National Rural Health Day is Thursday, Nov. 15

Rural communities have unique health-care needs: accessibility, a lack of providers, the needs of an aging population suffering from a greater number of chronic conditions, and larger percentages of people without health insurance or enough insurance. On top of that, rural hospitals – many of which are local economic linchpins – struggle with declining government reimbursements and the lack of Medicaid expansion in many states.

For these reasons and more, the National Organization of State Offices of Rural Health observes each third Thursday of every November – this year, Nov. 15 – as National Rural Health Day. "First and foremost, National Rural Health Day is an opportunity to 'celebrate the power of rural' by honoring the selfless, community-minded, can-do spirit that prevails in rural America," NOSORH says. "But it also gives us a chance to bring to light the unique healthcare challenges that rural citizens face – and showcase the efforts of rural healthcare providers, state Offices of Rural Health and other rural stakeholders to address those challenges."

Tyler Childers became a voice of Appalachia partly from his negative reaction to Diane Sawyer's 2009 documentary

Tyler Childers (Photo by David McClister)

This article is a few months old, but provides a great in-depth portrait of singer and songwriter Tyler Childers, an Eastern Kentucky native who has "earned praise from, and comparisons to, John Prine."

Childers, 27, was in high school when ABC News's "20/20" came to town for a report on children in Appalachia. He and many others disliked it for what they considered its use of stereotypes, especially after Diane Sawyer's crew gave out Mountain Dew and encouraged locals to drink it while they filmed, then reported on the prevalence of tooth decay because of drinking the sugary soda.

"This split reality — the way the media and the rest of the world, outside of his community, portrayed Appalachia and blue-collar America, and the way he saw it day to day — clearly left an impression," Marissa Moss writes for Rolling Stone. "Childers started writing songs about what life was really like up in those hills — on 2011’s Bottles and Bibles, recorded in a friend’s backyard studio, he sings about the struggle to raise a family and put food on the table with one foot in the coalmine and one in the grave ('Hell’s probably better than trying to get by,' he laments in the song 'Hard Times.') Childers was a teenager, but he wanted to tell the world what existed beneath the 'Mountain Dew Mouth' narrative, and he wanted to tell the people who lived there that he understood their plight. And that he would tell their truth. . . . Childers was a red-haired kid who wanted to be a journalist or an English teacher, but that changed once he started playing the guitar."

Moss writes, "Childers’ sound — a fusion of folk, bluegrass and country with a raw, emotionally gripping tinge that’s halfway between a confession and a holler — is born of his life growing up in East Kentucky, a place rich with forgotten stories and people just trying to do the best they can." Here's our favorite, "Universal Sound," full of Appalachian geography and culture:

Three-part package explores Missouri dairy industry

Kathryn Hardison of The Missourian, KOMU-TV and KBIA-FM have collaborated to produce "Evaporating," a stellar three-part package exploring the Show-Me State's dwindling dairy industry.

In the first piece, Hardison reports that consumers who care about locally grown food may have a hard time finding local milk: "Missouri is in a milk deficit. There isn’t enough milk to meet all of the state’s dairy needs — fluid milk, cheese, yogurt, ice cream. Missouri is already importing milk from other states for consumers, and that trend will only continue as its dairy footprint becomes smaller." The number of cows in the state has decreased from 27.8 million in 1945 to 84,000 in January 2018, the lowest number in more than a century. Some of the local shortage is because most milk processors in Missouri are cooperatively owned and move milk where it gets the best price.

The second piece is about the trend of consolidation that Missouri dairy farms have seen in recent years, and why that means fewer young people are getting into the business: "Larger dairy operations skew the economies of scale that small dairy farmers are so used to operating on. There's an oversupply of milk in the country, and milk prices are falling. The cost of becoming competitive is much larger than the size of the paycheck. The job is too labor-intensive to interest a young person."

The third piece explores what life is like for small dairy farmers and the financial pressures they face as they try to adapt to the modern dairy market. Third-generation dairy farmer Sean Cornelius told Hardison "Our cost of living has gone up so much, and our cost of what we sell has gone down; it’s just the reality is it takes more units of that small margin to be able to make a living."

USDA report says telehealth services are used least by rural residents, who need it most

Rural telehealth use in 2015 (USDA chart)

A new U.S. Department of Education report says telehealth isn't being used by those who need it most. Rural Individuals' Telehealth Practices: An Overview says the need for telehealth may be greater in rural areas, but rural residents were less likely to use it.

Study author Peter Stenberg, a USDA economist, used data from the Census Bureau's 2015 Current Population Survey to analyze how Americans age 15 and older use three basic telehealth activities: online health research, online health maintenance, and online health monitoring.

Online health research is essentially what it sounds like: looking up questions about one's health and healthy practices online. Rural vs. urban response was not much different here: 17 percent of rural residents and 20 percent of urban residents conducted online health research in the survey. Education was a bigger factor: 29 percent of college-educated respondents did online health research compared to 13 percent with a high school diploma. There was no difference in responses among different income levels.

