W.Va., Ky. legislators still embrace coal, but not as tightly; Ky. bill to help coal plants stay open shows rural-urban split

Coal was loaded at Cumberland, Ky., near Virginia, in 2019. (Photo by Scott Olson, Getty Images, via Kentucky Lantern)

Most policymakers in the two Eastern states with the biggest stakes in coal, West Virginia and Kentucky, remain "Friends of Coal," following the industry's bi-state slogan, but as the black rock is increasingly disadvantaged in the energy market, some no longer embrace it.

Thursday, the Kentucky state Senate passed a bill to help coal-fired plants keep operating, partly at the behest of coal-reliant rural electric cooperatives. "The bill is opposed by the state’s investor-owned utilities, who say it would prevent them from retiring uneconomical fossil fuel-fired generators and burden consumers with unnecessary costs," reports Jamie Lucke of Kentucky Lantern.

The bill passed 25-8, with all "no" votes coming from senators who represent cities and suburbs; half of them were Republicans, whose party controls the legislature. The state should be "fuel-agnostic," said freshman Sen. Shelley Funke Frommeyer, R-Alexandria, a Cincinnati exurb.

In West Virginia, "Several pro-coal lawmakers support clean-energy startups and alternative electricity sources," and the Legislature repealed the state's ban on nuclear power last year, reports Lee Harris of The American Prospect, a neoliberal magazine. Sean O’Leary, a senior researcher at the Ohio River Valley Institute, told Harris, “To the degree West Virginia is trying to diversify its energy portfolio, its principal focus is on [natural] gas. But folks are still worried and on particular projects and bills, some are starting to wander a little ways off the coal reservation.”

Market forces, and out-of-state politics, are at work. "In 2021, the state’s industry-compliant Public Service Commission approved upgrades at three aging coal-fired power plants, which are expected to keep them operational through 2040," Harris notes. "Kentucky and Virginia refused to impose the costs of those upgrades on their own ratepayers, meaning West Virginia residents will shoulder the full $448 million cost of the upgrades."

This year, West Virginia lawmakers selved a manufacturers-backed bill to encourage developent of gas-fired power plants in favor one directing the state to accelerate coal-fiered power projects, and "the Office of Coalfield Community Development, which was originally set up to help West Virginia transition away from coal, is now being called in to help revive the industry," Harris reports.

Last year, the legislature created a commission "to match grants that former coalfield communities receive, but Gov. Jim Justice hasen't appointed any members, Alexa Beyer of Mountain State Spotlight reports. "Justice owns multiple coal companies, and other lawmakers, including Democratic Sen. Joe Manchin, have deep ties to the industry," Harris notes. "The two may square off in Manchin’s 2024 Senate re-election race."

Murdaugh trial judge gave preference to news media that covered case consistently; press-group lawyer was liaison

Jay Bender with University of South Carolina journalism
students outside the Murdaugh trial (Photo by Teri Saylor)

Coverage of the sensational murder trial of Alex Murdaugh in Walterboro, S.C., which ended with sentencing today, was aided by Jay Bender, general counsel for the South Carolina Press Association, who was the liaison between Superior Court Judge Clifton Newman and the news media, Teri Saylor reports for Publishers' Auxiliary, the monthly newspaper of the National Newspaper Association.

Bender credited Newman "for drafting rules favoring broad cover­age of the Murdaugh trial," Saylor reports. Bender told her, "Judge Newman's instinct to have the court open and his understand­ing of the role the press plays in acting as surrogates for the public who can't be there in person has been key to a process that has gone relatively smoothly." 

Newman banned "electron­ics, including laptops, cellphones and even smart watches," Saylor reports, in a story written while the trial was going on. "Purses and bags must be clear plastic, and everyone enters the courthouse through a security checkpoint. Bender ordered old-school reporter notebooks printed up with a playful message to remind reporters of the rules."  

Bender's notebook reminder (Photo by Teri Saylor)

The cover read, "You have entered the no phone zone. #LeaveitAtHome," and included Bender's name and phone number. 

The trial in the town of 5,400 (seat of Colleton County, pop. 39,000) drew about 50 media representatives, "with 18 permanent media passes available and four issued by lottery," Saylor reports. "In allocating press passes, Judge Newman prioritized media outlets that have been covering Murdaugh consistently, with local newspapers at the top of the list."

"Sometimes I feel like Ticketmas­ter before a Taylor Swift concert," Bender told Saylor. 

"Behind the scenes, Bender mon­itors public access to evidence and court exhibits. Autopsy photos and images of the murder victims are sealed," Saylor writes. "Bender credits Judge Newman for recognizing the value of public access to courts."

Bender said, "This judge understands in South Carolina we have public trials and a constitutional provision that courts are public," Bender said. "He also understands that for the public to have confidence in the court system, they must have access to it." 

"Bender warns reporters against aggressively asserting their status as members of the press when it comes to court access," Saylor reports, quoting him: "Officials who wear black robes understand media privilege some­what differently, and there are some judges who wouldn't want a cam­era within a hundred miles of this courthouse."

Saylor concludes, "For reporters who want to cover court proceedings in their commu­nities, even for the routine proceed­ings, reporters should read the rules established in their state for court coverage, including using cameras, and begin the process of gaining access well in advance. That process could include communicating with the clerk of court, the presiding judge, law clerk and filling out any required forms."

"Always remember the goal in court is not to make the reporter's life easier," Bender todl Saylor. "The goal is to have a fair trial for the defendant." 

Homeland Security takes a deeper look at possible human trafficking of under-age workers to slaughterhouses

A child cleans a slaughterhouse for PSSI; the subject
was blurred by the source. (Department of Labor photo)

"Last month, the Labor Department found that Packers Sanitation Services Inc. . . . employed 102 children at 13 slaughterhouses across eight states," reports Julia Ainsley and Laura Strickler of NBC News. Now, "The Department of Homeland Security has widened its investigation into migrant children found cleaning slaughterhouses and is now working with the Justice Department to examine whether a human smuggling scheme brought migrant children to work in multiple slaughterhouses for multiple companies across multiple states, according to two U.S. officials familiar with the investigation."

The investigation is looking into "how Central American children, some as young as 13, wound up working dangerous jobs that are legal only for American adults by presenting identification stolen from U.S. citizens," NBC reports. "So far the investigation is focused on smugglers who may have provided the children with false identities and possibly led them to dangerous jobs. The companies themselves are not targets of the investigation, the officials said."

