Removal of people from Medicaid rolls, mostly because they don't follow procedure, starts to hurt rural health care

Looking for help at an office in Arkansas, which has aggressively
cut Medicaid rolls. (Photo by Andrea Morales for The Washington Post)

About 4 million Americans have been taken off the Medicaid rolls this year, most of them for reasons unrelated to their eligiblity, according to the Kaiser Family Foundation, a health-policy organization.

"Three-fourths have been removed because of bureaucratic factors," reports Amy Goldstein of The Washington Post. "Such 'procedural' cutoffs — prompted by renewal notices not arriving at the right addresses, beneficiaries not understanding the notices, or an assortment of state agencies’ mistakes and logjams — were a peril against which federal health officials had cautioned for many months."

When the pandemic began, the governments suspended the annual renewal process, in which Medicaid beneficiaries certify their eligibility. Now that process has resumed, and federal officials are finding problems with how states are handlign it. Nine states have agreed to pause removals from the rolls, but the removals are beginning to undercut health care in rural areas, which are more dependent on federal health programs.

"The large proportion of beneficiaries in some states tumbling into the ranks of the uninsured is starting to hurt clinics and hospitals that focus on low-income patients — especially in the poorest states, such as West Virginia, where about 1 in 3 residents have relied on Medicaid," Goldstein reports. At the clinics of Cabin Creek Health Systems, patients arrive every day only to find that they are not covered, Executive Director Craig Robinson told Goldstein: “It’s a total failure, this unwinding.”

Goldstein reports, "At West Virginia Health Right, a Charleston clinic with 43,000 patients at three sites, the number covered by Medicaid fell by about 1,600 in May and June, the first two months of that state’s unwinding, according to Angie Settle, the clinics’ chief executive. The number of uninsured patients, usually fairly stable, rose by about the same number during those two months. Settle said the unwinding is putting a strain on the staff as new people show up for medical services they can no longer afford — and a strain on finances as more people show up for medications for which no one else is paying the costs."

The Centers for Medicare and Medicaid Services says 34 states "have been out of compliance with at least one federal requirement," Goldstein notes, "but even some states that meet all the federal rules have high rates of people being dropped from the program for paperwork reasons, mystifying state officials and patient advocates alike."

News-media roundup: AL.com keeps winning prizes for police probe and commentary; latest on Aspen paper war ...

The winners of this year's Frank A. Blethen Award for Local Accountability Reporting from the News Leaders Association are John Archibald, Ashley Remkus and Ramsey Archibald of AL.com, for “The Rise and Fall of a Predatory Police Force” in an Alabama town, and Michael Stavola of the Wichita Eagle for “Secret Messages,” an expose about racist messages openly shared among law-enforcement officers. The judges said AL.com "took what everyone in a community knew to be true about a local police department and brought reporting depth and a clarity of writing that is too often hard to come by." It said Stavola "local newsroom had widespread impact that tremendously benefited the community and shocked even its highest-ranking officials." Kyle Whitmire of AL.com won the Mike Royko Award for Commentary and Column Writing, for “State of Denial: How 150 years of whitewashed history poisons Alabama today.” Whitmire's work and the police series also won Pulitzer Prizes this year. AL.com is owned by the Newhouse family's Advance Publications, which stopped printing its newspapers in Birmigham, Mobile and Huntsville this year. Those are the NLA winners with rural resonance; the rest are here.

FEDERAL ADS: The Senate bill to fund health and human services would direct agencies to prioritize advertising in "local media in small or rural markets." The provison was added by Sens. Jeff Merkley, D-Oregon, and Cindy Hyde-Smith, R-Miss., after lobbying by the National Newspaper Association.

LOCAL LEGALS: The city council in Aspen, Colo., has moved its public-notice advertising from the Aspen Times to the Aspen Daily News, reports Corey Hutchins of Inside the News in Colorado. The Daily News became Pitkin County's paper of record a year ago "to punish the Aspen Times over how the newspaper handled a lawsuit from a billionaire developer," Hutchins writes, but "deliberation among city leaders was prosaic. Staff and council members kept their reasoning limited to a 'clear set of criteria' between the two rival papers including experience, efficiencies, and cost." The Daily News is locally owned and has the motto “If you don’t want it printed, don’t let it happen;” the Times is owned by Ogden Newspapers. Hutchins notes, "Aspen is one of the few cities left in the United States with two daily newspapers." It has 7,000 people; the county has about 17,500.