Online health maintenance means maintaining medical records, paying medical bills, and/or communicating with a health care provider. Only 7 percent of rural residents did this in 2015, compared to 11 percent of urban residents. Respondents with higher income and education were more likely do conduct online health maintenance.

Online health monitoring means using health monitoring devices such as medical alert devices or implants that connect wirelessly to the internet to constantly monitor health conditions such as heart disease. "The devices can allow individuals to stay home rather than at a hospital, hospice, retirement home, or some other health facility," Stenberg reports. 1.3 percent of rural residents used such monitoring compared to 2.5 percent of urban residents. The more income someone has, the more likely they were to use online health monitoring.

Because rural residents tend to be older, poorer and in worse health, telehealth services would be useful, but poor internet services and spotty laws are a few of the barriers to greater adoption of such services, Stenberg reports.

Charter school advocate: Rural schools can better succeed with freedom to choose different educational goals

Education pundit and charter-school proponent Michael McShane says policymakers and researchers can't improve rural education if they don't have a good understanding of it and the more than 9 million children who attend rural schools. McShane is research director of EdChoice, an organization dedicated to promoting school choice, and has just published a book examining rural education.

Modern education reform has not considered the unique needs of rural schools, instead using a one-size-fits-all approach that badly serves rural schools, McShane writes for Forbes, and says would-be rural school reformers should heed two tips.

The first is to focus on the strengths of rural communities to improve education, such as "leveraging trust, pride and cohesion." Rural communities have long-resented and resisted the efforts of urban dwellers who come to their towns and try to fix schools without understanding the communities. But building on rural communities' greater social cohesion is a better approach, McShane writes.

The second is to broaden the goals of education. In order to better prepare rural students for adulthood, schools shouldn't just try to improve math and reading scores on standardized tests. Many rural communities disagree on the best goals for students though. A good education often leads the best rural students to leave town for college and never come back, so some communities want to make sure there are jobs available in town and prepare students for them. Some communities want to make sure students have better schooling in technical or trade areas. Each community should have the freedom to decide for itself what the best goals for students are and how to accomplish that, McShane writes.

"What we can do is try to collect and disseminate as much information as possible so that those families, schools, and communities can make informed decisions about what courses and programs to offer," McShane writes. "We can create flexibility in funding streams that allow schools to offer as broad a range of courses and programs as they can so that each student can find the path most appropriate to his or her goals and abilities. And, we can work with both industry and institutions of higher education to make better links between K-12 schools and the opportunities that follow them so that fewer students fall through the cracks."

Small town in California 'destroyed' by fast-moving wildfire

The Camp Fire burns in Paradise, Calif. (The Associated Press photo by Noah Berger)

Tens of thousands of homes have been evacuated because of three fast-moving wildfires in California.

Paradise, a town of 27,000 north of Sacramento, was quickly overtaken by the Camp Fire, which started around 6:30 a.m. Thousands fled their homes. Capt. Scott McLean, a spokesman for the California Department of Forestry and Fire Protection, said "Pretty much the community of Paradise is destroyed — it's that kind of devastation," David Li and Alex Johnson report for NBC.

The Camp Fire is now at 70,000 acres and is only 5 percent contained, according to the Chico Enterprise-Record in Chico, a city of about 90,000 near Paradise. The flames have reached but not penetrated Chico.

Evacuation from Paradise was difficult because the town is on a ridge and has limited escape routes, Stephen Lam reports for Reuters.

The other two fires are affecting more urban areas in the southern part of the state, though some surrounding small towns have been evacuated. The Woolsey Fire is down in Thousand Oaks, northwest of Los Angeles, and the Hill Fire has reached 10,000 acres in Ventura County, Lam reports.

Election firms up political realignment that began years ago but is now driven by President Trump

"The midterm elections brought to a head a decade-long realignment of the U.S.’s major political parties, with Democrats winning contests in and around major cities while Republicans carried rural and small-town America," Reid Epstein and Janet Hook report for The Wall Street Journal. "Just as rural white voters fled the Democratic Party after Mr. Obama took office, educated suburbanites abandoned the GOP after President Trump’s election. Those trends continued Tuesday, and will not only alter the governing coalitions in Washington but also will change how and where candidates engage with the American electorate."

The divide "exposes fundamental problems for each party," Hook and Epstein write. "Republicans are the party of older, white Americans, many without college degrees, a demographic that is shrinking as a percentage of the population. Democrats are clustered in cities and suburbs, hampering their chances in rural districts."

Screenshot of Wall Street Journal interactive chart

"Rural" is a broad brush, and rural politics differ from region to region, as the results of two governor's races show. "The Republican candidates who appear to have won squeaker gubernatorial contests in Georgia and Florida blew the doors off their Democratic opponents in rural counties," Tim Marema writes for The Daily Yonder. "On the other hand, Democrats who won close governor races in Wisconsin and Kansas kept the rural vote more competitive."

