeds by making it harder for farmers to find times when they are permitted to spray dicamba," Reuters reports.

Hardline American demands put NAFTA and Korea trade negotiations on the ropes

Negotiations on the North American Free Trade Agreement are on the ropes because President Trump's top negotiator, Robert Lighthizer, "is playing such extreme hardball with the Canadians and Mexicans . . . that sources close to the process say there's no chance of a compromise solution unless he changes tactics," Jonathan Swan reports for Axios. Withdrawing from NAFTA could cause big problems for farmers, many of whom voted for Trump. A host of lawmakers are begging Trump to stick with it for the sake of the farmers who depend on it.

Trump also wants a sunset clause that would cause NAFTA to dissolve five years from now unless all parties agree to extend it at that time, and has threatened to withdraw from it summarily unless he gets his way in the negotiations.

The automotive industry could lose out too, which could hurt Republicans since most of the top 10 states for auto manufacturing voted for Trump. A new study says up to 50,000 auto-parts jobs could be lost if the U.S. ditches NAFTA completely, and up to 24,000 jobs could be lost if the U.S. keeps NAFTA but pushes through stringent "Made in America" auto manufacturing requirements.

Trump wants tariff-free cars crossing the U.S. border for manufacturing to be made of at least 50 percent American parts. "That's viewed as a non-starter by virtually every party involved in automobile manufacture," according to The Canadian Press.

Renegotiation of the U.S. trade deal with South Korea, which also helps U.S. agriculture, aren't going so well either, and for much the same reason: hardball negotiation. But a poison pill to torpedo the deal may be the point: "Trump believes to his core that the deal is a scam," Swan writes. The negotiations matter, he says, because "Between NAFTA and KORUS you're talking more than $1 trillion in annual trade in goods and services. Withdrawal would do far more than simply roil the U.S. markets; it would profoundly alter U.S. alliances, test a crucial national security partnership in Asia, and could result in the election of a hard core leftist (and no friend to the USA) in Mexico."

Cost-sharing subsidies more prevalent in Trump states; his end of them could have big rural impact

On Oct. 12, President Trump made good on threats to pull the cost-sharing subsidies that reimburse insurers for reducing out-of-pocket costs of lower- and moderate-income people with Obamacare insurance policies. Here's an update on what that means and what could happen because of it.

About 7 million people, 58 percent of all marketplace enrollees, got cost-sharing reduction (CSR) subsidies in 2017, which cost the government about $7 billion. Nearly 70 percent of these enrollees live in pro-Trump states and many have no other current insurance options. Insurers are still required by law to offer these plans in the markets they serve, but without CSRs, insurers will likely either hike rates or withdraw from some markets entirely, Hannah Recht reports for Bloomberg. Most of the counties that have only one Obamacare insurer are rural.

In some places, nearly all policyholders get subsidies. (Bloomberg map; click to enlarge)

Most insurers feared Trump would end the subsidies and based their rates accordingly, Recht reports. Now his move may give them an exit clause. "Medica Health Plans recently exited North Dakota after state insurance officials there would not accept Medica’s high-rate, no-CSR request, she writes. "With less than three weeks until open enrollment, we’ll be watching closely to see if other companies choose to leave."

The attorneys general for 17 states and the District of Columbia filed suit against Trump's administration in an effort to block the subsidy cut-off.

Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) have been working for months on a bill to give states more flexibility in implementing Obamacare and fund the subsidies, which are authorized by the law but have not received appropriations form Congress. President Obama used other means to pay them, but a court has ruled against that, and the case is on appeal.

Stephanie Armour reports for The Wall Street Journal, "Trump has privately told at least one lawmaker that the payments may continue if a bipartisan deal is reached on health care, according to people familiar with the matter on Capitol Hill and in the health-care industry." The next distribution of the subsidies was set for around Oct. 20, and the Department for Health and Human Services said they "will be discontinued immediately." Armour notes, "The administration is scheduled to update the court on the status of the case on Oct. 30."

Permits approved for two controversial pipelines

The Federal Energy Regulatory Commission granted important permits for two controversial gas pipelines on Oct. 13. Getting a "Certificate of Public Convenience and Necessity" means, effectively, that both pipelines can now claim private land for easements through eminent domain.

For the $3.7 billion Mountain Valley Pipeline, "securing FERC’s blessing moved the venture a giant step forward toward launching construction of the 42-inch diameter, 303-mile buried pipeline. The project would transport about 2 billion cubic feet per day of natural gas that has been extracted by fracking in the Appalachian Basin," Duncan Adams reports for The Roanoke Times.

Some private land owners were upset about the MVP. The late Clarence Givens of Giles County, Virginia, was so upset about it that he talked about halting pipeline construction in his obituary.

Other stakeholders support the pipeline, saying it's an important step in growing the region's economy.

The Atlantic Coast Pipeline, which secured the same type of permit on Oct. 13, would run 600 miles from West Virginia through eight counties of rural North Carolina, Lauren Ohnesorge reports for the Triangle Business Journal. 

