Friday, August 07, 2020

Pandemic shutdowns exacerbate rural broadband gap; rural publisher says papers should educate lawmakers about it

For many rural residents, the only way to access reliable high-speed internet is to go to a restaurant or library. But pandemic shutdowns have left such residents high and dry, exacerbating the already stark rural-urban broadband gap, Dustin Stephens reports for CBS News.

It's difficult to say precisely how many Americans lack real high-speed internet service; the Federal Communications Commission estimates around 23 million people, but they tend to overestimate rural broadband access. Recent reports estimate that 42.8 million people in the U.S. lack broadband access, and about 70% of people with no broadband access are in rural areas, according to a 2019 study.

Lack of broadband has wide-ranging impacts on rural Americans, from work and e-commerce to telehealth and news access, says Tonda Rush of the National Newspaper Association.

NNA President Matt Adelman, publisher of the Douglas Budget in Wyoming, said this week that newspapers serve a vital role in keeping rural residents informed, especially those who lack broadband access, and that newspapers should remind lawmakers of that: "Newspapers have to educate their public policy representatives constantly about what meaningful internet access is. It is more than just having fiber under the road near someone’s house. It is about having adequate speed to use the system. And then, it is about having the money to pay for the service. The big picture: paying a dollar or so for a local newspaper is more effective and reliable when you need to know what is going on."

Adelman includes public notices under readers' right to know, Rush reports. Lawmakers in many states have tried (sometimes successfully) to roll back laws requiring governments to purchase ads in local newspapers for public notices, instead arguing that the public can access them online. But those who lack adequate internet access are effectively cut off from such public notices, Adelman said.

Paid public notices comprise an increasing part of newspapers' income as other advertising shrinks during the pandemic.

Rural covid-19 deaths surpassed 10,000 on July 30; daily death numbers doubled during the last half of July

Covid-19 red zones, July 26-Aug. 1.  Daily Yonder map; click the image to enlarge it or click here for the interactive version.
Covid-19 deaths in rural America more than doubled in the last half of July, leading to rural America's 10,000th death from the coronavirus disease on July 30. Hundreds more have died since, as the pandemic continues to spread.

"From July 16 to Aug. 1, the average number of rural residents who are dying each day from covid-19 climbed from 77 to 171. The number of rural deaths in July was 70 percent higher than the number of deaths in June," Tim Murphy, Bill Bishop and Tim Marema report for The Daily Yonder. "Rural deaths now constitute 6.7% of all deaths in the U.S. cumulatively, up by more than 2 points from July 1."

Another 12 rural counties were added to the White House Coronavirus Task Force's "red zone" list last week, bringing the total number to 746 (more than one-third of all rural counties). That's a much lower increase than the previous week's, which saw 104 rural counties being added. Red zones have a new-infection rate of at least 100 per 100,000 (or one per thousand) residents in the task force's seven-day reporting period, which runs from Mondays through Sundays.

Quick hits: USDA says don't plant random seeds from China; what rural hospitals can teach their urban peers

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

Commentary: lack of indoor plumbing in marginalized communities is a too-often neglected environmental justice issue. Read more here.

A popular Instagram account raises funds for LGBTQ+ people in Appalachia, but it's not clear where the money actually goes. Read more here.

USDA warns people not to plant any random unsolicited seeds they get from China. Read more here.

What rural hospitals can teach their urban counterparts about patient engagement. Read more here.

Commentary: researchers need to use a combination of measurements to get the clearest picture of broadband's impact on the economy. Read more here.

New debut novel a mystical, moving tale about surviving childhood sexual abuse and poverty in Appalachia

Every Bone a Prayer, a debut novel from Kentucky author Ashley Blooms details a young girl's journey to survive—and understand—sexual abuse and poverty in a tale that's part Southern Gothic and part magical realism.

"In this novel, poverty weaves through community; ownership — of property, of personal space, of land — is intrinsically tied to the bonds and boundaries of family. Layers of things unsaid are wrapped around shame, faith, and the natural world in ways that are often very close and difficult to bear," Fran Wilde writes for NPR. "Novels like Every Bone A Prayer are important specifically because they give a lyrical voice, agency, and a resonating mythos to those fighting to reclaim their names, and selves."

The novel is worth the journey, but packs an emotional punch, Wilde writes: "This book hurts. The detailed author's note in the frontmatter only reinforces the fact that Every Bone a Prayer is a difficult, important, and beautifully rendered story of generational trauma, survival, and healing. The characters I met within its pages have stayed with me, their names and stories etched on my memory."

Non-partisan workshops to discuss election cybersecurity

In an uncertain election season, "journalists are being warned not to expect to call winners on Election Night, Nov. 3, as they might do for a typical election. The pandemic has turned everything upside down," University of Kentucky associate journalism professor Buck Ryan writes for the Chatham News + Record in North Carolina. "Whether it be cybersecurity or misinformation and disinformation or crisis communications, your public election officials are facing battles on multiple fronts to ensure fair and accurate vote counts."