In Wisconsin, Democrat Mark Evers ousted Republican Gov. Scott Walker, who had benefited from rural resentment, with an interesting mix of urban and suburban votes. The result was similar in Kansas, where Democrat Laura Kelly defeated Republican Kris Kobach. In Florida, where U.S. Rep. Ron DeSantis beat Tallahassee Mayor Andrew Gillum, "the pattern of Republican support climbing as counties become more rural was apparent," the Yonder notes.

The Wall Street Journal story suggests that the clearest example of realignment is along the lines of educational attainment: "Democrats hold 81 percent of House districts with the highest shares of bachelor’s degrees, up from half of such districts in 1998. Republicans hold nearly 60 percent of House districts with the lowest shares of bachelor’s degrees, compared with 44 percent in 1998."

Rural areas tend to have lower educational attainment. "In the 2010 midterm election, Republicans picked up 18 suburban districts and 41 seats situated in blue-collar or rural areas. In Tuesday’s contests, they lost at least 27 suburban seats, enough to give the Democrats the House majority. The GOP forfeited just seven seats in rural or small towns."

In Iowa, a quintessential swing state, former prosecutor Rob Sand "said Democrats can’t expect to win in Iowa or nationally if they don’t figure out a way to compete in rural areas," the Journal reports. "His campaign for state auditor emphasized cultural issues. He talked about his first job catching chickens on a farm and printed campaign banners attached to trophy deer mounts." He won.

North Dakota town, hungry for workers, starts program to get high-school grads to return after getting tech degrees

Unemployment is at a 50-year low, "five of the 10 states with the lowest unemployment are also among the most rural of states,"and tight job market always forces employers to get creative in hiring," the Christian Science Monitor reports. "But a worker shortage is especially challenging in places that are often overlooked: small rural towns."

Sperling's Best Places map, adapted

Reporter Laurent Belsie writes, "Large swatches of the rural countryside are losing population or barely holding their own. As a result, rural communities are trying creative ways to cope. In Devils Lake, N.D., local businesses have just agreed on a tuition reimbursement program for high school graduates who promise to return and work after getting a technical degree. The idea: If they come back for a job, they’ll stay and raise families. Fully 80 percent of tuition will be covered, mostly by each student’s sponsoring business."

Brad Barth, head of the local economic development agency, told Belsie, “We talked to 15 businesses in two weeks and they were all in.” Doug Darling, president of the local Lake Region State College, says that “if we work together on these things, I think it’s going to help.”

Department of Education issues report on rural schools

The U.S. Department of Education has issued a required Report on Rural Education outlining "actions the department will take to meaningfully increase the involvement of rural schools and school districts in helping develop and execute department processes, procedures, policies and regulations," the agency said. The report was mandated by Congress in 2015.

The report's conclusion says in part, "Rural students constitute approximately one-fifth of the nation’s students, representing a diverse array of experiences and circumstances. Rural education is a vitally important area of the education landscape involving virtually every aspect of the Department of Education’s work. The Department is committed to helping provide rural students with the same opportunities for access, achievement, and success as their counterparts in other locales."

Election results highlight rural-urban divide

Yesterday's election highlights the deep divide between rural and urban Americans. "Fueled mainly by gains in urban/suburban areas, Democrats won control of the U.S. House of Representatives," Chuck Todd, Mark Murray and Carrie Dann report for NBC News. "Fueled mainly by turnout in rural America — especially in states Trump won by significant margins in 2016 — Republicans expanded their Senate majority, picking up what looks like two seats (and it could be three if Rick Scott hangs on in Florida)." Scott appears to have won but the race could go to a recount.

Washington Post chart

"Democratic incumbent senators who performed poorly with rural voters were part of the Republican formula that helped the GOP retain control of the Senate for at least the next two years," Tim Marema reports for The Daily Yonder. That includes Missouri Sen. Claire McCaskill, who lost as Republican Attorney General Josh Hawley performed well with rural voters. McCaskill performed 30 points worse in rural counties than in 2012.

Despite the rural impact on the Senate, overall support for Republicans declined more among rural voters than among suburban and urban voters. It declined likewise among blue- and white- collar workers; and among voters at all levels of education, Ted Mellnik and Kevin Schaul report for The Washington Post: "Republicans may have garnered more votes across the battlegrounds, but only by a fraction of a percentage point. That compares with a Trump win of almost six points in 2016. Across racial lines, Republicans won handily in areas that are more than 90 percent white, but by less than half of Trump’s margin. And in majority nonwhite areas, Democratic candidates also won by less than Hillary Clinton two years ago. Both shifts may be related to relative declines in turnout for minority as well as rural voters."