A former Packers Sanitation Services manager, who spoke on the condition of anonymity, told NBC, "In this industry you have a lot of people who are undocumented workers. A lot of times it’s because they’re not going to pay well enough to hire people in America who want to do it." NBC reports, "The former manager confirmed that the company uses the federal government’s E-Verify program, but said that while some employees presenting false documents were turned away, it was common for workers who presented obviously false IDs to get hired as long as the documents stated they were legal and of age."

Packers Sanitation spokesperson Gina Swenson disputed the former manager, saying, "This is categorically false — period. We have been crystal clear that we do not want a single person under the age of 18 working for the company. We have trained and retrained our hiring employees on how to actively spot identity theft — as part of our extensive efforts to enforce this absolute prohibition against employing anyone under the age of 18."

Rules on 'forever chemicals' could cost communities billions

As early as today, the Environmental Protection Agency "is expected to propose restrictions on harmful 'forever chemicals' in drinking water after finding they are dangerous in amounts so small as to be undetectable, The Associated Press reports. "But experts say removing them will cost billions, a burden that will fall hardest on small communities with few resources." Translation: rural.

"Concerned about the chemicals’ ability to weaken children’s immune systems, the EPA said last year that PFAS could cause harm at levels “much lower than previously understood, AP's Michael Phillis and Brittany Peterson write. "There is also evidence the compounds are linked to low birthweight, kidney cancer and a slew of other health issues. It’s unclear what the EPA will now propose and how well it will protect people from these recently-understood harms."

PFAS stands for "per-and polyfluoroalkyl substances." They "are widespread, don’t degrade in the environment and have been around for decades," AP notes. "They’ve been used in nonstick pans, food packaging and firefighting foam. Their use is now mostly phased out in the U.S., but some still remain. . . . Over the last decade, an increasing number of cities and towns, often abutting manufacturing plants or Air Force bases, suddenly realized they had a problem."

While Friday was the deadline for the proposal, it has to be reviewed by the White House Office of Management and Budget. "As of Thursday, that review wasn’t finished," AP reports.

Rural people have long been more likely to die from diabetes; now the disparity seems to be increasing

Annual diabetes death rates per 100,000 people, for diabetes as a multiple cause of death and for diabetes as an underlying cause of death. (Mayo Clinic graph from Centers for Disease Control data; click on it for a larger version)

Diabetes comes with lifelong care and an extensive list of possible complications, which range from eye problems to foot problems to kidney problems, gum disease and cancer. A Mayo Clinic study has found that rural counties have higher diabetes death rates, and the disparity seems to be increasing. "The researchers point out that these rural health trends would not be visible in an analysis of national-level data," the National Institute on Minority Health and Health Disparities reports. "Large declines in diabetes mortality in recent decades in more urbanized counties have resulted in national-level declines in ADMR, masking the health disparities present in rural counties."

NIMHS reports, "Using data from the Centers for Disease Control and Prevention, researchers compared the annual diabetes mortality rate per 100,000 people in 2017-2018 with the rate in 1999-2000. This mortality rate includes deaths where diabetes is listed as one of multiple causes." Rural death rates rose slightly, but fell in urbanized counties, "showing that people in rural areas were not experiencing whatever factor accounted for the decrease in more urbanized areas. . . . Rural health disparities in diabetes were a consistent theme across all groups."

While the study showed that rural people are more likely to die from diabetes, it did not isolate causes. "The researchers suggest several possible reasons why people in rural areas may be more likely to die from diabetes. People in rural areas may be more likely to have other medical conditions that could make their diabetes worse. They may have difficulty accessing health care and may not consume as many fruits and vegetables as people in urban areas do. They may also be disproportionately affected by environmental pollution," NIMHS reports. "The researchers write that further research could show why these disparities exist and support development of ways to improve rural health."

The study, "Assessment of disparities in diabetes mortality in adults in U.S. rural vs. non-rural counties, 1999-2018," was published in JAMA Network Open, a publication of the American Medical Association.

A study revives debate on masks: Twitter explodes, public is 'befuddled;' prevention may depend on how they're worn

To be effective, masks need to be worn correctly. (Jacek Poblocki, Unsplash)

Haven't the questions about masking been asked and answered? "Or at least that we had all agreed to disagree, but no such luck," writes Felice J. Freyer of The Boston Globe. "The debate over whether masks limit Covid-19 transmission recently reignited after a new review of the research came out, drawing out skeptics and defenders, and — as so often happens — leaving the ordinary citizen befuddled."

How did this get started — again? "A British outfit known as the Cochrane Library put out a new report on masking. When the Cochrane Review, which is highly respected in medical circles, tackled the mask question, it found that "wearing a mask may make little to no difference in how many people caught a flu‐like illness/Covid‐like illness," Freyer writes. "But the review encompassed primarily studies conducted before the pandemic, which examined the spread of influenza. The flu is far less contagious than Covid-19, which could lead to underestimating the effects of masks. The review also mixed studies of health-care workers with those involving the general public, and included studies that couldn’t answer the question of whether people actually wore their masks correctly."

Who's causing the fuss? "Twitter erupted with criticisms. Then one of the Cochrane Review authors was quoted in a Substack newsletter article saying of masks, "There is just no evidence that they make any difference. Full stop." . . . The Substack interview prompted New York Times columnist Bret Stephens to scold all those who favored mask mandates, saying they owed the world an apology. That unleashed another round of social media outrage. . . . But as others have pointed out, there’s no evidence that masks don’t make a difference. The big problem is that there isn’t enough evidence, period."

Wait a minute; what do masks prevent? “We have good evidence from laboratory studies [that] if you’re wearing a mask correctly and you’re in the presence of the virus, the mask will protect you,” Jennifer Nuzzo, professor of epidemiology at Brown University School of Public Health, told Freyer. Commenting on the Cochrane Review, Freyer added, “The appropriate conclusion is, we don’t have great evidence showing that masks change infection rates in populations. But we don’t know why that is. It’s probably not to do with masks themselves, but how they’re worn.”

What did Dr. Anthony Fauci, former director of the National Institute of Allergy and Infectious Diseases, say about the Cochrane study? “It’s a meta-analysis of a very large number of studies, many of which had nothing to do with Covid, and many of which did studies with masks that were not regularly worn every day and properly,” Fauci told Freyer. “There were only two studies in that entire meta-analysis that were exclusively looking at masks with Covid.”

Could I get a straight answer? "The basic advice hasn’t changed. Wear a mask in situations where you think you’re at risk of infection, such as a crowded indoor setting, especially during a time when Covid transmission is high," Freyer reports. "The level of that risk is determined by the level of transmission in your community, your own vulnerability to severe illness, the vulnerability of people you expect to come in contact with, and your personal tolerance for risk."