One major concern is cybersecurity. A bipartisan initiative from the University of Southern California Annenberg's Center on Communication Leadership and Policy is holding a workshop in each state to discuss the topic, including information on efforts at the state and local level. The initiative, funded by Google, has already visited most states, but more are scheduled. Click here to see when your state's workshop will be or has been.

Don Blevins Jr., the chief election official in Fayette County, Kentucky, said in his state's workshop that his main concern wasn't cybersecurity as much as the public's confidence in the elections: "My primary concern is that the public will lose confidence in elections through misinformation or other types of activities that might lead them to believe their vote doesn’t count or that the election is rigged... I think that is a far greater challenge we need to watch for."

Thursday, August 06, 2020

Cattle producers continue to struggle with 'absurdly low prices' as the four major meatpackers make record profits

Cattle producers generate more than half of U.S. farm revenue, but they've been dealt a bad hand: cattle prices dropped this spring as meatpackers had to shut down, but farmers had to keep their farms running with less income and, in many cases, continue to house and feed cattle they couldn't ship to slaughter. But during the height of the plant shutdowns in April and May, beef packers' profit margins reached historic highs, Jessica Fu reports for The Counter. That has a lot of cattle farmers upset.

"Cattle producers from one end of the country to the other are convinced their markets were long-ago hijacked by the 'Big Four.' Namely, they blame Cargill, JBS, National Beef and Tyson — who collectively control more than 80 percent of the U.S. slaughter market for beef — for pricing inequities," Victoria Myers reports for DTN/The Progressive Farmer. "Confidentiality agreements these buyers operate under are allegedly responsible for thin cash markets and what many cattlemen believe are absurdly low prices at the farm level. Simply put, as covid-19 drove up beef demand and sent prices received by packers soaring, cattle producers struggled to understand why they were losing money. That struggle continues."

Meatpackers are operating at high volumes again, but the Kansas City Federal Reserve Bank estimates that farm revenues could still decline this year because of the earlier disruptions, Chuck Abbott reports for Successful Farming

The Food and Agricultural Policy Research Institute "has estimated an 8 percent decline in livestock revenue this year, compared with 2019, with lower average hog, cattle, and poultry prices," Abbott reports. "Per-capita meat consumption would decline this year and take years to recover, said the University of Missouri think tank in June. Overall, it projected a 3% decline in farm income, thanks to record federal subsidies that would largely offset big losses in farm receipts."

Society of Environmental Journalists' annual awards include several winners with rural resonance

The Society of Environmental Journalists has announced the winners of its annual Awards for Reporting on the Environment for articles, radio broadcasts and videos released in the year through March 2020. Most categories feature winners for large and small newsrooms or circulation. The small-newsroom winners aren't necessarily rural, but their reporting has rural resonance. Click the award name for links to stories, judges' comments, and the runners-up.

The Kevin Carmody Award for Outstanding Investigative Reporting went to "Unwell Water" by Kyle Bagenstose and Jenny Wagner for the Bucks County Courier Times in Pennsylvania. The judges said, "This excellent five-part series investigated the foot-dragging and legal maneuvering that has slowed cleanup of toxic firefighting chemicals around military bases. Kyle Bagenstose and Jenny Wagner's thorough reporting over an eight-month span detailed efforts by U.S. Department of Defense officials to avoid liability for cleaning up contaminated streams and aquifers. Extensively documented and well-sourced, this series shines important light on a dysfunctional regulatory process."

The award for Outstanding Beat Reporting went to "Holding the Powerful to Account for the Environment" by James Bruggers for InsideClimate News. "This entry stood out as the judge's top choice for versatility of topics, depth of reporting and skillful writing to create five very readable stories on regional environmental and energy problems and politics. Down-to-earth analysis shined a light on inadequate federal maps to predict flooding and erosion from mine runoff, flooding of coastal properties and a utility's bias in seeking to renew expensive fossil fuel contracts. James Bruggers used both grit and finesse in lining up a wide variety of sources inside and outside government. A nice human touch gave voices to coal miners, small town mayors and politicians from both parties concerned about whether a powerful senator was protecting miners' pensions and black lung payments amid the transformation of an ailing coal country. We get a sense of place in coal country. We also get an appreciation of how regulation of climate change can affect people's lives. In short, the entry showed how a beat reporter can use ingenuity and hard work to produce fresh stories that inform and are pleasurable to read."

The award for Outstanding Feature Story went to "Undone Science: When Research Fails Polluted Communities" by Nancy Averett for Undark. "This compelling and deeply personal story reveals the failure of the research community to put any significant effort into understanding the environmental plight of communities. Focused on the impact of air pollution from a coke plant in Avalon, Pennsylvania, it takes us to other communities where a lack of public information about chemical emissions may have contributed to autism, asthma and cancer. "Undone Science" is an articulate, well-researched and persuasive plea to scientists for data that acknowledges the environmental challenges facing towns, families and their children. It is a powerful reminder that for every Flint, Michigan, there are hundreds of Avalons."

