Small-business owners worry about guest worker cutbacks, reflect similar gripes among farmers; regrets about Trump

Some small business owners who voted for President Trump say his immigration policies may put them out of business. Cuts in the Labor Department's H2-B "guest worker" program "are hurting small businesses across the country that can’t find Americans willing to do hard, manual labor: Maryland crab processors, Texas shrimp fishermen, and Kentucky landscapers and construction companies," Tom Eblen writes for the Lexington Herald-Leader. Not to mention workers needed to harvest agricultural crops, a major concern for fruit and vegetable growers.

Eddie Devine, who owns a landscaping company in Harrodsburg, Ky., population 8,500, has hired 20 seasonal workers for years, mostly from Guatemala. He'd like to hire Americans, he told Eblen, but he can't find enough dependable, drug-free citizens to take his $12-an-hour jobs. Devine lost a big client last year because of the lack of manpower, and worries he'll go out of business this year if he can't find workers. "I feel like I've been tricked by the devil," Devine said. "I feel so stupid."

Central Kentucky construction company owner Ken Monin, also a Trump voter, told Eblen his company almost went bankrupt last year because immigrant workers' visas were delayed for months, but is more charitable toward the president than Devine; he said Trump understands the need for immigrant workers but is "politically trapped by the far right," Eblen writes. Still, Monin worries he will go out of business this summer if he can't find workers. He's tried to hire locally, but said Americans don't want to do the grueling work required, even at $17 an hour.

Trump said at an April rally in Michigan that the U.S. would bring guest workers in because small business owners need them, but didn't get much of a response from the crowd. Devine wondered if cutting back on the guest-worker programs is about racism and not economics, and is angry that Trump's properties in New York and Florida use H-2B workers. "I want to know why it's OK for him to get his workers, but supporters like me don't get theirs," he told Eblen.

Coal predictions get more dire; renewables and gas benefit

"More coal plants are now projected to retire more quickly than experts thought a year ago, according to energy-industry analysts who gathered in Chicago Tuesday," Jeff McMahon reports for Forbes. "Three alternative energy sources—wind, solar and natural gas—are expected to divide up the spoils, they said at the American Wind Energy Association's Windpower 2018 conference."

Max Cohen, an IHS Markit analyst, said his company predict about 100 gigawatts of coal retirements in the next decade, about a third of the available coal energy. 

Bruce Hamilton of Navigant has projected 73 gigawatts will retire in the next 10 years. "That's more than twice what we projected last year at this time. It's more than we had two years ago when the Clean Power Plan was in the assumptions," Hamilton told McMahon. The predictions changed partly because of announced retirements of coal-fired power plants, but also because the costs of coal have gone up while its competitors have all gotten cheaper. 

Free Rural Health Journalism Workshop in North Carolina June 8; deadline to apply for travel stipend is May 23

The Association of Health Care Journalists is hosting a free one-day workshop on covering health on June 8 in Research Triangle, North Carolina.

The conference is free for AHCJ members, but registration is required by May 25. Members who need financial assistance should apply for one of the limited travel stipends by the May 23 deadline.

The keynote speaker will be Hannah Koch, a research and technical assistance associate at the Mental Health Program, Western Interstate Commission for Higher Education. Koch will tentatively discuss key behavioral health issues in rural communities.

Five workshops will cover a variety of topics, including "What reporters should know about rural residents and rural health," featuring Alan Morgan, chief executive officer of the National Rural Health Association and Dr. Jeffrey Heck, president and chief executive officer of the Mountain Area Health Education Center.

Another workshop, "Will your local hospital survive?" includes George Pink, deputy director of the North Carolina Rural Health Research Program and Dana Weston, president of the University of North Carolina Rockingham Health Center.

The "Addressing rural health workforce hurdles" workshop includes Mark Holmes, director of the North Carolina Rural Health Research and Policy Analysis Center and the director of the Cecil G. Sheps Center for Health Services Research and Dr. Robert Bashford, associate dean for the Office of Rural Initiatives at the University of North Carolina School of Medicine.

The "Rural opioid crisis: Access to treatment and harm reduction" workshop includes Regina LaBelle, visiting fellow, Duke-Margolis Center for Health Policy and a former chief of staff in the White House Office of National Drug Control Policy and Donald McDonald, executive director, Addiction Professionals of North Carolina.

And wrapping up the day is a workshop titled, "Can telemedicine transform health care in rural communities?" featuring Latoya Thomas, policy director for the American Telemedicine Association.

To register for the event click here. To request a travel stipend click here or send an e-mail to the membership coordinator Tina England at Tina@healthjournalism.org.

On GateHouse and Gannett building 'stronger communities'

After GateHouse Media bought the Pueblo Chieftain in Colorado, it said  it would leverage its national resources "to support the community that will enhance quality of life and help create a stronger community." Kevin Slimp, founder of the news industry site State of Newspapers, was skeptical of the claim by the company that owns more U.S. newspapers than any other.