Final thoughts? Fauci told Freyer, “Everyone is different. Everyone’s risk for a complication is different. So there’s no set rule.”

Sunshine Week, March 12-18, is a good opportunity to promote journalism as the public's watchdog on government

Sunshine Week, which promotes open government and the role of the news media in preserving it, begins Sunday, March 12. At a time when trust in news has faded, it's an opportunity for journalists and their paymasters to promote journalism's role as the public's watchdog on government.

 

Sunshine Week was launched in 2005 by the American Society of News Editors, now the News Leaders Association. This year, it has a new partner, the Society of Professional Journalists.

SPJ has long promoted March 16 as Freedom of Information Day because it is the birthday of James Madison, chief author of the First Amendment: "Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for redress of grievances."

Most of the First Amendment was written to keep government accountable to the people through speech, publication, assembly and petition. Accountability requires transparency, so we can know what government is doing. States and the federal government do that through open-records and open-meetings laws, and those laws are used as much or more by the general public as by journalists.

To deliver such knowledge to the public, NLA and SPJ want as many journalists and news organizations as possible to participate in Sunshine week by doing news stories, editorials, columns, cartoons and graphics and sharing them with contact@sunshineweek.org. You can participate on social media by tweeting @SunshineWeek or using #SunshineWeek.

News stories can explain open-government laws and how to use them, and point out other stories that were made possible by those laws. Editorials and columns can argue for open government but also address citizens' concerns about the news media and encourage letters to the editor, social-media discussions and other dialogue and engagement with the public.

Sunshine Week also encourages news organizations to hold Freedom of Information Day or Sunshine Week events, and has an events calendar for them. If your organization is holding an event and you would like it to appear on the calendar, fill out the interactive form that will soon be available on the Sunshine Week website.

Fox News hosts seem to make the case that they acted with malice, Mississippi Press Association executive opines

By Layne Bruce

The first time I recall hearing the phrase “absence of malice” was from a film of that title released in 1981 starring Paul Newman and Sally Field.

Newman plays a liquor wholesaler falsely accused in the disappearance of a local union leader and whose life is wrecked when the news hits the papers. Field is the reporter who’s manipulated by a corrupt district attorney who wants to squeeze Newman for information about another case.

It’s a convoluted work of fiction, but it’s one of my favorite movies about journalism and what can go wrong when people motivated by careerism forget that their actions can have very real and dramatic consequences for many people around them.

Layne Bruce

After studying journalism in college, I came to understand “absence of malice” as a legal term that also represents an incredibly high burden of proof that must be met by litigants who claim they’ve been defamed by the press.

When a plaintiff sues a media outlet for defamation, they must prove that whatever inaccuracies the outlet reported were borne of actual malicious intent. In other words, the defendants in such cases must act intentionally and spread false information knowingly.

That must be provable. It’s difficult to do, and it’s one of the cornerstone protections of freedom of the press in this country.

But if we were going to write a screenplay based on the defamation lawsuit filed against Fox News by Dominion Voting Systems for the reporting of false claims of fraud in the 2020 presidential election, it wouldn’t be a drama; it would have to be a farce. It seems like a black comedy of lies, hubris, and gaslighting.

A cursory review of text messages entered into the record and recently made public between Fox News personnel leaves little doubt the producers and hosts knew claims against Dominion that aired repeatedly on the network and sister channel Fox Business were bogus.

Marquee hosts Tucker Carlson, Sean Hannity, Laura Ingraham, and others engaged in numerous conversations about the veracity of the claims against Dominion and even the sanity of the lawyers pressing the conspiracy theories on air and in daily press conferences.

“No serious lawyer could believe what they were saying,” Ingraham says in the text messages. “Sidney Powell is a bit nuts,” she wrote in another. That did not keep the network from repeatedly putting Powell, a key lawyer at the center of the scandal, on air to regurgitate nonsense about alleged fraud, krakens, and other incoherent conspiracy theories.

That Fox News allowed this, and in so doing spread the toxicity to millions of viewers daily, goes a long way to addressing a heretofore almost unattainable bar of proving malice.

And by putting their private thoughts into texts while engaging in the apparent fiction of “just asking questions” on air, the hosts have exposed the network to a potentially landmark—and hugely expensive—judgment against it.

They’ve single-handedly lowered the bar for proving malice.

Wall Street Journal columnist Bill Galston on The Bulwark’s “Beg to Differ” podcast laid out four points necessary to prove malicious intent and reckless disregard to a jury:

• A false statement purported to be fact. The text messages prove network personnel knew the claims of voter fraud by Dominion were bogus.
• Publication or communication of the false statement to a third party. Fox hosts did this nightly for weeks to viewers numbering in the millions.
• Fault amounting to “at least negligence.” Galston contends the repetition of falsehoods over network air was not just reckless disregard, but a “deliberate lie” motivated by fear the network would alienate its audience if it debunked the conspiracies.
• Damages must be sustained to the reputation of the plaintiff. This may the easiest claim to prove. How many of us had heard of Dominion as a company before it was dragged into the contrived effort to throw the 2020 election results into doubt?

“If this isn’t a slam dunk case after the revelations that came out because of the (disclosure of the text messages), I don’t know what is,” Galston concluded.

This is by no means the first time Fox News’ dirty laundry has been aired in public. But it is for sure the first time the network has been so nakedly exposed to potential damages that might have a lasting effect on its business practices.

If malice has not been proven in this case, I’m with Galston—I’m not sure it could ever be proved. Whatever the ultimate decision, the case will be taught in future media law classes.

And I can’t wait to see the movie.

Layne Bruce, a former journalist, is executive director of the Mississippi Press Association. His email address is lbruce@mspress.org.

Derailments and explosions aren't only worries for railroads' neighbors; noise and vibrations can cause health issues

Train tracks in Newberg, Oregon (Photo by David Herron, Unsplash)

The train explosion and controlled burn of hazardous materials in East Palestine, Ohio, reminded us that living near a railroad can be hazardous to your health and safety. But some health threats from rail are more chronic and unseen, "and while fiery crashes with towering smoke clouds make for lots of headlines, studies suggest trains carry health costs even when they don’t derail," reports Jason Bittel of National Geographic. "Noise pollution and vibrations are some of the biggest concerns, particularly for people who live within one-third of a mile of railroads or railyards, says Natalia Caldeira Loss Vincens, an expert in public health at the University of Gothenburg in Sweden."