Google map, adapted; click to enlarge

PRINT SITES: Hutchins also reports that the shuttering of the press at The Pueblo Chieftain "has put at least one newspaper out of business," the Eastern Colorado Plainsman in Hugo. It's the paper of record for Lincoln County; that status is likely to go to its sister paper, the Limon Leader, which says it is increasing prices and moving its printing to CherryRoad Media in Hutchinson, Kansas. That's a five-hour drive from Limon, but such hauls are becoming more common as newspaper chains consolidate their printing locations.

One 'needle sewing the thread binding Rural America together': a weekly paper run by a College of Journalism

This week's Echo; for a larger version, click on it.

When a journalism school takes over a rural weekly newspaper, it's not just about preserving local news coverage and giving students real-world experience. It's also about sustaining the enterprise, adjusting to the digital environment and overcoming suspicion of outsiders at the local paper.

That's the unspoken message in what University of Georgia faculty member Amanda Bright calls "the first snapshot of what building a news-academic partnership to avert a news desert looks like," in her report for NiemanLab at Harvard University.

Bright is, in effect, the publisher of The Oglethorpe Echo, which was going to close 18 months ago until Oglethorpe County resident, newspaper-chain co-owner and Georgia alum Dink NeSmith put it into a nonprofit and got Charles Davis, dean of the Grady College of Journalism and Mass Communication, to staff it with journalism students.

With 20 students writing at least 10 bylined stories a week, coverage has improved and subscriptions have doubled, Bright reports: "A website, audio and video reporting, a weekly email newsletter, and regular posts on Facebook and Instagram have aided that growth, too. These products alone reach 4,500 each week, nearly a third of the county’s population. On the flip side, our Twitter and YouTube have languished, and our website’s high bounce rate shows that our paywall rarely leads to conversions. However, we plan to implement digital advertising and sponsorships in the next six months or so, which will change that paywall strategy significantly."

A survey of 75 Echo readers by the school's Kyser Lough provided encouragement and caution. "It’s possible to build trust when new to a community, but it’s nearly impossible to escape the perception of bias," Bright writes. "However humble and intentional our approach, there’s a gap revealed through perceived bias and occasional errors. Just 42% of our community felt strongly that the Echo was not biased at all in its reporting. . . . One error can undo months of good-faith effort. Our editor, Andy Johnston, has handled complaints transparently, inviting those who say we got it wrong into dialogue. But, it’s hard, especially in a community where missteps travel fast (usually in Facebook groups). In the end, though, the data is encouraging; 82% said they feel some level of trust in our coverage."

Bright says the survey also found some readers unhappy with "journalistic editing" of material from local residents, and removal of "long, unsubstantiated police-report narratives." But some said the reports "create suspicions" and wecomed their replacement by bullet-point arrest reports.

The county seat of Lexington is 15 miles from
Athens and the university. (Wikipedia, adapted)

Some also said they appreciated the Echo's effort to "intentionally pursue stories from a variety of demographics" in a county that is 79% white, 16% Black, and 7% Hispanic or Latino, Bright reports. "One long-time subscriber mentioned he didn’t remember seeing any photos of Black community members on the front page before we took over. It was a record we were happy to break."

And the survey of readers elicited at least one comment that resonates far beyond the borders of Oglethorpe County and Georgia. One of them wrote, “I believe printed news is the needle sewing the thread binding Rural America together. More publications such as the Echo are needed in today’s times.”

Warren Wheat, who showed how and why small daily newspapers can make political endorsements, dies at 83

Warren Wheat, who helped start USA Today and ended his career as editor of a small daily newspaper that took the unusual step of endorsing candidates in almost every local election, died Sunday in Lexington, Ky. He was 83.

He retired as editor of The News-Enterprise in Elizabethtown, Ky., in 2009 after 55 years as a reporter and editor at newspapers in Kentucky, Ohio, Washington, D.C., and South Carolina. He was Columbus bureau chief for The Cincinnati Enquirer, worked in the Enquirer's and Gannett News Service's Washington bureaus, and was part of the initial team that launched USA Today in 1982, serving as deputy Washington editor and later reader editor for the editorial page. He was governance and national editor at The State in Columbia, S.C., before becoming editor in Elizabethtown in 2002.