The award for Outstanding Student Reporting went to "Small Farmers Wait for California's Groundwater Hammer to Fall" by Madison Pobis, Stanford University, published in Bill Lane Center for the American West blog. "The judges found this an impressive overall effort, which combined on-the-ground reporting, extensive use of archival images, videography and data to explain a technical but crucial issue looming as California tries to apportion a shrinking resource — water. The package illustrated the likely human impact on family farmers of arcane water rules, and provided a glimpse of the future as society deals with resource shortages. The writing by Madison Pobis blended the big picture with the human scale, and the videos and data made excellent use of the resources of the Bill Lane Center, government archives and data."

Outstanding rural volunteers could win $10,000 award; top local elected leaders must send in nominations by Aug. 15

Nominations are open for the Small Town America Civic Volunteer Award, which recognizes extraordinary volunteer service in communities of 5,000 people or smaller. The program will honor 100 outstanding volunteers nationwide; the top three will receive $10,000, $7,500, and $5,000, respectively. Nominations must be made by the chief elected official of a community by Aug. 15, and the awards will be announced Sept. 15. Click here for more information.

"Research shows that the percent of people volunteering in small communities and rural counties has dropped substantially over the last 12 years," says the website. "Civic volunteerism is the lifeblood of small town and rural America. STACVA is intended to help address this critical shortage by recognizing and supporting 'hometown heroes,' and by promoting best practices designed to spur a cadre of new civic volunteers to fill these vital roles."

The award is organized by CivicPlus, a technology platform company geared toward local governments, and co-sponsored by the National Association of Counties, the National Volunteer Fire Council, the National Association of Towns and Townships, Points of Light, and Main Street America.

Black households less likely to get to benefit from co-ops' rural fiber-optic buildouts because of high subscription costs

Broadband has never been more important, but many rural areas lack it, or have slower service installed by major telecommunications companies. Rural electric and telephone cooperatives are increasingly building out fast fiber-optic internet in rural areas, but Black households are less likely to get it due to high subscription prices, Nicolás Rivero reports for Quartz.

"Across the rural U.S., more than 100 cooperatives, first launched to provide electric and telephone services as far back as the 1930s, are now laying miles of fiber-optic cable to connect their members to high-speed internet. Many started building their own networks after failing to convince established internet service providers to cover their communities," Rivero reports. "But while rural fiber-optic networks have spread swiftly over the past five years, their progress has been uneven. In North Dakota, for example, fiber-optic co-ops cover 82% of the state’s landmass, while Nevada has just one co-op. And in the states where the utilities do exist, they tend to serve the whitest communities."

Some co-ops serve mostly Black households, but they aren't doing fiber internet. Fiber internet generally requires 50 to 60% of members to pay at least $50 a month for internet, according to Christopher Mitchell, who studies local broadband networks with the Institute for Local Self-Reliance. "If you look at the kind of poverty we see in the rural Black community, I don’t think we can forecast that level of subscription," Mitchell told Rivero.

Racial disparities are not a new phenomenon among rural co-ops, said Oleta Fitzgerald, a regional administrator for the Southern Rural Black Women’s Initiative. She noted that 13 rural co-ops in Mississippi recently got state funding to build out fiber-optic networks, and only one serves a predominantly Black community.

Fitzgerald, who is 72, told Rivero that majority-Black communities were often the last to get electricity or running water, and said rural co-ops today need more federal funding for fiber-optic projects that can reach the poorest communities. "While there is no unified federal fiber funding program, the USDA has been funding a patchwork of projects through other grants," Rivero reports.

Human trafficking is on the rise, and rural health-care providers are uniquely positioned to identify victims

Human trafficking may sound like a faraway problem to many, but it happens in rural areas, and rural health-care providers must be alert to it. That's because up to 88 percent of trafficking survivors said they interacted with health-care providers while they were trafficked, Jenn Lukens reports for the Rural Health Information Hub's Rural Monitor.

Human trafficking involves force, fraud or coercion to obtain labor or commercial sex acts, and it's on the rise. According to the federally funded nonprofit Polaris, which maintains a hotline and one of the largest data sets on human trafficking in the U.S., "Human trafficking has continued to rise, from 7,748 confirmed cases reported to the hotline in 2016 to 10,949 in 2018. Polaris’s demographic breakdown shows that nearly half of survivors are minors, there are five times more females trafficked than males, and minorities are more likely to be trafficked," Lukens reports. "It has been identified as a public-health concern by researchers, federal agents, and healthcare professionals alike."

Both sex trafficking and labor trafficking have been identified as problems in rural America, though sex trafficking is nearly eight times more common. There are no definitive statistics on the incidence of human trafficking in rural areas, but the secluded nature of many rural areas makes them attractive to traffickers, Lukens reports.

"While cinematic portrayals of human trafficking may resemble reality in some parts of the world, research has found that what is true in rural America can look much different," Lukens reports. "Those trafficked commonly have vulnerabilities, such as recent migration or relocation, single motherhood, recent contact with the child-welfare system, a substance dependency, homelessness, or mental-health conditions. Often, the victim already has a relationship with the perpetrator who has taken advantage of their trust and targeted their vulnerabilities to create dependency."