“These exposures to noise and other things” are stressful, and chronic stress can lead to “a cascade of pathophysiological changes,” including inflammation, and changes in appetite or a person’s insulin sensitivity. "In a 2022 study in the journal Environmental Research, Vincens found a link between railway noise and incidences of diabetes, even when accounting for variables such as sociodemographic and lifestyle factors," Bittel reports.

Luca Fredianelli, an acoustic technician with the Italian National Council of Research, told Bittel, "If the sounds are quite stable, in the end, we do not perceive it at all." Bittel elaborates: "It’s the less intense but more unpredictable noises, such as squeals, whistles, and grinding brakes, that really bother people, since they’re difficult to acclimate to, he said."

Housing insecurity at rural colleges leads some to drastic measures, including fish houses and possibly barges

An 'Ice Castle' fish-house trailer. (Photo from Ice Castle Fish Houses)

Low-income seniors, struggling families and rural college students are all experiencing a similar problem: There is no place to live! "Housing insecurity has long been an issue in rural areas, but high inflation, pandemic migration, and last year’s record-breaking real estate market have created an untenable situation at rural campuses across the country," reports Nick Fouriezos of The Daily Yonder. "Administrators at Minnesota State Community and Technical College have heard of students living on frozen lakes, in makeshift camper communities that double as ice fishing huts."

Carrie Brimhall, president of the Moorhead school, told Fouriezos, "I know we have students living in Ice Castles," one brand of fish house. "When the housing market was so crazy, the people who had rented to students sold their properties. Not every buyer kept them as rentals, so now students don’t have a place to live. . . . Even if we start a new destination program, it’s hard to find places for students to live so they can take it.”

The lack of housing is not compatible with university expansion plans. In California, "Cal Poly Humboldt. . . is in the middle of an ambitious plan to rapidly boost its 5,700-student enrollment by 50% in the next three years," Fouriezos reports. "It’s already struggling to meet the basic housing needs of the students it has, not to mention those to come."

Humboldt County,
California (Wikipedia)

Fouriezos reports, "The first Saturday of February, Cal Poly Humboldt quietly updated its housing website. Incoming first-years would have priority for all on-campus housing, the university revealed. The move sparked instant protests, a petition from parents demanding that enrollment increases halt and even the formation of a new student organization—Cal Poly Homeless—to address the changes. . . The university has since said it would find on-campus beds . . . . However, many Cal Poly Humboldt students are worried that those solutions will be far from ideal." On Feb. 15, the San Francisco Chronicle reported that the Cal Poly was considering putting student dorms on floating barges.

“We have all these housing projects in the works, but it takes a few years, and students are coming before those are done,” Cal Poly Humboldt VP Jenn Capps told Fouriezos, adding that hotels would be a key part of their plan. Oden Taylor, a Cal Poly Humboldt junior, told Fouriezos, “This is not a big city, where there is adequate public transportation. Everything is very small. . . .There are so many problems with the infrastructure at the school already."

Fouriezos writes, "The university’s [expansion] decisions have contributed to ongoing tension between the college and its surrounding community. Students are often the target of that rift. . . . Still, the students may actually share more in common with the townies than one would think—and both populations have significant concerns about Cal Poly Humboldt’s rapid expansion plans."

In states where abortion is illegal, some physicians are afraid to say the word; women struggle to get needed care

Lauren Miller traveled Colorado for medical care that is
now illegal in Texas. (Photo by Nitashia Johnson, NPR)

Hormone changes, nutritional deficits, and mental worry make pregnancy stressful for women and their bodies. When things go wrong, such as in the case of fetal fatality or an abnormality that prevents viability, women face an entirely new set of stressors. In some states, needed medical care may be illegal -- so illegal that physicians don't even want to say the word "abortion," reports Selena Simmons-Duffin of NPR.

The case of a woman in Dallas is an example of a state with tough abortion laws and no exceptions. "This past fall, when Lauren Miller was 13 weeks pregnant with twins, she got horrible news. One of the twins had trisomy 18, a genetic abnormality that causes about 90% of fetuses to die before birth. The other twin was healthy," Simmons-Duffin explains. "She learned from a genetic counselor that continuing to carry both fetuses could put the healthy one at risk. She saw a doctor who specializes in high-risk pregnancies who told her: 'You can't do anything in Texas and I can't tell you anything further in Texas, but you need to get out of state.'. . .That's exactly what she did. Miller traveled to Colorado and, at 15 weeks pregnant, she had a 'selective reduction' procedure to help ensure her pregnancy with her healthy twin could continue." In Miller's case, she was able to afford to go to another state, but many women do not have the means.

Once Miller had the procedure, she encountered another barrier. "When she returned and continued her prenatal care, she found herself navigating silence around abortion. She wondered if the ultrasound technician knew she'd traveled out of state for an abortion, could she get reported? Miller told Simmons-Duffin, "You don't know where anybody stands, so it feels like we're all kind of talking in code."

"What Miller did does not violate current abortion laws in Texas, legal experts say," Simmons-Duffin writes. "But the fear among doctors and patients in the new legal landscape in Texas is extreme, to the point where some doctors won't say the word 'abortion' in the exam room. Elizabeth Sepper, professor of law at the University of Texas, told Simmon-Duffin, "Physicians have independent speech rights, to speak to their patients openly," she says. "Physicians should not be scared to say the 'a-word.'" Simmons-Duffin adds, "Many doctors in Texas who treat pregnant patients are extremely scared. Especially of language in one of the state's abortion bans that allow people to take civil action against anyone who 'aids or abets' abortion." 

While some many states have abortion exceptions, the exceptions are rarely granted, reports Amy Schoenfeld Walker of The New York Times. "But in the months since the court’s decision, very few exceptions to these new abortion bans have been granted." In Kentucky, the only exception is threat to the woman's life; Alex Acquisto of the Lexington Herald-Leader wrote about two women who had to go out of state because Kentucky laws banning abortion "do not legally permit the standard-of-care treatment for a nonviable pregnancy."

Some think Texas physicians are over-reading that state's law. Amy O'Donnell of the Texas Alliance for Life, an anti-abortion rights group, told Simmons-Duffin that its attorneys "believe there is a constitutional right to interstate travel," but courts have yet to rule on the law and without precedent, it seems physicians will remain fearful. Dr. Andrea Palmer, an obstetrician-gynecologist in Fort Worth, told NPR, "People are scared to talk . . . The law's vague – it's really poorly written. . . . Nobody wants to be defendant number one on this."