Though President Trump was not on yesterday's ballots, most voters viewed the election as a referendum on his presidency. "Nearly two thirds of voters said they cast their ballot for Congress either to support Trump (26 percent) or oppose him (38 percent). More voters said they were casting a ballot to support Trump than oppose him in Senate races in Missouri, Indiana and North Dakota, three states where Republicans beat Democratic incumbents," Reid Wilson reports for The Hill.

In January, the two parties (and their bases) will likely continue drifting apart and "double down on divisiveness heading into 2020," Mike Allen and Jim VandeHei write for Axios. "The Republican strategy of targeting men, whites and rural voters was vindicated with the larger Senate majority. We saw record conservative turnout in rural Trump country."

That benefited Republican Rep. Andy Barr of Kentucky's 6th District, where former Marine fighter pilot Amy McGrath had won an upset victory in the Democratic primary on a strong rural vote. Barr racked up big margins in rural areas to win, 51 percent to 48 percent.

Voters approve animal-space rules in Calif., Medicaid expansion in Idaho, Utah and Neb., recreational pot in Mich.

Voters not only chose officeholders yesterday but decided a host of ballot initiatives.

Colorado voters rejected, 57 percent to 43 percent, a proposal to increase the minimum distance from buildings and waterways for oil and gas drillers. John Aguilar of The Denver Post has a report.

California voters passed Proposition 12, requiring farmers to provide more space for egg-laying hens, breeding pigs and veal calves. "California businesses will be banned from selling eggs or uncooked pork or veal that came from animals housed in ways that did not meet these requirements. Prop 12 also bans the sales from other states not meeting California’s standards. The changes must happen by 2022," KOVR-TV in Sacramento reports. That could have a huge impact on the nation, as it did in 2008 when California passed a similar measure that barred farmers from keeping those animals in cages so small they could barely move. "Since then, supermarket shelves have filled with cage-free egg varieties. Corporations like McDonald’s, Costco and Taco Bell have committed to using cage-free products," the station reports.

The largely rural states of Idaho, Nebraska and Utah voted to expand their Medicaid programs under the Patient Protection and Affordable Care Act. That will extend coverage to about 325,000 people who make less than 138 percent of the federal poverty level. Since the poverty line in 2018 is, for example, $12,140 for an individual and $25,100 for a family of four, that means individuals making $16,146 and families of four making $33,250 will qualify for Medicaid, Sarah Kliff reports for Vox.

Montana rejected an initiative to increase taxes on tobacco products to keep funding its Medicaid expansion. Montana's legislature expanded Medicaid in 2015, but only funded the program for four years. In July 2019 the expansion will end without a reauthorization of funds, and the initiative was an attempt to head off a possible reauthorization fight, Kliff reports. The initiative failed in part because of heavy opposition from the tobacco industry; Altria Group, which includes Philip Morris, spent more than $12 million, Kelly Gooch reports for Becker's Hospital Review.

Marijuana was also on several ballots. Michigan became the 10th state to legalize recreational marijuana while North Dakota said no to the idea. In both states, the winning side got about 60 percent of the votes, Michael Grass reports for Route Fifty.

Medicinal marijuana was on the ballot in two states. In Missouri, voters had three initiatives to legalize medical cannabis and tax its sales. The differences were the level of tax and what the revenue would be used for. The one that passed, with 66 percent of the vote, will tax sales at 4 percent and use the revenue to pay for services for veterans, German Lopez reports for Vox. It also allows people to grow marijuana at home, which the other two did not.

Utah also legalized medical marijuana with 53.2 percent of the vote though the Church of Jesus Christ of Latter Day Saints opposed the measure in favor of a legislative approach. "To some, the vote seemed largely symbolic, since top lawmakers are busy constructing a different model for delivering medical cannabis to Utah patients. State legislators were expected to overwrite Prop 2 if it succeeded at the ballot box and approve their own cannabis act if it failed," Bethany Rodgers reports for The Salt Lake Tribune.

Voters in Florida automatically restored voting rights to former felons, affecting some 1.4 million residents," the National Conference of State Legislatures reports. "In Louisiana, voters instituted a five-year waiting period for felons to seek political office." NCSL has resources on felon voting rights.

In West Virginia, 52 percent of voters passed a measure that could limit access to abortion. "In 1993, the state Supreme Court interpreted the state constitution to say that medically necessary abortions could not be denied to the poor. That meant state Medicaid funds would have to pay," WSAZ-TV reports. "With the passage, this language will be added to the state constitution: 'Nothing in this constitution secures or protects a right to abortion or requires the funding of abortion.'"

Democratic takeover of House ends Republican efforts to require work for food stamps, clears way for Farm Bill

The Democratic takeover of the House "effectively terminated" Republican efforts to add work requirements to the food-stamp program, "although it has not been excised officially," Chuck Abbott reports for Agriculture.com.