Rural health-care providers are uniquely positioned to identify human trafficking victims since health-care facilities are one of the few places trafficked people may be allowed to visit. Some states, hospital systems, and federal agencies have released guides or begun programs meant to help providers identify victims, like this one from the Nebraska Hospital Association. Lukens' article has a list of resources.

Study: Surge in child ATV injuries likely linked to pandemic

An increase in all-terrain-vehicle injuries among children is likely linked to more of them being out of school during the pandemic, according to a study by the Injury Free Coalition for Kids.

Dr. Charles Jennissen, a pediatric emergency physician and University of Iowa professor who led the study, compared ATV injuries during the pandemic to a year ago. “Clearly, we are seeing more injuries, including of ATVs,” Jennissen told the National Children's Center for Rural and Agricultural Health and Safety. "Overall injuries are probably four to five times higher because many don’t go to the ER, he added. In the US, about 40,000 children under the age of 16 are treated in emergency departments for ATV-related injuries each year, according to the American Academy of Pediatrics."

For information about child ATV accidents in your area, check, a project launched by the NCCRAHS and the Marshfield Clinic Research Institute. The open-access online database catalogs agricultural injury reports, including ATV accidents, from news stories and other sources.

Part of the problem, Jennissen said, is that younger children are allowed to drive ATVs, even though the American Academy of Pediatrics recommends that only people ages 16 and older operate them. “More kids in the U.S. under 16 die from ATVs than bicycle crashes," Jennissen told NCCRAHS. "We talk a lot about bicycle safety for kids, but this is a bigger killer, and we need to protect our children."

Wednesday, August 05, 2020

Eviction wave could be coming; see how your county ranks

Screenshot from the Eviction Lab webiste, showing eviction rates contrasted with population. The website is also searchable by other factors. Click the image to enlarge it; click here to view the interactive version.
"Americans owe more than $21.5 billion in overdue rent, according to one recent analysis that underlined the urgency of the housing crisis facing American renters as the coronavirus pandemic drags on," Emma Coleman reports for Route Fifty. "With eviction moratoriums ending in many cities and states, experts are warning of an impending wave of families being forced out of their homes with devastating collateral consequences if immediate action is not taken to keep people housed."

Areas with high proportions of low-income families, immigrants, and people of color are most likely to be hard-hit by evictions, Coleman reports.

Princeton University's Eviction Lab website has an interactive map showing state- and county-level eviction data; click here to see how your county ranks.

Trump orders agencies to form a task force to find ways within 30 days to improve rural health-care access

President Trump signed an order Monday aimed at improving rural Americans' access to health care. It directs the Department of Agriculture, the Department of Health and Human Services, the Federal Communications Commission and a few other agencies to form a task force to identify and implement ways to overcome barriers rural Americans face in accessing care, within the next 30 days, Larry Lee reports for Brownfield Ag News.

The order also calls on HHS to develop a new pilot payment model for rural hospitals, and also extend expanded coverage of telehealth services for Medicare patients beyond the pandemic, Elise Reuter reports for MedCity News.

"Prior to the pandemic, Medicare had several restrictions in place for virtual visits. Telehealth visits were only covered for patients in rural communities, and they still had to take place in a doctor’s office, hospital, or other health facility. The number of covered services was also limited," Reuter reports. "Since the start of the covid-19 pandemic, the Centers for Medicare and Medicaid Services has waived those restrictions, allowing Medicare to cover 135 new services over telehealth, such as physical therapy or mental health services."

Site lists resources for rural communities during pandemic

Rural schools will face a host of logistical challenges as they resume classes during the pandemic, and it can be difficult for school administrators and parents to know where to find reliable information to help them make such decisions, Lisa Foust Prater reports for Successful Farming.

A new website aims to provide that information. The Rural Community Resource Hub has news, videos, advice, and plenty of data. It was created in partnership between the staff of the Harvard Education Redesign Lab and Mara Tieken, an associate professor of education at Bates College and author of Why Rural Schools Matter. Click here for more information.

Two rural classmates, a white conservative and a liberal of color, find common ground in NPR dialogue on race

Scott Hobgood and Jason Niupulusū (photos submitted to NPR)
After NPR invited two rural men from a Kentucky town—one pro-Black Lives Matter and one against—for a dialogue on race on "Morning Edition" with David Greene, the men discovered an unexpected bit of common ground, reports Ashley Westerman, a native of their county.

Westerman is from Webster County in Western Kentucky. She noticed that a local acquaintance, Jason Niupulusū, posted frequently on Facebook in support of BLM and criticizing racism and police brutality. Niupulusū, 40, is a construction worker who is part Samoan.

Westerman also noticed that another local man, 40-year-old Scott Hobgood, a white plumber, frequently pushed back on Niupulusū's posts. "As their Facebook exchanges have unfolded, it has become clear that the reckoning on racial justice taking place in big cities is also happening in smaller, more rural towns and communities like Webster County — a quiet place that prides itself on being friendly, helpful and welcoming," Westerman reports.