Putting the mighty back into the Mississippi: River levels rise

The Mississippi River and its tributaries could be back
to normal by this spring. (Photo by Chip Flory, Farm Journal)

After months of drought and barge congestion, "The shipping crisis on the Mississippi River might finally be ending," reports Michelle Rook of Farm Journal. "Since last July, the U.S. Army Corps of Engineers has been dredging the river 24 hours a day, seven days a week to ease shipping backups. With improved snowpack in areas such as Montana and precipitation through the midsection of the country late last fall and this winter, the Mississippi River and its tributaries could be back to normal by this spring."

The needle is moving in the right direction. “When you look at the river gauges for points such as Memphis, Tenn., and St. Louis, Mo., we’re seeing water levels equal to or at least comparable to this time last year,” Mike Steenhoek, executive director of the Soy Transportation Coalition told Rook. "So, we’ve seen about a 20-foot swing in river levels since last fall, which is really meaningful."

The U.S. Bureau of Transportation Statistics reports, "In 2020, the river carried more than half of the 165.5 million tons that moved between 12 states." With that amount of traffic, "Steenhoek says it takes time for barge and river traffic to resume normal levels," Rook reports."Steenhoek says barge freight rates have also eased in the past year. In early February, the Department of Agriculture reports the barge rate for a shipment originating in St. Louis was $18.55 per ton. That is 26% less than a year ago. Last October, freight rates for St. Louis cargo hit $105.85."

The Mississippi shipping crisis reignited a push for the U.S. to add transportation flexibility through fortification of rail systems, which also struggled to meet demand during the drought.

High-quality Texas weekly quitting a week early: 'We have done what could be done . . . there seems little more to say'

Wikipedia map, adapted

When Laurie Ezzell Brown announced last week that she would publish only two more editions of The Canadian Record, one of the nation's best weekly newspapers, she did it in the middle of the third column of a three-column opinion piece and acknowledged that she had buried the lede, as her newspaper friends had accused her of doing recently. This week, she did it again, annnouncing in the second half of her column that it was her last:

We have decided to suspend publication with this issue, a week earlier than we had announced, having felt we have done what could be done, and that there seems little more to say. As we promised, we will continue to search for someone worthy of carrying on this 75-year Ezzell family legacy, and hope you will help us.

Tonight, I will wonder what my parents would think of the job we’ve done, the changes we’ve made, and this final, difficult decision that really made itself. Deep in my heart, though, I believe we have done the job given us to do, and have honored them in word and deed.

We leave with these words, written by Annie Proulx in her Pulitzer Prize-winning novel, The Shipping News: 'A paper has a life of its own, an existence beyond earthly owners.' May it be so. And for my newspaper friends . . . 

-30-

Laurie Ezzell Brown

The Record continues to post on its Facebook page, but a weekly paper can miss only two weeks of print publication before it loses its postal permit. Laurie once thought she had a sale, but the buyer couldn't find anyone to move to Canadian to run the paper. Last month, she was ready to sell until the buyer jerked her around and she said no. She, the Record and the 3,400 residents of Hemphill County deserve so much better. This is an opportunity for a young person to buy at little cost a newspaper that makes enough money for a living, and one that has a tremendous legacy on which to build. Few jobs can be more rewarding.  –Al Cross, director and professor, Institute for Rural Journalism and Community Issues, University of Kentucky

If you need a rural ride, it may be hard to schedule, or it may not; states, localities work to find transportation solutions

A Cedar County Transit van makes its way down a Nebraska road.
(Photo by Forrest Czarnecki, Special to Harvest Public Media)

In rural areas, getting from here to there without a vehicle can be tough. "In rural areas, residents can be miles away from essentials like doctors and grocery stores instead of minutes. Absent transportation, people who don’t have a car or can’t drive often have to move closer to service," reports Elizabeth Rembert of Harvest Public Media. "More than a third of state rural-health offices reported lack of transit was the biggest barrier to elderly people staying in their homes, according to research by Carrie Henning-Smith, who studies rural health at the University of Minnesota. . . . Rural America tends to be sicker, poorer and older than its urban counterparts. Henning-Smith said the negative-but-true statistics make it even more important for rural residents to be able to access transit."

Rembert provides an example: "Joel Tyndall lives off a gravel road in northeast Nebraska, miles away from the nearest town. As a double amputee, some have suggested he could move closer to the biggest town, Norfolk, where he has three dialysis appointments a week to manage his diabetes. . . . But it hasn’t come to that — thanks in part to the Cedar County Transit — which works a little like a rural Uber; anyone can call to schedule a ride. Tyndall told Rembert he doesn't plan on leaving his home, "as long as this transit continues to run I'll be using it for just about everything. These guys help me out more than you would believe.”

Cedar Country Transit was designed to support rural citizens, "The northeast Nebraska county has had some level of public transportation since about 1980 . . . They now have 15 vans, 15 drivers and a full-time scheduler. The operation recently launched services into a bordering county and moved into its own building," Rembert writes. "Anyone living in Cedar County and parts of Knox County can schedule a ride, as long as it’s within 200 miles and on a weekday from 6 a.m. to 6 p.m. . . . The service runs on money from the state and federal government, grants and contracts and local community funding, as well as fare for rides."

Nebraska isn't alone in seeking rural transportation alternatives. "Providing public transit in rural areas is a difficult task, but a patchwork of services serves towns and counties throughout the Midwest and Great Plains," Rembert reports. "Kansas was tied in 2019 for the most rural transit agencies in the nation, and in Iowa 35 providers serve riders across the state’s 99 counties. In 2020, Oklahoma developed a transit plan to help it become a 'top 10 state in transit' by 2040. . . . Missouri’s 'Operating Above the Standard' Transit is the largest agency in the country and operates in 87 counties. But it doesn't reach every corner of the state."

America doesn't have enough truck drivers; the is job lonely, stressful and dangerous, so few of them stick with it

Truck drivers roll through swaths of lonely countryside.
(Photo by George Etheredge, The New York Times)

In his song "All I Do Is Drive," Johnny Cash sums up a lot of why there's a shortage of truck drivers: "All I do is drive, drive, drive/Try to stay alive/And keep my mind on my load/Keep my eye upon the road."

"In a world contending with the unrelenting impact of the Great Supply Chain Disruption, a shortage of truck drivers is frequently cited as an explanation for shortages of many other things — from construction supplies to electronics to clothing," reports Peter S. Goodman of The New York Times. "Last year, trucking companies in the United States suffered a record deficit of 80,000 drivers, according to the American Trucking Association, a trade association. Given that trucks move 72 percent of American freight, a lack of drivers spells substantial disruption."