"Please, someone … anyone … who has been in a community where GateHouse has purchased the local paper and helped create a stronger community, please let me know. I just haven’t seen it," Slimp writes.

Same goes for Gannett Co., which posted a sign outside the Sioux Falls Argus Leader in South Dakota that said something about building a stronger community. "I couldn't help but chuckle, thinking, 'They just didn't mention the community is someplace besides Sioux Falls!'" Slimp writes.

Slimp concedes he may be missing something. It's possible GateHouse and Gannett really are building strong communities, but smaller newspaper publishers keep thanking him for sticking up for them, implying that Gannett and GateHouse don't. Slimp recalls a quote from Upton Sinclair's The Jungle: "It is difficult to get a man to understand something when his salary depends upon his not understanding it."

Some rural areas hit by opioid epidemic don't get priority for federal response grants; CDC cites lack of county drug data

"A federal agency recommended steering the $100 million Congress appropriated for rural counties to battle the opioid epidemic to those dealing with high rates of hepatitis C infection and HIV/AIDS instead," leaving out many rural counties hit by the epidemic, Susannah Luthi reports for Modern Healthcare.

In April, the Health Resources and Services Administration said it would award 75 grants to counties to develop plans for opioid-abuse treatment and recovery, selecting counties considered "at risk" by the Centers for Disease Control and Prevention. But the CDC prioritized counties based on confirmed cases of hepatitis C instead of opioid-overdose rates, according to emails obtained by Modern Healthcare. A CDC official wrote in one that the agency's selected counties are not those "most at risk for overdose or with the highest rate of opioid overdose." The emails said the agency chose hepatitis C infection rates as the key indicator because there is no county-level measure of injection drug use.

While there is a great deal of overlap between the counties facing hepatitis C and those with many  overdoses, some counties with high overdose rates and low hepatitis C rates were left out of the CDC's recommendations. "The CDC's metrics excluded some states battling the highest rates of opioid deaths, including New Mexico, New Hampshire and Florida. Other states with equally high rates, such as Nevada and Pennsylvania, have only a few counties flagged even though they are heavily rural," Luthi reports. "Kentucky, Tennessee, West Virginia and Missouri hold the most counties recommended for funding. These states face the same high opioid overdose death rates as excluded states like New Mexico and New Hampshire. But counties in other states with significantly lower death rates, such as Kansas and Georgia, also made CDC's priority list."

Report: industry insiders influence EPA more than ever

The Environmental Protection Agency is on the verge of "regulatory capture," a form of government failure in which an agency advances the interests of the industries it's meant to regulate instead of public interest and impartial research, according to a new study in the American Journal of Public Health, Neela Banerjee reports for Inside Climate News.

The study, based on interviews with current and former EPA staff and reviews of White House and EPA initiatives, found that the agency is closer to regulatory capture than it has ever been in its 47-year history. "New EPA leadership has thus far aimed at deconstructing, rather than reconstructing, the agency by comprehensively undermining many of the agency's rules, programs, and policies while also severely undercutting its budget, work capacity, internal operations and morale," said the study.

The report suggests that EPA Administrator Scott Pruitt has enabled this shift toward industry interests by making policy decisions with little input from scientists or longtime staff, and also notes "the extraordinary lengths that Pruitt has [gone to] to preserve secrecy and autonomy from the EPA career staff, such as cordoning his office wing off from career employees, reportedly forbidding note taking at some meetings and employing 24-hour armed guards," Banerjee reports.

The report also chronicled Pruitt's efforts to trash longstanding scientific practices in the agency by dismissing scientific advisory boards and hiring industry insiders. It also noted that the EPA issued 60 percent fewer civil penalties in the first six months of Pruitt's term and an overall decline in enforcement.

Searching public notices nets this reporter big stories

Jim Lockwood

Public notices may seem dry, but they can provide leads to good stories. Jim Lockwood, a reporter at the Scranton Times-Tribune, has won numerous awards for stories he wrote after discovering their genesis in public notices, from estate sales, meeting notices and sheriff's sales of property confiscated in drug seizures. He began searching public notices and clipping out interesting ones as a young reporter in New Jersey, a practice he continues today.

"Reading public notices for story ideas is a skill Lockwood has acquired through years of practice. He can look at most notices and tell, at a glance, if they hold a key to unlocking a good story," Teri Saylor writes for the Public Notice Resource Center. "Lockwood’s sharp eyes and skilled follow-up have earned him several prestigious awards over the years, including PNRC’s Public Notice Journalism Award in 2015, and every public notice award in the Pennsylvania NewsMedia Association’s annual journalism contest since that category was opened in 2014."