Intrigued by their ongoing dialogue, Westerman invited the two—who graduated high school together—to discuss the issue on the air, via a Zoom conversation with Greene.

"It's a tough situation because George Floyd was completely done wrong, "Hobgood said. "There's no way a man should be treated like that. But at the same time, I felt like the media and the public's reaction was a very knee-jerk response." Hobgood said he's seen evidence of a personal vendetta between Floyd and the officer who killed him, and doesn't think race was a factor.

Niupulusū said he's often identified as Mexican or Black, has been called racist names and has been racially profiled, though not by police, and is acutely aware of racism's impact in everyday life.

Webster County, Kentucky (Wikipedia)
Hobgood said he believes that Black lives matter, but that he can't support a group that promotes any race over another, because he believes all lives should matter. Niupulusū responded that Black people have been "held down" in the past and that that needs correcting. Hobgood agreed, but said there's nothing people today can do to fix the past: "The only thing we can do now is fix our mistakes."

Greene noted that Niupulusū had written on Facebook that Hobgood doesn't understand about the BLM movement, and asked him what he meant. "He understands some, but to actually be a person of color, to actually be called racial slurs or have something done wrong to you because of the color of your skin...that's the part he doesn't understand," Niupulusū said. "He can empathize all he wants to and have compassion for it, but until he experiences it, he won't quite understand." BLM has never been about Black lives mattering more than white lives, he said.

Hobgood said he felt as if news articles about the protests pushed a "with us or against us" agenda. "Using that tactic is counterproductive to have a good-faith talk because that approach makes people feel a little bit of attacked," Hobgood said.

Greene asked them both if their discussion that day had changed their minds or given them new understanding of the issue. Hobgood said: "I understand that he's experienced life totally differently from what I have. So I can't judge him because I haven't lived through his experiences. We all act and react differently to our experiences we've lived in life." Hobgood said he had had a rough childhood dealing with a violent, alcoholic father who was a convicted pedophile, and that Niupulusū could not understand that, for example, having not shared that experience. Then Niupulusū said he could sympathize with part of Hobgood's experience, since his father was also a violent alcoholic.

When Greene asked how difficult it was to have these sorts of conversations face-to-face in small towns, Niupulusū and Hobgood agreed that it could be difficult to make waves sometimes. Niupulusū said many people seemed not to care and wanted to ignore such issues. "But you can't ignore it," he said. "You gotta have these conversations to grow and understand."

Hobgood agreed: "Yeah, that's definitely part of growing up in the country. I was always taught to say what you mean and mean what you say. And if you say it on the internet, you should probably mean it in person too."

Poll: farmers and ranchers expect to make less money this year than last

"An unusually large portion of U.S. farmers and ranchers expects worse financial performance on their farms this year than last, said a Purdue University poll released on Tuesday. And although producers are less worried by the coronavirus pandemic than in the spring, they are calling for President Trump and Congress to provide more money," Chuck Abbott reports for Successful Farming. "The monthly Ag Economy Barometer, based on a survey of 400 large-scale producers, said 43 percent of respondents expected a worse year financially, sharply higher than 30% at the end of 2019 or 22% in April 2018. Farmers are a famously dour group. In Purdue polling, few expect a better year and the majority routinely says things will be 'about the same,' with a sizable vote for 'worse.'"

Respondents were slightly less worried about the impact of the pandemic on their farm's profitability than they were earlier this year. "In May, 71% said they worried about the coronavirus’ impact on their farm’s profitability and 54% said they expected a worse financial performance this year," Abbott reports. "In the latest poll, 61% said they worried about the coronavirus and 43% expected worse financial results." However, two-thirds of respondents said, then and now, that Congress should pass another bill providing economic support to farmers because of the pandemic.

Congress will likely give farmers more money in the next stimulus bill, Senate Finance chairman Chuck Grassley (R-Iowa) said in a recent press conference. "The USDA has paid $6.8 billion in coronavirus aid to farmers so far this year," Abbott reports. "The House has voted for an additional $16.5 billion for payments to producers and Senate Republicans have proposed $20 billion for Agriculture Secretary Sonny Perdue to distribute. But there was a chance of a 'skinny' bill that would handle urgent issues such as unemployment compensation, with agriculture and other sectors left for action in September," Grassley said.

Tuesday, August 04, 2020

Schools face re-opening challenges; see county estimates of number of infected people likely to arrive in first week

New York Times map; click the image to enlarge it or click here to view the interactive map.
"While the Trump administration threatens to cut funding for school districts that don't reopen in the fall, rural schools try to find the best way to move forward in the era of covid-19 education," Isabelle Lee reports for The Daily Yonder.

Rural schools are more likely to reopen this fall with in-person classes, but that puts students and their families at a higher risk of spreading the coronavirus. Rural schools are at a disadvantage in holding distance learning though, since such areas have less access to broadband internet.

Some rural schools are assembling take-home packets for students to complete and drop off periodically instead of or in addition to holding classes online, Lee reports. When one rural Tennessee school district found that parents were slowing on turning in packets, they incorporated packet drop-off with a local food drop-off program and saw return rates increase.