To investigate truck driver life, Goodman joined seasoned truck driver Stephan Graves for three days riding shotgun, from Kansas City, Mo., to Fort Worth, Texas and back. Graves told Goodman, “The lifestyle probably is the first thing that smacks people in the face. You know what it does to you. You’re thinking about it all the time. We’re tired. Our bodies are starting to go. Our bladders have been put to the test. And no exercise. We end up with all types of heart and other health ailments. You can’t truly fathom what it’s done to you.” Goodman writes, "He is prone to rhapsodizing about the open road. But he does not struggle to explain why his industry is perpetually bemoaning a shortage of drivers. . . . It is a job full of stress, physical deprivation and loneliness."

Are there not enough workers, or is it something else? "Some experts counter that the very notion of too few drivers is bogus," Goodman reports. "The average trucking company has a turnover rate of roughly 95 percent. . . . As the trucking association itself noted, more than 10 million Americans held commercial driver’s licenses in 2019. That was nearly triple the 3.7 million trucks that required a driver holding that certification."

Steve Viscelli, a University of Pennsylvania labor expert who once worked as a truck driver, told Goodman, “There is no shortage of truck drivers. These are just really bad jobs. . . . Until the 1980s, truck driving was a lucrative pursuit in which one union — the Teamsters — wielded enough power to ensure favorable working conditions, Mr. Viscelli recounts in his book The Big Rig. But the Carter administration deregulated the industry in the name of fostering competition, clearing the way for an influx of new trucking companies that diminished pay and increased demands on truckers."

Goodman writes, "Graves is satisfied with his employer. . . . He earns what he describes as 'a comfortable living.' . . . He and his fellow drivers are now enjoying the upper hand. Trucking fleets are handing out across-the-board raises to retain drivers while offering $10,000 cash bonuses in a frantic effort to court new hires. . . . Still, a three-day run in Graves’s vehicle — from Kansas City, Mo., to Fort Worth and back — reveals the inherent pressures of a relentlessly stressful job. . . . Here is a life spent navigating the hazards of piloting a truck weighing 26,000 pounds and pulling a 53-foot trailer, while balancing the need to ingest caffeine against the imperative to limit bathroom breaks. . . . The hours pass, the towns recede, while the gnawing loneliness of the road is constant." 

As an over-the-road driver, "Graves typically does not make it home by nightfall. He drives roughly 9,000 miles a month, spending two and three weeks on the road at a time, before returning home to his condo in Kingsport, Tenn. . . This is Day 10 of a 19-day trip that has taken him from Texarkana, Ark., to Texarkana, Texas, with three separate runs through Chicago, a stop in Indianapolis and a drop in Spartanburg, S.C., before bringing him to Kansas City. . . . Mostly, he rolls through vast stretches of emptiness, the flat, largely treeless plains punctuated by distant herds of cattle. . . .One of the primary reasons young people tend not to stick as truck drivers, Graves explains, is the challenge of maintaining ties to the rest of the world."

Higher religious participation linked to fewer deaths of despair; research suggests it's the social ties that matter

National Bureau of Economic Research working-paper graph
shows underlying cultural trends that preceded the opioid edpidemic

In 2000, the label "death of despair" did not exist. The phrase is now common and often attached to the opioid epidemic, but a deeper understanding of its root causes is still being explored. "A new paper by Tyler Giles of Wellesley, Daniel Hungerman of Notre Dame and Tamar Oostrom of Ohio State bolsters the case that deaths of despair stem in part from weakening social ties. It shows that mortality from these causes among middle-aged whites stopped falling around 1990—well before the rise in opioid use," The Economist reports. "What changed at that time? The authors studied attendance at religious services. They found that states with more participation had fewer deaths of despair and that the faster religious attendance fell in a state, the more such deaths rose. A paper in the Journal of American Medical Association in 2020 also showed that of 110,000 health workers, those who went to services were less likely to die from these causes."

To study the relationship between deaths of despair and religious participation, "The authors tried to isolate the impact of religion by studying blue laws, which banned commerce on Sundays to encourage churchgoing," The Economist reports. "Whenever a state repealed a blue law, religious attendance tended to plummet, creating a natural experiment. And sure enough, deaths of despair rose unusually quickly in the few years following these repeals. Although legalizing alcohol sales on Sundays may account for some of this trend, the biggest increase in mortality came from suicides."

A Google search of "Why go to church if I can pray at home?" yields pages of responses. And yet, this study "strikingly found that private prayer was not linked to lower deaths of despair," The Economist notes. "This suggests that the risk reduction stems not from belief, but rather from the interpersonal connections that organized religion provides. Although secular groups like charities or labor unions also produce such 'social capital,' the JAMA authors say that faith-based networks provide unusually potent protection."

The phrase "death of despair" comes from a 2015 milestone paper published by Anne Case and Angus Deaton that analyzed death rates in America and found deaths of despair to be disproportionately rural. "The economists found that mortality had been rising among middle-aged whites, thanks to a surge in drug overdoses, alcohol-related illness, and suicides—causes they deemed 'deaths of despair,'" reports The Economist. Since 2015, academics have sought tease out the root cause of these deaths -- are they caused by mental anguish or opioid abuse -- the answer is yet to come.

Beginning with mysterious disappearance of some bats, an ecological danger is unmasked: The world needs darkness

The Luxor Hotel’s 'sky beam' in Las Vegas. (Illustration by Carson Ellis, The New Yorker)

White-nose syndrome, windmill turbines and climate change have all contributed to bat deaths. In Darkness Manifesto, Swedish ecologist Johan Eklöf's reveals an entirely different threat to bats and humans, which he discovered studying Swedish belfries, reports Adam Gopnik of The New Yorker. "According to Eklöf, most churches in southwest Sweden had bat colonies back in the 1980s, and now most of them don’t. Light pollution, his research suggests, has been a major culprit." Eklöf's Manifesto explains, "District after district has installed modern floodlights to show the architecture it’s proud of, all the while the animals—who have for centuries found safety in the darkness of the church towers and who have for 70 million years made the night their abode—are slowly but surely vanishing from these places.”

Eklöf is an bat expert at Stockholm University. "He is able to tell us authoritatively that, though bats do indeed use natural sonar to echolocate their way around, their eyes see well enough in the dark to help in their navigation," Gopnik reports. "Though the book is written as a sort of Silent Spring manifesto against the ecological devastations of light pollution, its considerable charm depends on the encyclopedic intensity with which he evokes the hidden creatures of the night."