And this year he won first place in PNA's contest, and honorable mention in the PNRC competition, for his coverage of municipal issues discovered in the Times-Tribune's public notices. "The notices inspired extensive reporting on a variety of topics including the municipal budget, a delinquent-tax sale affecting 1,900 properties, local government plans to divert federal money allocated for a bridge repair to a variety of street paving projects, and one of his favorites — the sale of the local sewer authority to a water company," Saylor reports.

Some officials complain that public notices are too expensive, and are trying to get state legislatures to cut back on them. Lockwood notes that Scranton taxpayers benefited when the city was forced to publish a list of delinquent tax bills. The city had failed to published them for years, so the notice took up 10 pages. Because people don't like seeing their names in print for delinquent taxes, they're more likely to pay up, Lockwood said. That means fewer people owe delinquent taxes, the city has to spend less on publishing notices, and gets more revenue from back taxes. "It's a great return on their investment," Lockwood told Saylor.

Five myths about U.S.-Mexico border

A group of Central American asylum-seekers who arrived at the U.S.-Mexico border last week has prompted a new round of debate on border management and security. But some of the rhetoric isn't based in fact. So Christopher Wilson, the deputy director of the Wilson Center's Mexico Institute and a knowledgeable source on border affairs, has debunked five popular myths about crossings at the  U.S.-Mexico border.

The first myth is that the border is out of control. Though retired Gen. Barry McCaffrey's 2011 strategic military assessment described conditions along the border as tantamount to living in a war zone," the Mexico Institute's data analysis shows that all but one of the 23 U.S. counties along the border had violent crime rates lower than the national average for similar counties from 2011 to 2015, Wilson reports for The Washington Post.

The second myth is that a border wall would help the opioid epidemic. President Trump said in March that 90 percent of the heroin in America comes through the U.S.-Mexico border, Wilson reports. But heroin was only the third most frequent cause of opioid-related deaths in 2016. The top two were fentanyl and prescription opioids, respectively. Prescription opioids are produced and shipped within the U.S. Some fentanyl is trafficked through Mexico, but usually in vehicles at official crossings where a border wall wouldn't help, and the lion's share of fentanyl is shipped by mail from China. And though most heroin is trafficked from Mexico, like fentanyl, smugglers mostly bring it in vehicles through legal border crossings.

The third myth is that border enforcement doesn't reduce illegal crossings. For decades, increased border security spending failed to reduce illegal immigration, instead causing immigrants to simply try crossing in more remote, dangerous areas. But border officials have gotten better at catching undocumented immigrants. "And surveys show that Mexican migrants apprehended and returned to Mexico have become much less likely to attempt to reenter the United States, with the share saying they’d try again falling from 95 percent in 2005 to 49 percent in 2015, according to a Migration Policy Institute report," Wilson reports.

The fourth myth is that terrorist groups are exploiting a porous border. In 2014, Rep. Duncan Hunter (R-Calif.) said least 10 ISIS fighters were caught crossing the border into the U.S. in Texas. In 2015, some reported the Islamic State had a camp outside of Ciudad Juarez, Mexico. Both claims were quickly proven false. "As the State Department has reported, Mexico has cooperated closely with the United States on counterterrorism issues, and there is 'no credible information that any member of a terrorist group has traveled through Mexico to gain access to the United States,'" Wilson reports.

The fifth myth is that Mexico has strong border laws and the U.S. has weak border laws. President Trump has bolstered that claim recently, tweeting that the caravan of Central American asylum-seekers was "largely broken up thanks to the strong immigration laws of Mexico," Wilson reports. It's true that Mexico plays an important role in either absorbing Central American migrants by giving them refugee visas or deporting them before they reach the U.S. border, but Mexico also reformed its immigration policy in 2011 to decrease corruption and strengthen protection of migrants' human rights. "As for U.S. immigration laws being weak, that is hard to square with an immigration and border security system that detains and removes hundreds of thousands of people from the country each year," Wilson writes."Rather than a weak legal framework, the United States has an under-resourced asylum and immigration court system. Asylum applications have more than quadrupled over the past decade, causing a backlog of more than 300,000 cases."

'Blue wave' Democrats hope for in fall elections isn't likely unless they do better with voters outside the largest cities

With the midterm elections approaching, pundits and news stories keep talking about a possible "blue wave," a surge in votes for Democrats as a response to President Trump and Republican policies. In this narrative, rural residents triggered Republican control of Congress in 2010 and the White House in 2016, "at best a misleading and incomplete account," Bill Bishop and Tim Marema write for The Daily Yonder. "And it also misses a more important trend in the nation’s politics since Barack Obama won the presidency in 2008: the increasing concentration of Democratic voters into the largest metropolitan areas."