Free webinar on rural HIV and AIDS set for Nov. 7

The Rural Health Information Hub and the the Walsh Center for Rural Health Analysis, part of the research organization Norc at the University of Chicago, will host a free webinar, "Rural HIV/AIDS Prevention and Treatment," Thursday, Nov. 7.

The one-hour webinar will begin at 1 p.m. EDT, and will present a toolkit designed to help rural communities plan, implement and sustain HIV/AIDS programs. The toolkit was developed by Norc for the federal Office of Rural Health Policy. The speakers will discuss examples of successful programs and lessons learned. Featured speakers will be:

• Alycia Bayne, senior research scientist at the NORC Walsh Center for Rural Health Analysis;


• Daniel Wakefield, interim director of the Ursuline Sisters HIV/AIDS Ministry in Youngstown, Ohio; and 


• Lisa McKeithan, director of Positive Life and the North Carolina Rurally Engaging and Assisting Clients who are HIV positive and Homeless (NC REACH) project at CommWell Health. 

 A recording will be available on the Rural Hub website afterward. Click here to register or for more information.

Congress helped drug manufacturers loosen federal oversight of opioid shipments last year, quietly

After years of being lobbied by drug manufacturers, Congress last year stripped the Drug Enforcement Administration of its most effective tool to police drug distributors, “even as the opioid epidemic raged and thousands of Americans were dying of overdoses.” So says The Washington Post, introducing its report of a joint investigation with CBS's “60 Minutes” found.

"A handful of members of Congress, allied with the nation’s major drug distributors, prevailed upon the DEA and the Justice Department to agree to a more industry-friendly law, undermining efforts to stanch the flow of pain pills," the Post reports. "The industry worked behind the scenes with lobbyists and key members of Congress, pouring more than a million dollars into their election campaigns."

The story notes that millions of pills were sent to Mingo County, West Virginia by Miami-Luken Inc. of Springboro, Ohio. "Many went to one pharmacy in Williamson, the county seat, population 2,924," the Post reports. "In one month alone, Miami-Luken shipped 258,000 hydrocodone pills to the pharmacy, more than 10 times the typical amount for a West Virginia pharmacy. The mayor of Williamson has since filed a lawsuit against Miami-Luken and other drug distributors, accusing them of flooding the city with pain pills and permitting them to saturate the black market."

The bill requires the DEA to show that a “substantial likelihood of an immediate threat” of death, serious bodily harm or drug abuse before it can freeze drug shipments. It passed the House and Senate by unanimous consent, a non-debating procedure usually "reserved for bills considered to be noncontroversial," the Post reports.

"The White House was equally unaware of the bill’s import when President Barack Obama signed it into law, according to interviews with former senior administration officials." However, the Post and CBS report that Attorney General Eric Holder warned that an earlier version of the bill would undermine DEA's ability to block suspicious drug shipments. Obama and Loretta Lynch, attorney general at the time, declined to be interviewed.

Joe Rannazzisi, former DEA official (CBS News photo)

Near the start of the process, Joe Rannazzisi, who ran DEA's program to keep drugs from being diverted for illegal purposes, told congressional staffers, "You'll be protecting criminals." DEA's already poor relationship with Congress went downhill, the bill passed the House, the DEA administrator resigned for unrelated reasons, Rannazzisi lost his job, and the agency "was forced to accept a deal it did not want" in the Senate, CBS reports. "The new law makes it virtually impossible for the DEA to freeze suspicious narcotic shipments from the companies."

Republicans Tom Marino of Pennsylvania and Marsha Blackburn of Tennessee sponsored the bill, drafted by a former DEA lawyer who went to work for drug companies and now works for Cardinal Health, the distributor that pushed back earliest and hardest on DEA enforcement efforts. on It was steered through the Senate by Sen. Orrin Hatch of Utah. President Trump has nominated Marino to be head of the White House Office of National Drug Control Policy. "Marino’s staff called the U.S. Capitol Police when the Post and '60 Minutes' tried to interview the congressman at his office on Sept. 12," the Post reports.

UPDATE, Oct. 16: Sen. Joe Manchin (D-W.Va.) asked Trump to withdraw Marino's nomination; on Oct. 17, Trump tweeted that Marino had withdrawn.

DEA had fined Cardinal Health and McKesson Corp. millions for filling suspicious orders. AmerisourceBergen is the other major drug distributor in the U.S. CBS's Bill Whitaker asked Rannazzisi, "These big companies knew they were pumping drugs into American communities that were killing people?" Rannazzisi replied, "That's a fact. . . . This is an industry that's out of control."

The Post reports, "The DEA and Justice Department have denied or delayed more than a dozen requests filed by the Post and '60 Minutes' under the Freedom of Information Act for public records that might shed additional light on the matter. Some of those requests have been pending for nearly 18 months. The Post is now suing the Justice Department in federal court for some of those records."