Lack of funding is a significant hurdle for rural schools attempting to reopen, Lee reports.

Beyond the logistical and financial problems, in-person classes could further the spread of the coronavirus. An interactive map from The New York Times shows county-level projections of how many infected students or employees would likely arrive in the first week of in-person classes.

Census Bureau to end count a month early; map shows estimates of which rural counties are behind in response

Response rates to 2020 Census. Daily Yonder map; click the image to enlarge it or click here for the interactive version.
"The U.S. Census Bureau is ending all counting efforts for the 2020 census on Sept. 30, a month sooner than previously announced, the bureau's director confirmed Monday in a statement," Hansi Lo Wang reports for NPR. "That includes critical door-knocking efforts and collecting responses online, over the phone and by mail."

That means rural areas are less likely to be counted, since non-metropolitan counties have a lower response rate than metro counties. "Nationally, 62.8% of households have responded to the census," Tim Marema reports for The Daily Yonder. "Only a quarter of non-metropolitan counties have met or exceeded that response rate, while more than half of metropolitan counties have."

Of the nation's 1,971 non-metropolitan counties, 38% have a response rate under 50%, as of July 29, Marema reports.

An undercount of the rural population would have wide-ranging implications beyond Electoral College votes and apportionment of U.S. House and state legislative seats. "The Census website includes examples of how the population count can affect community programs in education,  health care, hospital funding, and more," Marema notes.

Covid-19 outbreaks in farming areas spark harvest fears

Migrant farm workers and others in farming communities are at a particularly high risk of becoming infected with the novel coronavirus. Outbreaks of covid-19 in such areas could overwhelm rural health systems and threaten farmers' ability to harvest crops. "Across the U.S., rural communities have been largely spared the worst of the pandemic, but the influx of new people who live together in tight quarters where social distancing is difficult is raising fears of viral outbreaks," Reid Wilson reports for The Hill.

Okanogan County, Washington
(Wikipedia map)
Okanogan County, Washington, for example, is "one of the hardest-hit areas in the world," Wilson reports. "In the last two weeks, almost 1 percent of the county has tested positive for the virus." Many are migrant workers who come to the area each summer to harvest apples and other orchard fruits. Gebbers Farms, the county's largest employer, "has spent hundreds of thousands of dollars testing its workers, and it has set up a separate dorm space for workers who need to be quarantined."

As the PBS program "Frontline" noted in a recent package, the Trump administration declared farm laborers essential workers, but didn't provide much federal guidance on how to keep them from getting sick, leaving states and farms to figure it out. And, as Wilson notes, many rural public health departments don't have the funding or manpower to do adequate contact tracing or other pandemic prevention or containment measures.

New engineered seed resists five different pesticides, but scientists question chemicals' future role in weed control

"A new genetically engineered corn seed designed by Bayer to be sprayed by up to five herbicides could represent the future of farming, providing growers with more pesticides to combat the problem of weed resistance," Jonathan Hettinger reports for The Midwest Center for Investigative Reporting. "But for how long? That’s the question raised by weed scientists, who say farmers need to start switching to non-chemical options to keep weeds under control." The new seed is resistant to glyphosate, glufosinate, dicamba, 2,4-D and quizalofop.

Weed resistance has become a big problem for U.S. growers over the past 50 years, and "the problem has increased significantly since the introduction of genetically modified crops and use of accompanying herbicides in the 1990s," Hettinger reports. In essence, the presence of weedkillers has led weeds to adapt, resulting in a decades-long arms race. Some scientists say that weeds are developing resistance so quickly that a different long-term solution may be needed.

The growing use of pesticides has also triggered thousands of court cases—many successful—accusing pesticide makers of causing health problems and damaging non-resistant crops. "In June, Bayer announced a $10 billion settlement of claims that glyphosate, the active ingredient in Roundup, causes cancer," Hettinger reports. "The company also announced a $400 million settlement of claims that dicamba, a herbicide sold by Bayer and German agribusiness company BASF, has drifted and harmed thousands of other farmers."

The U.S. Department of Agriculture allowed public comment for the seed petition on the Federal Register until July 7, drawing 4,112 comments, Hettinger reports.

Monday, August 03, 2020

HHS can cut some Medicare reimbursements to rural and other safety-net hospitals, federal appeals court rules

As rural hospitals struggle to get through the pandemic, they and other safety-net hospitals could see their bottom lines shrink even more, Robert King reports for Fierce Healthcare.

A federal appeals court has ruled that the Trump administration can cut drug reimbursements for the 340B drug discount program by nearly 30 percent. The 340B program requires drug manufacturers give safety-net hospitals discounts—averaging between 20-50%—in exchange for participating in Medicaid, King reports.

In 2017, the Department of Health and Human Services "sought to address a payment gap between 340B and Medicare Part B, which reimburses providers for drugs administered in a physician's office such as chemotherapy. There was a 25% and 55% gap between the price for a 340B drug and on Medicare Part B," King reports. "So HHS administered a 28.5% cut in the 2018 hospital payment rule. The agency also included the cuts in the 2019 payment rule."