Democrats have been losing voters outside large metros since 1980, but the trend is accelerating. "Democrats don’t have a rural problem. They’ve got an everywhere-but-the-nation’s-largest-cities problem," Bishop and Marema report. They broke down communities into six categories: Major Metro Core (pop. 1 million or more), Major Metro Suburbs (the suburban counties of major metropolitan areas), Medium Metro Core (pop. 250,000 to 999,999), Medium Metro Suburbs (the suburban counties of medium-sized metropolitan areas), Small Metro (pop. 50,000 to 249,999), and Nonmetro/Rural (all counties not located in a metropolitan statistical area). On the charts below, the red and blue lines denote congressional races, while the columns denote presidential races:

Daily Yonder map; click on the image to enlarge it.

Bishop and Marema note that rural voters didn't heavily swing Republican until 2010, two years after Democrats won the White House and took control of Congress. They have since turned more Republican, but so have smaller metros, to a lesser extent.

"For a 'blue wave' to crash into Washington this election season, Democrats will have to do more than activate the major metropolitan base," Bishop and Marema write. "That tactic was enough to get Obama re-elected in 2012 but not enough to fend off Donald Trump in 2016. And for congressional races, it hasn’t been enough to win a House majority since 2008."

Ohio voters pass limited reform of redistricting

Ohio's current congressional districts (Vox map)

Ohio voters reformed their redistricting system in a referendum Tuesday, with about 75 percent of voters favoring the proposal aimed at limiting partisan gerrymandering. "The new redistricting process, which affects how Ohio draws its congressional district lines, will be used when those lines are next redrawn, after the 2020 census," Andrew Prokop reports for Vox.

The ballot initiative received strong bipartisan support, and passed both the state House and Senate unanimously three months ago. That's notable in a state with some of the most pro-Republican gerrymandered districts: In 2012, though President Obama won the popular vote in Ohio, Republicans won 12 of the state's 16 congressional districts under the map Republicans created in 2010.

The plan could limit Ohio Republicans' power in the future, but groups like the League of Women Voters and Common Cause gathered public support for reform, and the GOP feared that failing to cut a deal would result in more radical measures later. With this plan, "the legislature would have to try to come up with a new map supported by a big bipartisan majority," Prokop reports. "If they fail, however, a one-party map could still pass — but it would now expire after four years, rather than the current 10." The plan also restricts how often counties can be split up, and mandates that maps can't "unduly" favor a political party or its incumbents. That will be open to interpretation by the courts.

Medicare-Medicaid agency says it will lower barriers to telehealth, improve outreach to rural health-care providers

This week the Centers for Medicare and Medicaid Services released a rural health strategy as a sign that it won't forget rural communities when creating regulations. More than 60 million people live in rural America.

The eight-page plan outlines "reduce regulatory barriers to telehealth, improve outreach to providers in these communities to make sure they understand CMS programs, and identify practical solutions that will help better care in these areas," Virgil Dickson reports for Modern Healthcare. "The document did not outline policy announcements."

The plan aims to formally analyze what, if any, impact proposed CMS rules will have on rural health providers and communities, which it has not consistently done until now. 

National Rural Health Association CEO Alan Morgan told Dickson, "We are optimistic that this effort at 'rural proofing' will provide a better regulatory environment for rural providers."

During grilling by House panel, some opioid distributors express regret for feeding West Virginia's drug habit

Past and present executives for five top pharmaceutical distributors testified before the House Energy and Commerce Committee's oversight subcommittee yesterday in a probe of their role in providing pills to West Virginia, the state with the highest rate of opioid-overdose deaths. "Lawmakers drilled the executives on key questions, such as whether they fell short of complying with federal regulations to report suspicious orders, whether their products have contributed to the opioid abuse crisis and how they’re ensuring pill dumping doesn’t happen again," Paige Cunningham reports for The Washington Post.

Some executives expressed regret: Miami-Luken Chairman Joseph Mastandrea said he thinks his company contributed to the opioid crisis. And Cardinal Health executive chairman George Barrett said he wished the company had moved more quickly to stop sending millions of opioid pills to West Virginia, and believes that Cardinal would "reach different conclusions" about the unusually large orders of opioids ordered for a handful of pharmacies. "But Barrett, along with executives from AmerisourceBergen, McKesson and H.D. Smith said they don’t think their companies contributed to the opioid crisis," Cunngingham reports.

Those executives who denied culpability argued that their companies only fulfill orders from pharmacies, but do not make or prescribe the drugs. Several said they've made changes in their distribution systems to stop suspicious orders from being fulfilled. Several companues face lawsuits from states blaming them for the epidemic.

Controversial coal man places poor third in W. Va. primary

Don Blankenship

Convicted coal operator Don Blankenship came in third yesterday in the Republican primary for a U.S. Senate seat in West Virginia. Blankenship got about 20 percent of the vote, compared to nearly 35 percent for the winner, state Attorney General Patrick Morrisey. U.S. Rep. Evan Jenkins got about 29 percent. "Blankenship, who has poured millions of dollars into state elections, vowed he would not support Morrisey in the general election," reports  Jessica Farrish of The Register-Herald in Beckley.