The election "could be the jolt that breaks the stalemate in Senate-House negotiations over the Farm Bill, headlined by the battle over food stamps," Abbott reports, citing unnamed analysts. "In any case, the Farm Bill was the only item on the agenda for food and ag groups in the lame-duck session. House Republicans are running out of leverage on the Farm Bill, since they will soon lose their majority."

“If the House of Representatives wants a five-year Farm Bill … they better fish or cut bait and give up on that,” Republican Sen. Charles Grassley of Iowa told reporters. "Otherwise, he said, Congress was likely to pass a stopgap revival of the farm policy law that expired on September 30 and begin work anew in 2019 on a farm bill," Abbott reports.

Democratic Rep. Collin Peterson of Minnesota, who is expected to regain the Agriculture Committee chairmanship in January, told The Hutchinson Leader last week that he warned Republicans four months ago that "this food-stamp stuff . . . was not going to fly. It wasn’t necessarily that I was against so much what they were doing, it was that the Senate wasn’t going to do it." He said Kansas Sen. Pat Roberts, "a Republican, has been the most vehement against this in these meetings, more so than" him and Michigan Sen. Debbie Stabenow, the ranking Democrat on the Senate Agriculture Committee. "He wants a bipartisan bill, and he knows he’s not going to get one if that’s in there. It looks like they will come around on that."

The House bill would require “work-capable” adults ages 18 to 59 to work at least 20 hours a week or spend equivalent time in job training or workfare to qualify for food stamps, now known as the Supplemental Nutrition Assistance Program. President Trump said today that he would like to see the bill include work rules, but acknowledged that it would take perhaps 10 Democratic votes to get that done in the current Senate.

Perhaps contrary to the belief of some, the creative class thrives in most rural counties; map shows details

Creative class share in U.S. counties (CityLab map by David Montgomery)

In the sixth part of a series that explores the myths and realities of America's urban-rural divide, CityLab examines the rural creative class: people who work within the arts, design and media, and/or people who draw on complex knowledge of topics to solve problems. About 10 percent (2.6 million) of them live in rural areas, Richard Florida reports. The population as a whole is about 15 percent rural.

When counties are broken down into large, medium and small categories of urban counties, rural counties adjacent to a metro county, and rural counties not adjacent to a metro county, and workforce patterns are analyzed, some interesting patterns emerge, reports Florida, an economist and social scientist who heads the Martin Prosperity Institute at the University of Toronto.

"The most striking thing to jump out from the data is that there is not as much variation in the share of the creative class across urban and rural places as you might think. The creative class makes up roughly 30 percent of the workforce across all counties. Indeed, the creative class makes up almost the same share of the workforce in small rural counties that are not adjacent to metro areas as it does in urban counties in medium-sized metros. This may reflect the fact that certain professions like doctors and teachers are over-represented in small, isolated rural counties."

Compared to other rural areas, the most remote rural areas have an outsized share of creative class workers, most likely because they tend to be home to knowledge institutions or labs, like Los Alamos County, New Mexico, which is home to Los Alamos National Laboratory.

Supreme Court says governments, no matter how small, can't discriminate on the basis of age

The U.S. Supreme Court ruled 8-0 today that government employers of all sizes, even in small towns, can't discriminate against employees on the basis of age. Justice Brett Kavanaugh did not vote since he wasn't on the court when the case was heard in October, Laura Maggi reports for Route Fifty.

The case comes from Mount Lemmon, a rural town in southeastern Arizona. John Guido and Dennis Rankin, the oldest firefighters oin the Mount Lemmon Fire District, filed an age discrimination suit after they were laid off in 2009. The Supreme Court wasn't deciding whether or not the firefighters had been discriminated against, but whether a small government employer could be sued for it because of the Age Discrimination in Employment Act of 1967, Maggi reports.

"The fire district, which at the time of the layoff had just 11 full-time employees, argued they were exempt from the law, as is the case with private-sector employers with fewer than 20 workers," Maggi reports. "But Guido and Rankin, along with the Equal Employment Opportunity Commission, said the law covers any public employer."

The court said public employers of all sizes were subject to the law. "The fire district warns that applying the ADEA to small public entities risks curtailment of vital public services such as fire protection. Experience suggests otherwise," the court said.

Pharmaceutical marketing strategies may have protected Southern rural blacks from opioid epidemic

Overdose rates (left) are lower in rural Southern counties with more African Americans and higher in counties with more whites (right). (Walsh Center on Rural Health Analysis map; click the image to enlarge it.)

"Rural counties in the South with a high percentage of African Americans tend to have lower drug-overdose rates, leading to speculation that racism may have had the unintended consequence of insulating blacks from some of the opioid epidemic," Tim Marema reports for The Daily Yonder.

The lower overdose rate can't be explained by economics or social conditions, so race is the most likely factor, according to Michael Meit, co-director of the Wash Center for Rural Health Analysis, which recently released a map of county-level overdose deaths.