Three hospital groups sued, saying that HHS did not have the federal authority to adjust the rates to the program. A lower court sided with the hospital groups and told HHS to roll back the cuts, which had already taken effect. But HHS argued that it has the authority to adjust 340B payment amounts to make sure hospital reimbursements don't exceed the cost of acquiring the drug, King reports.

If there is no data for how much hospitals pay to acquire certain drugs, HHS can use the average drug price to determine the reimbursement amount. HHS argued in court that it needed to do that in this case because hospital cost acquisition data was not available, King reports.

The appeals court sided with HHS, and added that "the $1.6 billion gleaned from the cuts would go to all providers as additional reimbursements for other services," King reports. "This is the latest legal defeat for the hospital industry. A few weeks ago, the same appeals court ruled that HHS had the legal authority to institute cuts to off-campus clinics to bring Medicare payments in line with physician offices, reversing a lower court’s ruling."

As covid-19 cases surge in Appalachia, health agencies and elected officials tamp down politics; newspapers help, too

Like much of the nation, stopping the spread of the novel coronavirus in Central Appalachia isn't just a public-health effort, but also involves convincing its citizens that it isn't a political issue, Chris Kenning reports for the Louisville Courier Journal. 

The Bell County Health Department's Leighann Baker brings groceries
to Alan Smith, who is quarantined. (Photo by Pat McDonogh, Courier Journal)
Health officials worry that covid-19 will have a disproportionate impact on the region because it has fewer hospitals and intensive-care beds, high rates of poverty, and conditions such as diabetes and heart and lung disease that make people more vulnerable .

"All that has meant special challenges for health departments hollowed out by budget cuts, such as those in Bell County, which battle distance, poverty, spotty cellphone coverage, neglected health, difficulty getting some residents to testing and distrust amid the growing politicization of public health," Kenning reports. 

In addition to their ongoing daily work to keep a community safe, public health departments have been stretched even thinner as they have increased their their contact-tracing efforts to identify those who have been infected, then tracking down everyone they have come into contact with and asking them to self-quarantine. 

"We’ve got a small health department, and we did get a little overwhelmed," Harlan County Judge-Executive Albey Brock told Kenning. "Contact tracing is no joke. It’s laborious. They keep daily communication. If we have 104 active cases, they each have to be called every day. That’s on top of having to track down people they've had contact with, getting them a letter, let them know to quarantine. 

Judge-Executive Albey Brock
"And then you run into the knuckleheads who don't want to stay quarantined because they’re not positive . . . Some of them don’t want to cooperate." 

Also, there's the politics. Kenning writes that Bell County, in Kentucky's southeast corner, is "a conservative place, where every elected official but one constable is Republican. When cases were slow to materialize, some found it easy to dismiss alarms over the coronavirus as a Democratic plot to make President Donald Trump look bad or infringe on rights by requiring masks, local residents and officials said." 

In adjoining Harlan County, Brock, a Republican, told Kenning that he has attempted to depoliticize the pandemic by sending public-health messages via social media and radio and having stern talks.  “We’ve tried real hard locally to stamp that down. If you want to fight with Trump or Biden, have at it. Just wear a mask,” he said, adding jokingly, “Some believe we never walked on the moon, so I can’t help them.”

Local officials and local newspapers can be an effective combination, Rural Blog Publisher Al Cross writes in his fortnightly column on Kentucky politics. He notes that the Licking Valley Courier of West Liberty did a story about Morgan County Magistrate Donnie Keeton's notice on Facebook that he has tested positive.

Keeton, a Democrat, said he voted for Trump because “It’s kind of hard to go with the national Democratic Party right now,” but he had the president’s words in mind when he told the Courier's Miranda Cantrell, “It’s not a hoax and it’s probably not going away anytime soon.” Trump implied Feb. 28 that the pandemic, or Democrats’ criticism of his response to it, was Democrats’ “new hoax” after their failed impeachment of him. He walked that back, but Keeton told Cross that the phrase probably gave a lot of people the wrong idea.

Cross writes, "Trump was elected partly because a lot of Americans, especially in rural areas, thought they were being left behind and disregarded by the urban elite. Many if not most of those people have never liked elites and experts telling them what to do (remember the debates about seat belts?), and Trump appealed to their resentment. That approach turned dangerous when Trump started contradicting public-health experts and scientists . . . "

He concludes, "It’s more important than ever for public officials at all levels to set good examples. . . . and in an age where social media have more sway than news media, it’s important to hear covid-19 stories from authoritative victims. . . . Cantrell put a note at the end of her story about Keeton asking other victims to tell their stories, because locals wonder 'whether the effects are as severe as mainstream media outlets have reported.' Yes, they can be that severe, but many don’t trust those outlets – especially after four years of 'fake news' bashing from a president who has uttered more than 20,000 falsehoods. Local news media are more trusted, so they need to step up, tell these stories and help their audiences understand how to deal with the pandemic. The politicians can only go so far."