The former Massey Energy CEO's campaign grabbed national headlines as the public wondered how a candidate who called himself "Trumpier than Trump" would do in a region where the president enjoys some of the highest approval ratings in the country. Then Trump said in a Monday tweet that Blankenship couldn't win in the general election against Democratic Sen. Joe Manchin. "Blankenship said Tuesday night that he thought the tweet cost him 10 percentage points or more," Trip Gabriel reports for The New York Times.

Blankenship had pulled even with Morrisey and Jenkins in one recent poll after pouring $2 million of his personal fortune into ads. He painted himself as a victim of government insiders, referring to his prison sentence for his role in the Upper Big Branch mine explosion that killed 29 miners in 2010. He also decried national Republican leaders' efforts to derail his campaign, calling Senate Majority Leader Mitch McConnell "Cocaine Mitch," a reference to the drug being found on one of the ships owned by McConnell's Chinese-American in-laws (whom Blankenship described as "China persons"). Which explains the post-race tweet from McConnell's 2020 re-election campaign:

Telemedicine brings transgender care to rural areas

Much has been made about the value of telemedicine in rural areas, but there's another, not often discussed, benefit to it: its ability to help transgender people access discreet, experienced medical care. Ten percent of transgender people said they'd faced discrimination while seeking care, and 22 percent said they've avoided seeking care because they worried about discrimination, a 2017 poll found. "Many fear discrimination will increase with strengthened protections for doctors and nurses refusing to provide certain care on religious grounds," Keren Landman reports for NPR. "The more care refusals transgender people experience, the less care they seek, and the higher their rates of preventable and treatable conditions, including cancers, mental health problems, and substance-use disorders."

Beyond the fear of discrimination, it's hard for transgender people to find medical care in rural areas because there are far fewer doctors and nurses competent in transgender care. And that's on top of the challenges cisgender people face in finding rural medical care: long drives and long waits to receive care.

That's why Izzy Lowell, an Atlanta family practitioner who specializes in transgender care, created QMed in 2017. Transgender or gender non-conforming patients in the Southeast  can set up telemedicine appointments with Lowell in which she addresses sensitive topics like body changes or sexual function. To ensure privacy, Lowell uses headphones during webcam visits and uses white noise machines in her waiting room for in-person visits.

As with other telemedicine services, lack of reliable, affordable broadband may be a barrier for potential patients. And though 32 states have laws mandating that private insurance companies compensate doctors as much for telemedicine appointments as they do for in-person appointments, telemedicine providers in other states may struggle to get reimbursed and turn a profit, Landman reports.

Lowell reports that, less than a year after starting QMed, she's almost covered her startup costs and will soon turn a profit. But she says the administrative headaches are worth it. "The current system is not at all fair to transgender people," she told Landman. "And I don't like unfairness."

Coal's share in national energy mix falls; gas's share rises

"Coal’s share in the nation’s electricity mix is predicted to fall to 29 percent this year, as natural gas-fired power continues to increase, according to the Energy Information Administration’s Short Term Energy Outlook, released Tuesday," Heather Richards reports for the Star Tribune in Casper, Wyo. That's down from last year's 30 percent. Natural gas will take the biggest slice of the energy mix this year at 34 percent, up from 32 percent last year.

The prediction coincides with an expected decline in coal production, though Appalachian coal may take more of a hit than the Powder River Basin. According to the EIA, coal from Western states will increase from 430 million short tons in 2017 to 432 million short tons in 2018. Midwestern coal will also get a small bump, while Appalachia will lose tonnage, Richards reports.

"Most of the new power capacity built this year is also expected to be in the form of natural gas plants, representing a shift in the renewable energy trend," Richards reports. "Since 2013, the majority of new power has been from wind and solar, according to the Energy Information Administration. The majority of new gas plants are planned in eastern states, including Pennsylvania and Virginia, according to the Energy Information Administration. There are no new coal plans in development nationally."

Interactive map shows how much each county relies on SNAP; 85 of 100 highest-ranking counties are rural

SNAP enrollment as a percentage of county population (Daily Yonder map; click the image to enlarge it)

Use of the Supplemental Nutritional Assistance Program, once known as food stamps, is declining nationwide as the economy improves, but it remains more of a lifeline in rural areas. When U.S. counties are ranked by the percentage of population on SNAP, 85 of the top 100 are rural, according to 2015 census data. Rural counties are likely to rely on it at a higher rate for the foreseeable future, since most haven't yet reached pre-recession job levels. The counties most reliant on SNAP tend to be in Indian Country, Appalachia and the Black Belt, Tim Marema reports for The Daily Yonder.

"SNAP is in the news because of a dust-up in the House of Representatives," Marema reports. "Republicans on the Agriculture Committee have passed a farm bill that could cut as much as $9 billion from SNAP. This maneuver appears to be shattering the classic coalition of lawmakers that normally makes the Farm Bill a bipartisan exercise." The cuts are not expected to pass the Senate.