"I do think that the pathway into opioids for many rural communities was prescription drugs," Meit told Marema. "And I think, for whatever reason, the prescription drugs were not marketed towards rural African American populations."

That goes back to the beginning of the opioid epidemic in the mid-1990s, when Oxycontin maker Purdue Pharma marketed the drug heavily to doctors who already prescribed large amounts of opioids. According to former Roanoke Times reporter Beth Macy, author of Virginia opioid epidemic chronicle Dopesick, those doctors tended to be in rural, white communities with blue-collar jobs that cause more injuries, like logging, mining and fishing.

Another reason for the lower overdose rates among rural black residents: "Doctors are less likely to prescribe painkillers to African Americans because of conscious or unconscious stereotypes about blacks and drug abuse, numerous studies have shown," Marema reports. "Nationally, whites were more than 50 percent more likely to die from an opioid overdose than blacks in 2016, according to the Centers for Disease Control.

Villain 'Progressive Liberal' fires up Appalachian crowds

The Progressive Liberal and frequent nemesis Pretty Boy Stan Lee get ready to wrestle. (LAT photo by Clary Estes)

In rural Appalachia, Daniel Harnsberger rushes in where angels fear to dropkick: the real estate agent from Richmond, Va., moonlights as the Progressive Liberal, a professional wrestler who praises renewable energy and insults President Trump, Jeffrey Fleishman reports for the Los Angeles Times.

Harnsberger's a villain in the tradition of the WWE's Nikolai Volkoff and the Iron Sheik, but with a twist: where the WWE guys played on a stereotype all the way to the bank, Harnsberger is serious about his political stances -- though as the Progressive Liberal he's more insulting than he otherwise might be. "These people are stuck in time," Harnsberger told Fleishman. "They’re on the wrong side of history. They’re not watching Rachel Maddow before they go to bed every night. So I keep it simple: Trump. Hillary. Russia. Coal."

The locals, accordingly, loathe him. "I’ve had husbands and wives come after me. Grannies have cussed me out," Harnsberger told Fleishman. "My whole intent is to get people worked up, to create a reaction. We are selling tickets after all. They’re paying money to see me get my ass kicked."

Fellow wrestler Beau James expressed concern for Harnsberger: "Somebody has to filter Dan or he’s going to get killed. The whole thing of wrestling is to play on the raw emotions of the crowd, but with Dan there’s a chance you may have to fight your way out of the building."

Rural hospitals struggle to cope with increase in babies born addicted to opioids

Yet another way the opioid epidemic is hurting rural America: rural hospitals are ill-equipped to cope with the rise in infants born addicted to opioids. The number of mothers with opioid use disorder and babies with neonatal abstinence syndrome has increased in the past eight years; in 2018 a baby with NAS is born every 25 minutes in the United States. "A new study in The Journal of Rural Health shows that almost half of pregnant women with OUD living in these areas give birth in rural hospitals, which are not necessarily equipped to deal with their complex medical needs," Annabelle Timsit reports for Quartz.

Besides the long-term behavioral, developmental, and health problems triggered by NAS, it can also cause problems like diarrhea, vomiting, high fevers and seizures for up to six months after birth. That means they tend to stay much longer in the hospital than the average newborn and need intensive and sustained treatment. Opioid-addicted mothers are at higher risk of medical complications during pregnancy and after birth, like placental abruption, preterm labor, maternal obstetric complications, and fetal death. Many rural hospitals don't have the resources to care for such infants and mothers, especially since fewer than half of rural hospitals in the U.S. offer obstetrical care at all, Timsit reports.

University of Minnesota researchers gleaned the data for the study from the hospital discharge records of 950,000 rural mothers who delivered 980,000 babies between 2007 and 2014. "The researchers measured the incidence of maternal OUD among rural residents who gave birth in urban teaching, urban non-teaching, and rural hospitals," Timsit reports. "They found that maternal OUD rates had increased between 2007 and 2014 across all three hospital categories, including rural hospitals, where 48.3 percent of rural residents with maternal OUD give birth."

Study: Native Americans on reservations most vulnerable to wildfires

Likelihood of wildfire (top) compared to vulnerability of
population. (UW map; click to enlarge)

Minorities, especially Native Americans living on federal reservations, face more risk from wildfires than whites, according to a newly published study. But it's not always because they live in places more likely to see wildfires; it's because they're less able to respond and rebound from a fire, Kendra Pierre-Louis reports for The New York Times.

The study's author, graduate student Ian Davies of the University of Washington, worked with researchers from conservation nonprofit the Nature Conservancy to identify which regions of the U.S. were at most risk for severe wildfires. They found that 29 million Americans live in high-risk areas, mostly in the West but also in the Southeast. Most of them are white and wealthy, but 12 million of them are particularly vulnerable to wildfires because of socioeconomic factors Davies calls "adaptive capacity." That includes things like access to a car to evacuate, a secure job, the ability to speak English fluently, or having insurance.