With the creation of artificial light, humans erased some of their own connections with the natural world. Gopnik writes, "Where once human life had its nocturnal rhythms, interrupted only by the dim light of candles and fireplaces, the Earth is now so lit up that, seen from space, it glows like a Japanese lantern. Eklöf writes, 'artificial light, the polluted light, is now dominant—light that causes birds to sing in the middle of the night, sends turtle babies in the wrong direction, and prevents the mating rituals of coral in reefs, which take place under the light of the moon.'”

Often extreme light pollution is "not some helpful harborside lighthouse but the 'sky beam' atop the Luxor Hotel in Las Vegas. Creating forty-two billion candlepower of light every night, meant merely as a come-on to tourists and gamblers, it unintentionally excites and undoes flocks of birds, genetically programmed by evolution to fly toward bright light—and, in 2019, attracted clouds of grasshoppers, who flew toward the pseudo-Egyptian pyramid with all the horror of a pseudo-Egyptian plague."

Gopnik adds: "Eklöf insists that doom is still avoidable. 'Light pollution is the easiest of all environmental problems to solve, at least technically,' he writes. 'We, as private individuals, can, with little cost, reduce the amount of our light pollution. With light shades, downward-facing light sources low to the ground, and dim lighting, we can reduce the cities’ total amount of light, as well as the artificial light scattered in the atmosphere.'”

Gopnik reminds us, "The light of reason makes searchlights and lighthouses; the love of darkness asks us to adjust our eyes and egos sufficiently to see as owls do. Seek light in the morning; accept the night when it comes. Then call it a day."

Quick hits: As farmers mobilize for protest, one in 1979 is recalled; West Virginia crooner invites folks to visit state . . .

U.S. Rep. Dan Glickman, D-Kansas and later secretary of agriculture, left, with prized Polled Hereford bull "King George" and his owner, farmer and American Agriculture Movement communications czar Leon Riffel. (Photo courtesy of Crystal Carson)

As Farmers for Climate Action get ready for their early-March rally in Washington D.C., let's revisit the 1979 Tractorcade. "In early February 1979, David Senter — a fourth-generation farmer from Burleston, Texas — and more than 3,000 other striking farmers from around the country drove their tractors to the nation’s capital to demand parity for farmers. The predominant issues at that time were fair commodity pricing and country-of-origin labeling," reports Dan Sullivan of Lancaster Farming.

Spring planting will soon be upon us. Heirloom seeds are something special to consider as you plan your 2023 garden.

"Don't hesitate, come and see the Mountain State," croons Landau Eugene Murphy, Jr. in his latest release, "Come Home to West Virginia." Murphy, who once washed cars, is working to keep jazz classics from what some call "the Great American Songbook" alive and is adding his own creations. He still lives in coal-rich Logan County and finds ways to celebrate Appalachian life through big-band music.

Read something unusual about America's last rural president: "A nuclear reactor was melting down. Jimmy Carter came to the rescue. As a 28-year-old Navy lieutenant, Carter was one of the few people on the planet authorized to go inside a damaged nuclear reactor," reports Gillian Brockell of The Washington Post.

Bison and Montana go together. In this outdoor classroom, a recent bison harvest highlights a growing number of state-level curriculum programs that teach students Native ceremony and food traditions.

Wikipedia map

Moffat, a small Scottish town of about 2,400, "first gained attention as a Victorian-era spa town known for its sulfur-rich springs. More recently, the town’s fame has taken a darker turn—literally. After upgrading its public lighting, in 2016, Moffat became the first European town to receive International Dark Sky Place certification," reports Blair Mastbaum of Atlas Obscura.

Catching Covid-19 may be the best way to avoid the worst of it, a new study from the University of Washington has found. Contracting the disease may offer more durable immunity, reports Julia Marnin of The Seattle Times.

Too hot? Too cold? "Cold is far more deadly. For every death linked to heat, nine are tied to cold," reports Harry Stevens of The Washington Post. It's a complex argument: "If cold was deadlier than heat, and the planet was getting hotter, global warming might actually save lives. But whose lives?"

How do human fingerprints get their special swirls? Their intricate patterns "are produced during fetal development by waves of tiny ridges that form on the fingertip, spread and then collide with each other — similar to the process that gives a zebra its stripes, or a cheetah its spots," reports Heidi Ledford of Nature.

"Phillip Andrew Marx takes care of chickens, ducks, and turkeys in exchange for money to help him graduate college with no student debt. . . . For Marx, he said he believes change starts with farmers, and he’s proud to work on projects related to farming and agriculture," reports Kristi Eaton of The Daily Yonder. This piece presents a new program in CaliforniaCorps, a job program for students, and it's a program other states can mimic.

Secret ballot or public votes from the floor? Pandemic-era changes stir debate on New England town-meeting structure

Town Meeting of Tunbridge, Vt., May 2022, delayed two months due to Covid-19 (Valley News photo by James Patterson)

May I have the floor? If you're at a New England town meeting, that's an important question. First, bear in mind that every bit of New England, except sparsely populated areas like northern Maine, lies within the boundary of a town or city. Towns are New England's fundamental unit of government, like the county is elsewhere in the U.S.

"The institution of Town Meeting dates to the 1630s, the days of the earliest European settlements," notes Alex Hanson of the Valley News in West Lebanon, N.H., and White River Junction, Vt., as he reports a move to secret-ballot voting: "The past two years with Covid-era trials have given Town Meeting voters a taste of Australian-ballot voting, where the polls are open from morning until 7 p.m., and in many cases universal mail-in voting, where ballots are sent to every verified voter. . . . In at least three towns on the Vermont side of the Upper Valley . . . will reconvene for floor meetings for the first time since before the pandemic and will consider whether to move to ballot voting."

Debating whether to have or not to have town meetings has "revived a long-standing debate about New England’s signature form of government," Hanson reports. "Supporters of moving to Australian-ballot voting for some or all town-meeting business note that, in some towns, turnout was double in 2021 and 2022 what it was in previous years of in-person meetings. But the value of the traditional meeting, where neighbors gather to talk over and amend town budgets and other matters, might be greater than ever following the pandemic’s isolation, backers of the in-person format say."

The push for Australian ballot vs. in-person town meeting is often economic, Hanson reports: "Vermont law requires employers to give workers the day off for the meeting, but it isn’t always feasible. . . . Eric Lopez, a member of the Strafford School Board, expects he’ll have to miss Town Meeting for work. The board hasn’t taken a position on Australian balloting, but speaking for himself alone, Lopez is for it. While he appreciates the deliberate nature of the in-person meeting, 'It’s difficult for me to take the position that denying access to the process is a viable way forward,' he said."