Click here for a list of the top 100 counties by population percentage reliant on SNAP.

Click here for an interactive map of each U.S. county's reliance on SNAP.

In many rural areas, dating gets tricky, but apps can help

Dating can be complicated for anyone, but it can be much more daunting if you live in a rural area. So many young people leave their rural hometowns for city life, that pickings can be slim, Rachael Vasquez reports for Wisconsin Public Radio. That means it's hard to meet strangers or go on a date without kicking up the town gossip mill. The other alternative? Being willing to drive long distances to the closest city to date.

Kris Evans, who lives in rural Wisconsin, joked about how hard it was for country folks to find a date without driving for hours: "I kind of laughingly call it 'city privilege,'" he told Vasquez.

But the proliferation of dating apps like Tinder, Grindr, and Farmers Only has helped rural people meet potential dates more easily than previous generations, even though they still sometimes find themselves driving to nearby cities to make it work, Vasquez reports.

Catalina Toma of the University of Wisconsin, who studies relationships and online dating, told Vasquez there can be benefits to a smaller dating pool: "When you have fewer people to choose from, you might be more committed to them and more willing to give your all to that relationship and more willing to work on it."

Bariatric surgery is out of reach in the heaviest states

In red states, Obamacare plans don't cover bariatric surgery.
(Bariatric surgery society map; click  the image to enlarge it.)

The reasons for obesity, which hits rural areas hardest, are many: lack of nutrition education, inability to afford or otherwise access healthy foods, cultural preferences, or an inactive lifestyle. And it can lead to a host of health problems, from diabetes and heart disease to early death. A combination of diet and exercise is theoretically the best way to take the weight off, but the morbidly obese who use only that strategy tend to gain it all back. Bariatric surgery is the most effective approach for such patients because it shrinks the stomach and changes the body's level of hunger hormones, but hundreds of thousands of patients in the nation's most obesity-prone areas can't access it because it isn't covered on their health-care plans.

In red states, state-employee plans don't cover the surgery.
(Bariatric surgery society map; click the image to enlarge it.)

Though the surgery cuts obese people's risk of death in half, "experts and surgeons say the procedure is treated by insurance companies less like a life-saving treatment and more like a nose job: frivolous and optional. According to the American Society for Metabolic and Bariatric Surgery, many states don’t cover the procedure in their state-employee, Obamacare, or Medicaid plans," Olga Khazan reports for Route Fifty.

Jon Gould, a surgeon at the Medical College of Wisconsin, notes that insurance companies could save money in the long term by covering bariatric surgery, since it often fixes expensive chronic health conditions like diabetes. "But state budgets, which help fund Medicaid, are often pinched and need immediate returns on investment, not savings on insulin and doctors’ visits that may not add up until five or 10 years later," Khazan reports.

Plans that do cover bariatric surgery often impose high barriers to qualify for it, such as requiring patients to quit smoking, not gain any weight for three months before the surgery, or fail at following a structured diet program for six months.

Outdated ideas about obesity as a personal failure may also be a factor. In Mississippi, where more than 37 percent of adults are obese, a bill to help bariatric patients pay for surgery in Mississippi stalled out in 2015 after it became known locally as the "belly-band bill."

"Adding a bariatric benefit in a conservative state where there is a prejudice or bias against morbidly obese people . . . so many people think you're enabling them," said David Dzielak, Mississippi's former Medicaid director.

Pipeline-protesting tree-sitters come down, hit the road

Theresa Minor Terry (L) and Theresa "Red" Terry (R) spoke at a
Charlottesville protest. (Daily Progress photo by Zack Wajsgras)

A mother and daughter who camped in trees to block a natural-gas pipeline on their family's Virginia property came down Saturday after a federal judge threatened heavy fines, Gregory Schneider reports for The Washington Post.

Late Friday afternoon, U.S. District Judge Elizabeth Dillon found Theresa "Red" Terry, 61, and her daughter, Theresa Minor Terry, 30, in contempt of a court order that granted the builders of the Mountain Valley Pipeline entry to their land. If they didn't come down by midnight, Dillon ruled, they would be fined $1,000 a day and arrested by federal marshals.

"After the ruling, Coles Terry [Red's husband] said the women would come down. Even if they didn’t mind paying the fines, he said, the judge had directed that the money go to the pipeline builders — a notion that disturbed the Terrys," Schneider reports.

The women came down from the trees shortly after 4 p.m. Friday, but have not given up their protest: both are now leading public protests in the area to demand action from Gov. Ralph Northam and urge the Virginia Department of Environmental Quality to report unfavorably on the Mountain Valley and Atlantic Coast pipelines' effect on streams and waterways, Tyler Hammel reports for The Daily Progress in Charlottesville.