"We’re not saying that people who are not poor aren’t affected by wildfires," Davies told Pierre-Louis. "What we’re saying is, if you have the characteristics of a disadvantaged community, you’re much more likely to take longer to recover."

Native Americans on federal reservations are at a double disadvantage: many lack adaptive capacity and are six times more likely than average to live in particularly wildfire-prone areas, Pierre-Louis reports.

FactCheck Monday: Both parties mislead in closing TV ads on health care, taxes and ICE, to name just three issues

Here's the last installment of a pre-Election Day series listing some of the most relevant items from FactCheck.org and other nonpartisan fact checkers. We encourage you to subscribe to their alerts, which you can do here, and republish their findings, which FactCheck lets anyone do for free with credit to them. Since elections are tomorrow, we focus on final-week ads. First up, the Democrats:

"In the past week, many Democratic ads across the country have focused on health care and taxes, campaign-long themes for the party’s candidates. Some of the ads have used familiar, and misleading, talking points," Lori Robertson reports for FactCheck. 

One ad claims that Rep. Martha McSally, R-Ariz., "voted to essentially end Medicare." That's inaccurate, because it refers to a Republican budget resolution that would change the way Medicare operates, but not end it. The ad also says McSally voted to "gut protections for preexisting conditions" because of her votes for repeal of the Patient Protection and Affordable Care Act and a Republican replacement. Repealing the ACA would repeal broad protections for those with pre-existing conditions, and the Republican replacements would have weakened those protections. But "if the ACA’s protections were to be eliminated or repealed, there would still be some previously existing protections for those with employer plans, who couldn’t be denied coverage or charged more based on health status under the 1996 Health Insurance Portability and Accountability Act," Robertson reports. "Before the ACA, those with employer plans could face coverage exclusions, however, if they had a gap in insurance coverage."

Several Democratic ads in House races across the country claim that the 2017 Republican tax law awards 83 percent of benefits to the wealthiest 1 percent of citizens. "That’s only the case for 2027, because most of the individual income tax changes in the law expire by then," Robertson reports. "Republicans say a future Congress will extend the tax cuts. In 2025, a quarter of the tax cuts go to the top 1 percent."

"In the final days of the 2018 election, Republicans across the country are running TV ads about immigration that falsely accuse some Democrats of wanting 'open borders,' plotting to 'abolish ICE,' supporting 'sanctuary cities' and more. The ads contain evocative images of tattooed gang members and 'caravans' of Central Americans traveling through Mexico in search of asylum," Eugene Kiely, D'Angelo Gore, and Robert Farley report for FactCheck. An ad database shows that 162 TV ads in the past week have contained anti-immigration messages. 

Here's an example: In Arkansas, Rep. French Hill has run an ad against Democratic challenger Clarke Tucker saying that MS-13 is "the most dangerous gang infiltrating America, but Washington liberals want to get rid of ICE, the police enforcing our immigration laws and protecting our border from MS-13." The ad flashes pictures of House Minority Leader Nancy Pelosi and Senate Minority Leader Chuck Schumer when the announcer says "Washington liberals," though neither support abolishing ICE. The ad also says Tucker attended an "anti-ICE" rally and won't take a position on abolishing ICE, and plays a quote of him saying "I don't know what it is," FactCheck reports.

On his website, Tucker says, "I support ICE and our Homeland Security agencies in carrying out the mission to keep our borders safe and strong, while increasing accountability and transparency in our immigration enforcement through common-sense strategic investments." So where do the ad's claims come from? Tucker did not attend an anti-ICE rally; the clip used in the ad is from when he attended a rally for "Families Belong Together," which opposes family separation without guarantee of reunification and advocates for due process for refugees seeking asylum. In the clip, a Republican asked Tucker if he supported New York Sen. Kirsten Gillibrand's position on ICE. A few days before, Gillibrand said she believed ICE should be abolished. Tucker said he wasn't familiar with her position on ICE, saying "I have not had a chance to look at that . . . I don't know what it is, so --"

"Since then, Tucker has given it thought and has taken a position — but the TV ad ignores that. So does another ad by the Republican Majority Fund, which is a PAC affiliated with Sen. Tom Cotton of Arkansas," FactCheck.org reports. Tucker says he supports protecting undocumented immigrants from ICE only when they're seeking emergency health care or reporting a crime. Such a stance doesn't condone shielding MS-13 gang members from ICE.

With 43 million in U.S. on private wells, 1/5 of which are polluted, rural residents wonder about lax regulation

Worries about increasingly contaminated well water have begun to emerge as an election-year issue, Jack Healy reports for The New York Times. "Rural communities call it their own, private Flint—a diffuse, creeping water crisis tied to industrial farms and slack regulations that for years has tainted thousands of residential wells across the Midwest and beyond," Healy writes. "President Trump’s actions to loosen clean water rules have intensified a battle over regulations and environmental protections unfolding on the most intensely local level: in people’s own kitchen faucets."