For broader perspective, Hanson called Susan Clark, longtime town moderator of Middlesex, Vt., and a researcher of town meetings. "While a move to Australian ballot would also entail holding an informational meeting prior to voting, such meetings tend to be poorly attended, Clark said. . . . If greater participation is a goal, it might be better to find ways to hold the meeting at a time when more people can get there." 

"Australian-ballot voting allows more people to participate, but it shrinks the legislature’s vocabulary" in holding town selectmen to account, Hanson writes, quoting Clark as saying that the results of a secret-ballot vote, without the background discussion, is like sending U.S. Sen. Peter Welch to Washington “and telling him he can only use two words: ‘yes’ and ‘no’.”

Clark quoted fellow town-meeting researcher Frank Bryan: "Yes, Town Meeting has its flaws, but show me a better system." Bryan argues that town meetings are "accessible to people of all classes, and that towns with lower socioeconomic status have just as much turnout as better-off communities," Hanson writes. Clark said the opposite is true with secret-ballot voting, which she said is skewed by socioeconomics and race.

“Basically, we do democracy differently at Town Meeting,” Clark told Hanson. “We tell stories. We show up as neighbors. … A story can humanize an issue and can actually carry the day.”  Hanson writes, "In the social-media era, that kind of democracy might be more important than ever, she said."

UPDATE, March 9: For the Valley News, former New Hampshire agriculture commissioner Steve Taylor laments the loss of community meals as a central feature of town meetings.  

Rural hospitals keep closing their maternity units, leaving many women far from care and their babies at more risk

Hills outside of Toppenish, Washington. Ambulances are often slow to arrive on the Yakama Indian Reservation, which spreads over a million acres. (Photo by Ruth Fremson, The New York Times)

Suspensions of obstetric services in rural hospitals "appear to have accelerated" in the last year, "as hospitals from Maine to California have jettisoned maternity units, mostly in rural areas where the population has dwindled and the number of births has declined," reports Roni Caryn Rabin of The New York Times. "A study of hospital administrators carried out before the pandemic found that 20 percent of them said they did not expect to be providing labor and delivery services in five years’ time."

The closings are predicted to continue. "From 2015 to 2019, there were at least 89 obstetric-unit closures in rural hospitals across the country. By 2020, about half of rural community hospitals did not provide obstetrics care, according to the American Hospital Association," Rabin writes. "In the past year, the closures appear to have accelerated, as hospitals from Maine to California have jettisoned maternity units, mostly in rural areas where the population has dwindled and the number of births has declined."

Hospital closures leave pregnant women feeling vulnerable and betrayed. Rabin reports from Toppenish, Washington, where "frustration and fear erupted at a recent City Council meeting, which drew such a large crowd that it spilled into the hallway outside the chambers." Astria Toppenish Hospital "had committed to keeping certain services, including labor and delivery, available for at least a decade after acquiring the hospital," Rabin writes. "Now the hospital said it could not afford to do so, and the state has taken no action." Leslie Swan, a Native American doula, told Rabin, “There will be lives lost — people need to know that."

Toppenish is on the Yakama Indian Reservation, but is "the canary in the coal mine" for other rural hospitals' obsttric units, Cassie Sauer, president and chief executive of the Washington State Hospital Association, told Rabin, who writes, "The closure in Toppenish mirrors national trends as financially strained hospitals come to a harsh conclusion: Childbirth doesn’t pay, at least not in low-income communities."

Obstetric units are expensive. They "must be staffed 24 hours a day, seven days a week, with a team of specialized nurses and backup services, including pediatrics and anesthesia," Rabin reports. "In Washington State, Medicaid would pay $6,344 for a childbirth, about one-third of the $18,193 paid by private plans, according to an analysis by the Health Care Cost Institute. . . In wealthier communities, private insurance helps offset low Medicaid payments to hospitals. But in rural areas where poverty is more entrenched, there are too few privately insured patients."

Rabin recounts the downward spiral of U.S. maternal care: "The United States is already the most dangerous developed country in the world for women to give birth, with more than one death for every 5,000 live deliveries. . . . Recent figures show that the problems are particularly acute in minority communities and especially among Native American women, whose risk of dying of pregnancy-related complications is three times as high as that of white women. . . . According to the March of Dimes, the maternal health nonprofit, seven million women of childbearing age reside in counties where there is no hospital-based obstetric care, no birthing center, no obstetrician-gynecologist and no certified nurse midwife, or where those services are at least a 30-minute drive away."

That has effects on mothers and babies, the Centers for Disease Control says: "Severe maternal morbidity includes unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman’s health. Using the most recent list of indicators, SMM has been steadily increasing in recent years and affected more than 50,000 women in the United States in 2014."

Rural hospitals' financial data show a significant advantage for them if their state has expanded its Medicaid program

Kaiser Family Foundation graph, adapted by The Rural Blog, based on KFF analysis of hospital data from 527 short-term general and/or critical access rural hospitals. Expansion status is as of July 2017 and excludes states that expanded Medicaid during the period, as well as Wisconsin (the only non-expansion state without a coverage gap), leaving 438 facilities. Margins reflect profit earned on patient care and other operations such as gift shops, parking, and cafeterias.

Just how big an advantage is Medicaid expansion for rural hospitals? It's significant, according to hospital finalcial data that the Kaiser Family Foundation compiled from Medicare cost reports.

"Median operating margins among the rural hospitals in our analysis increased earlier in the Covid-19 pandemic, likely as a result of government relief funds, but that these facilities face renewed financial challenges, especially in states that have not expanded Medicaid," Kaiser reports. "Among rural hospitals in non-expansion states, median operating margins were 2.1 percent during the July 2021-June 2022 period and were -0.7 percent when excluding documented relief funds. In Medicaid expansion states, median operating margins dropped, but remained positive even after excluding documented relief funds."

Now that the pandemic funds are going away, rural hospitals "face renewed financial challenges," Kaiser reports. "After increasing substantially earlier in pandemic, median operating margins among the rural hospitals in our analysis fell from 7.7% in July 2019-June 2022 to 3.3% in the July 2021-June 2022 period. When subtracting out relief funds documented in hospital cost reports, median operating margins were slightly lower than pre-pandemic levels during the July 2021-June 2022 period and would likely have been even lower if accounting for relief funds that were not specifically documented by hospitals. Industry reports suggest that the outlook for hospitals and health systems deteriorated in 2022, which is only partially reflected in our analysis of July 2021-June 2022 data. In this context, it is not clear whether hospital closures may reemerge as an issue facing rural communities. There were seven hospital closures in 2022, which was greater than the number in 2021 (two closures), but still less than the average number from 2005-2022 (10.3)."