At a rally in Charlottesville on Monday, Red Terry was blunt about what she told Northam she wanted: "I told him that I had to grow a set, and it's damn time he did too," she said. "I really think the governor should stop bending over for Mountain Valley and Atlantic Coast and stand with the people." The Terrys have planned several other protests around the state.

Kentucky's (and nation's?) oldest working dentist dies at 97

Dr. J.M. Stephenson

Julius Middleton Stephenson, who was Kentucky's oldest working dentist, and may have been the oldest in the nation, died May 5 in Bowling Green. He practiced in the Cumberland River town of Burkesville, population 1,500.

Stephenson worked in his office as recently as March. He was a fixture at the state high school basketball tournament well into his 90s, and was secretary-treasurer of the South Central Kentucky Dental Society for 40 years. His son and daughter, who survive, are both dentists.

His funeral service will be held at 2 p.m. Wednesday at Burkesville First United Methodist Church with burial in Burkesville Cemetery with military honors. Flowers are welcome, but donations are encouraged to Lindsey Wilson College in Columbia, Ky.

Full disclosure: In his youth, the writer of this post was a patient of Dr. Stephenson.

Small town Oklahoma daily editor explains why she stuck with rural journalism in thoughtful opinion column

Kim Poindexter

In a thoughtful opinion column, Kim Poindexter, the managing editor of the Tahlequah Daily Press in Oklahoma, explains why she stayed in rural journalism--and in journalism altogether, with its notoriously long hours and lousy pay.

Poindexter always wanted to be a writer, but her decision to become a journalist "was not welcomed with joy" by her family, who adored President Nixon and were appalled that journalists had forced his resignation. But: "Journalism is a noble profession. I know that, and so do you, or you wouldn't be reading this newspaper," she writes. "You and I know what the Father of this nation envisioned for the Fourth Estate, and how critical they deemed our 'watchdog' function to be against the inevitability of a government gone awry. That's why the First Amendment is first, and the Second, second: The pen truly is mightier than the sword, and all of us who have a lick of sense know that."

Today, journalists are a dying breed whom many Americans believe are the purveyors of "fake news," Poindexter writes. That didn't start with President Trump, though: "What came first was the disparaging of teachers, and attempts by self-serving politicians to dismantle public education," she writes. "It's a historical fact that the first people to be sent by would-be tyrants to the proverbial gulag are educators, journalists, doctors, lawyers and anyone else who might be in a position to question their authority. The power-brokers would rather keep the rest of us as ignorant as possible, so we'll believe whatever they say, no matter how preposterous, and regardless of how much evidence is put forth to dispel their lies."

Poindexter writes that she enjoys the opportunity to fight those power-brokers at the local level. "I've grown to love not just the Press, but Tahlequah itself. I've made a commitment to this little city, with its eclectic mix of people, talent, landscapes, and opportunities," she writes.

Read more here.

Rural mail carriers reeling after a decade of budget cuts

With fewer choices for rural retail, small-town residents increasingly shop online to buy everyday necessities. FedEx and UPS find it hard to make a profit in rural areas, so rural mail carriers have a bigger job than ever, one they're often obliged to do with less funding and fewer staff. The U.S. Postal Service is most critical as a public institution in rural areas, "but rural areas are also where the agency’s recent cutbacks have been the most debilitating," Jake Bittle reports for The Nation. "As the USPS has phased in workforce cuts over the past decade, it has created what amounts to a labor shortage at the country’s smaller stations. Across rural America, routes are vacant, offices are understaffed, and turnover rates are high." 

Some of the problem stems from a 2006 law that required the USPS to pre-fund retiree benefits; the financial blow prompted management to cut the workforce deeply and reduce investments in infrastructure. Nearly a dozen rural carriers told Bittle that their routes have gotten longer and their loads heavier because of the labor shortage, sometimes requiring them to work past dark on unlit roads. They say they've also had to work on days off, work unfamiliar routes far from home, and work double-length days for no extra pay, Bittle reports. 

The reason they're not paid extra for those long hours is that, instead of getting paid hourly, rural carriers are paid a flat rate based on how long their route should take, without regard to how heavy the mail is. "The pay system currently estimates that it takes about 30 seconds per parcel, which seems to some carriers almost comically low when they’re carrying a 50-pound bag of dog food or a cage of baby chickens to a farmhouse doorstep," Bittle reports.

That's not the only difference between rural and urban mail carriers. Most rural carriers drive their own cars, since regular mail trucks sometimes can't handle country roads. Also, "they are represented by a separate union, the National Rural Letter Carriers’ Association, which lacks the funding and thus the leverage of its city equivalent, the National Association of Letter Carriers," Bittle reports. 

Though the work can be dangerous (RuralInfo has an In Memoriam page to honor rural carriers who died on the job), rural mail workers told Bittle that the work was difficult but rewarding until recently. But in 2010 when e-commerce became more widespread and package volume increased dramatically, rural postal workers became increasingly overwhelmed by a job they say has not changed to keep track with reality.