Fact-checking Trump's claims about mail-in voter fraud

President Trump has repeatedly claimed that universal mail-in voting invites fraud, going so far as to ask in a tweet last week whether the election should be delayed. (It won't be.) With so much misinformation about the topic, has created an entry reminding readers of the facts.

"As we’ve explained, there is no evidence to support Trump’s overall claim that 'mailed ballots are corrupt,' as he said in April," FactCheck reports. "Voting experts told us the president is exaggerating when he says mail ballots are 'fraudulent in many cases.' While the instances of voter fraud via mail-in or absentee ballots are more common than in-person voting fraud, the number of known cases is relatively rare."

FactCheck delves into more specific false, misleading or unfounded claims Trump has made about absentee vs. universal mail-ballot voting, Michigan and California's mail-voting systems, and the notion he has promoted that mail-in ballots will be printed overseas, resulting in a rigged election.

It is worth noting that mail-in voting involves the U.S. Postal Service, a financially ailing entity Trump has long criticized. "Members of Congress and state officials in both parties rejected the president’s suggestion and his claim that mail-in ballots would result in widespread fraud," Michael Shear, Hailey Fuchs and Kenneth Vogel report for The Washington Post. "But they are warning that a huge wave of ballots could overwhelm mail carriers unless the Postal Service, in financial difficulty for years, receives emergency funding that Republicans are blocking during negotiations over another pandemic relief bill." Democrats have decried recent money-saving measures by new Postmaster General Louis DeJoy, saying he is laying the groundwork for mailed-ballot disputes. He denies it.

Hospitals seeking more help in next relief bill; rural hospitals fear lack of aid will lead to another round of closures

"U.S. hospitals are on the hook starting this week to pay back billions in federal loans that helped tide them over when they had to scale back services amid the pandemic’s initial surge in the spring," Paige Winfield Cunningham reports for The Washington Post. "But hospitals say the repayments, which are to be docked from their regular Medicare payments until they're fully paid back, could put rural and low-income-serving facilities underwater — particularly in areas where the coronavirus continues to surge." So they're seeking a fix in the next coronavirus relief bill.

Part of their ammunition is a report prepared for the American Hospital Association, predicting that half the nation's hospitals will be losing money by the end of the year unless Congress gives them more relief money, and that could bring another round of rural-hospital closures.

Overall, hospitals usually have an operating margin of 3.5 percent, but that is expected to be minus 3% for the second quarter of this year, once the figures are compiled, and could sink to minus 7% in the third and fourth quarters -- and half of all hospitals are likely to operate with a negative margin, said the report by Kaufman Hall, a health-care consulting firm.

AHA organized a call with reporters and hospital executives, including Sheila Currans, CEO of Harrison Memorial Hospital in Cynthiana, Ky. She said the hospital tries to get an 0.6% operating margin in a good year, but “We are at a negative 25 percent margin.”

Cunningham reports, "Congress probably won’t entirely forgive their loans, which span tens of billions of dollars. But there’s a good chance it will delay when hospitals have to start repaying them, spread out the repayments over a longer time, reduce the loan interest rate — or some combination thereof."

House Democrats' $3 trillion relief bill "would recoup the loans with just 25 percent of hospitals’ Medicare payments instead of 100 percent, thus spreading out repayments over a longer time," while delaying repayment for a year and cutting the interest rate to 1% from 10%, Cunningham notes. Senate Republicans' $1 trillion bill "doesn’t spread out the payments, but would delay the repayment period by five months and delay the start of interest accruing by six months. . . . A measure from Sens. Jeanne Shaheen (D-N.H.) and Michael Bennet (D-Colo.), which is backed by the American Federation of Hospitals, would go further than either of those by allowing the government to forgive balanced owed by hospitals in cases of financial hardship."

Resumption of in-person school likelier in Trump country

Each dot represents a school district. Brookings Institution graph; click the image to enlarge it.
Schools planning to reopen this fall with in-person classes are more likely to be in counties that President Trump carried in 2016, according to a new Brookings Institution study. On average, the counties where schools plan to hold in-person classes supported Trump with 55 percent of the 2016 vote. Districts reopening only with distance learning averaged just 35% support for Trump.

Since rural counties are more likely to support Trump, and rural counties often lack adequate broadband access, it's unclear whether the study conflates local political sentiment with a decision tied to lack of resources, Jon Valant reports for Brookings.

School districts across the nation are debating how resume classes, with the possibility that a delay in in-person instruction could cost them. "Reporting on negotiations between the White House and Republican legislators suggests that almost half of funds for K-12 schools in the covid-19 aid package could be unavailable to schools that do not reopen with in-person learning," Valant writes. "CDC guidance on school reopening has become so politicized that it now lacks credibility. This puts local decision-makers in the precarious position of making reopening decisions with insufficient resources and information, and problematic incentives. Moreover, now that school reopening has become politicized—like mask-wearing and hydroxychloroquine before it—we’re all in the precarious position of having local and state leaders who might, knowingly or not, prioritize politics over safety and reason in their decision-making."