Much of the reported contamination comes from large-scale farms and concentrated animal feeding operations, which can taint nearby wells with nitrates from fertilizer or E. coli bacteria. Environmental groups complain that Republicans running Midwestern states have weakened pollution rules and cut funding for environmental enforcement and inspections, Healy reports.

About 43 million Americans get their water from private wells, and one in five of those wells are contaminated, according to sampling by the U.S. Geological Survey. And once those wells are drilled, there are few water-quality rules to regulate them, so there's no easy redress for those with polluted water, Healy reports. Homeowners say they have to install expensive filtration systems, dig deeper wells, ignore the problem, or move.

"In Wisconsin, a state report recently found that as many as 42,000 of the state’s 676,000 private wells, or 6 percent, were likely to exceed the federal health standards for nitrates, which can come from fertilizer use and manure spreading," Healy reports. "Nitrates have been linked to a dangerous blood condition in babies and may increase cancer risks in adults."

As 'war on coal' narrative fades, UMWA bases campaign contributions on whether candidates back miner pensions

The United Mine Workers of America has reverted to form. "The top U.S. coal miners' union has put a larger share of its campaign donations behind Democrats ahead of the Nov. 6 elections than in 2016, as dimming hopes for a coal industry revival led by President Donald Trump reinforce fears about the safety of worker pensions," Reuters reports.

The UMWA "has donated nearly 84 percent of its money to Democratic candidates and committees in national races . . . a roughly 20-point jump from 2016, when Trump courted coal miners with promises of an industry comeback," Timothy Gardner and Grant Smith write. "The shift marks a setback for efforts by Trump and the Republican party to maintain control of Congress. He had won over many U.S. coal miners during the last election with promises to scrap Obama-era environmental regulations blamed for the industry’s demise. A Reuters survey of utilities found that the administration’s replacement of Obama-era carbon regulations will not save U.S. coal-fired power plants from shutdown."

The union told Reuters that its main criterion for contributions is support for miner pension funds that "have been undermined by coal company bankruptcies and which the Republican-led Congress has failed to backstop," Gardner and Smith report.

West Virginia University political scientist Simon Haeder told Reuters that the UMWA's giving returns the union to its core labor values, and away from hopes for rebound in the industry. “The ‘war on coal’ narrative is basically over,” Haeder said. “Now the things that people are concerned about are health care and pensions. . . . These are the overwhelming issues that dominate their lives.” The union has more retirees than working miners.

Farm bureaus and other ag lobbies were selective and bipartisan in campaign contributions, with an edge to GOP

Big agricultural lobbying groups "have been selective — and bipartisan — in handing out cash to candidates in the many competitive midterm races in farm states and districts this cycle," Ryan MacCrimmon reports in Politico's Morning Agriculture newsletter.

"Farm bureaus in the top 10 agricultural states spent more than $1 million through federal PACs ahead of Tuesday's elections," MacCrimmon writes, citing reporting by Liz Crampton. "Most contributions went to Republicans, but nearly all the farm bureaus donated to both parties." Many state farm bureaus do not make political contributions; Politico surveyed only 10 states.

"The top individual recipient among the 'Big Four' agriculture committee leaders was Senate Agriculture ranking member Debbie Stabenow, who took in about $18,000 in donations from six of the 10 states," MacCrimmon writes. "The Michigan Democrat is seeking reelection in a state President Donald Trump won in 2016, though Stabenow is widely favored to prevail."

Most contributions from ag lobbies were made to in-state candidates, "but ag policymakers and party leaders in competitive races — like Senate Ag member Deb Fischer (R-Neb.) and House Rules Chairman Pete Sessions (R-Texas) — also raked in campaign funds from farm bureaus elsewhere," Politico reports.

Veteran homelessness fell 5% last year, HUD and VA say

The number of homeless veterans in the U.S. dropped by more than 5 percent in the past year and is half the figure of 2010, the Trump administration announced last week. "The number of homeless veterans had fallen for six consecutive years before ticking up slightly in 2017," Eric Katz reports for Route Fifty. "The departments of Housing and Urban Development and Veterans Affairs have led an interagency effort to eradicate veterans homelessness since President Obama in 2010 announced a goal of ending the problem entirely within five years. There are now about 38,000 homeless veterans, according to the government’s count."

The HUD-VA Supportive Housing Program pairs VA case management and clinical services with HUD rental assistance offerings, and helped more than 4,000 chronically homeless veterans find permanent housing in the past year, HUD Secretary Ben Carson said.

Finding housing for homeless vets is difficult because many have fallen through the cracks and off the government's radar, Carson said. VA Secretary Robert Wilkie said the VA doesn't know how many veterans need help because many haven't contacted the agency for more than a decade. He also said issues such as opioid addiction and mental health must be addressed to reduce homelessness.