Tick-, flea- and mosquito-borne diseases tripled since 2004

Lone star tick. (Wikipedia photo)

Make sure to put on your bug spray before the family cookout this summer: Diseases spread by bites from mosquitoes, fleas and ticks tripled in the United States between 2004 and 2016, according to a new report from the Centers for Disease Control and Prevention. Those diseases include Lyme disease, West Nile virus, the plague, and Zika.

Lyle Petersen, director of the Division of Vector-Borne Diseases at the CDC's National Center for Emerging and Zoonotic Infections Diseases, said "The data show that we're seeing a steady increase and spread of tick-borne diseases, and an accelerating trend of mosquito-borne diseases introduced from other parts of the world," John Tomasic reports for Route Fifty.

In addition to the diseases they cause, bites from the lone star tick can trigger something weirder: an allergy to beef and pork, Zoya Teirstein reports for Grist. Because of global warming, the once-scarce tick has expanded its range to most of the eastern half of the U.S. Lone star ticks thrive in warm, humid environments, and with fewer days below freezing, they're able to stay active longer and breed more. Reforestation efforts may also contribute to the lone star tick's resurgence: they love to hitchhike on white-tailed deer, which are coming back because they have more room to roam.

Interior Dept. gas and oil development plan weakens sage grouse protections; conservation groups file suit

The Bureau of Land Management has released a plan that would change Obama-era rules that kept oil and gas companies from developing on the Western greater sage grouse's habitat, which is mostly in Wyoming and 10 other surrounding states. The rules had been developed over nearly a decade with input from states, ranchers, developers and conservationists to keep the rare bird off the endangered species list. Scientists and conservationists say the changes, which will make millions of acres in Western states available for mining and drilling, "will continue the fragmentation of the sage grouse, a bird that gains strength in numbers and withers when development breaks groups apart," Darryl Fears reports for The Washington Post.

Interior Secretary Ryan Zinke promised that states where the sagebrush grouse lives will be allowed to decide where projects on federally leased land will go--a courtesy which, conservationists complain, was not offered to coastal states that opposed leasing federal waters to oil and gas companies.

Two conservation groups, the Western Watersheds Project and the Center for Biological Diversity, filed suit on Wednesday. The "suit highlighted 'a massive proposed development of some 3,500 oil and gas wells within critical sage grouse winter habitat' — the Lance project — as a cause of concern. According to the legal action, the U.S. District Court for Idaho, where it was filed, did not stop the project during earlier hearings in 2012 because the project wasn’t final. Now, the suit said, 'BLM is moving forward in approving the Lance project even though it poses severe threats to sage-grouse and other wildlife habitats and populations,'" Fears reports.

Apply by June 1 for year-long fellowship, starting with expense-paid trip to NYC, on covering rural jails and prisons

Photo by mksfly via Flickr

Jail populations are rising in rural areas, partly because prosecutors delay trials in the hope of extracting guilty pleas. Jails have also become warehouses for the mentally ill, and many are outdated and badly cramped. There is a need for more enterprise and investigative reporting on jails on rural jails and prisons, and the John Jay College of Criminal Justice at the City University of New York is trying to help with a program called "Rural (In)Justice: Covering America's Hidden Jail Crisis."

On July 10-11, the college’s Center on Media, Crime and Justice will hold a two-day conference to start a year-long fellowship program to "strengthen the capacity of journalists in rural and smaller jurisdictions to investigate the causes of the growth in jail populations, and report on policy remedies and alternatives," says the center, which will select up to 30 journalists for fellowships, which include a required, all-expense paid trip to the conference.

The conference, on the John Jay campus, "will bring journalists together with leading practitioners, researchers and officials who are involved in jail and incarceration issues for in-depth, on-the-record discussions," the center says. In the year that follows, the fellows will have online “refresher” sessions with sources and policymakers and get research assistance for their reporting projects.

The center will select fellows through a competitive process, which will give special preference to journalists in small or rural areas, or those covering state capitals. Applicants should provide biographies of 100 to 150 words, a supporting letter from a senior editor or assigning editor and a brief description of projects underway or contemplated relating to jail/rural justice issues. Freelance journalists are also eligible, as long as they fit program criteria.

Applicants are encouraged to highlight any work in progress that would benefit from their participation. Fellows will be expected to have produced for publication one or several stories related to their project proposals within six months of the conference close. Their work may be posted in The Crime Report, the center's online criminal justice news and resource network.

The deadline for applications is 11:59 p.m. Friday, June 1. Selections will be announced the following week. To apply, click here. Questions? Contact journalism coordinator Maurice Possley at mauricepossley@gmail.com or project administrator Ricardo Martinez at rmartinez@jjay.cuny.edu.