The page on which Wheat began election endorsements; click to enlarge

Soon after he arrived, Wheat concluded that the newspaper should make endorsements in local elections, because growth in Hardin County had limited citizens' personal contact with candidates and created more partisan competition. He told readers, “It would be a lot more comfortable to avoid controversy by sitting on the sidelines during this election season. But members of the editorial board felt it is this newspaper’s duty and responsibility to fulfill its role as a voice in the community we serve by providing leadership and guidance for our readers.” The News-Enterprise gradually expanded the number of races in which it made endorsements, including even those with small constituencies, such as school-board member. But as its staff shrank after he left, it was less able to do that, and finally stopped.

A brief service for Wheat will be held at 11 a.m. Saturday, July 29, at First United Methodist Church in downtown Lexington. Pictures will be on display at 10:30 a.m. The family requests that instead of flowers, donations be made to the scholarship established in Wheat's honor at the journalism school of his alma mater, the University of Kentucky, at this site, or by checks to College of Communication and Information, Attn: Director of Philanthropy, 308 Lucille Little Library, Lexington KY 40506.

Farm Bill may offer more mental-health help for farmers, who are showing more stress from extreme weather

Ali Aas graphic forAmbrook Research, from AP photo 

Extreme weather is hard on everyone, but farmers may be some of the most vulnerable to its often brutal impact, which can affect their mental health. This year's Farm Bill could bring additional funding and resources for mental-health care for farm families and workers. "Experts say they have witnessed a rise in farmers struggling with anxiety and depression as climate impacts have worsened in recent years," reports Mélissa Godin of Ambrook Research. "The farmer crisis hotline run by Farm Aid, for instance, has seen a significant increase of calls from farmers during natural disasters linked to climate change." Caitlin Arnold-Stephano, a farmer and a Farm Aid program manager, told Godin, "When climate disaster strikes, or an ongoing disaster such as drought is occurring, the toll on farmer mental health is high. Often a disaster can push a farmer over the already-thin margin or edge that existed."

The 2018 Farm Bill was the first with contained "direct funding toward farmers' mental health, by providing grants for the Farm and Ranch Stress Assistance Network, which connects farmers, ranchers and agricultural workers with mental-health-assistance programs and resources," Godin notes. "Advocates hope that the 2023 Farm Bill will offer even more support. Bipartisan legislation, led by Sens. Joni Ernst (R-Iowa) and Tammy Baldwin (D-Wis.), would reauthorize the FRSAN to establish helplines, provide suicide prevention training for farm advocates and create support groups for farmers and farm workers. The bill would increase funding for the program, authorizing $15 million per year for the program for the next five years, up from $10 million allocated in the last Farm Bill."

Farmers have long faced unrecognized and untreated mental-health problems. "The rate of suicide among farmers has historically been three and a half times higher compared to the general population, according to the National Rural Health Association," Godin reports. "Many farmers, however, struggle to access mental health services, often not readily accessible in rural areas. And when services are available, they are not always tailored to farmers' needs. Traditional mental health services can be alienating to farmers, who sometimes come from communities where mental health is highly stigmatized. . . . Unless the federal government takes action to address the root causes of farmers' distress — the economic precarity, the lack of support, the increasingly unpredictable weather — many experts are concerned farmers will continue to struggle."

Greg Mruk, executive director of New York FarmNet, an organization that offers financial and emotional counseling to farmers, told Godin: "More than anything, farmers want to be given a chance to be part of the solution, a chance to figure it out. Let's not be of the 'sky is falling' mindset. We need to take a proactive approach."

Purdue professor explains why the world is getting hotter and what that means for wildfires, rain and air quality

Dr. Daniel Cziczo

Is it hotter than it used to be? The short answer is yes. Why? A video explanation from Daniel Cziczo, a professor and head of the Department of Earth, Atmospheric and Planetary Sciences at Purdue University, has been loaded for viewing by members of The Associated Press, AP reports. "He goes over why higher temperatures have become more common and what that means for wildfires, rain and air quality." The video can be found here.

"Cziczo says that as man-made greenhouse gases are released into the environment, heat becomes trapped and raises temperatures. Greenhouse gases such as carbon dioxide and methane act like a blanket over Earth, keeping the sun’s heat from escaping the atmosphere," Purdue reports. "Thanks to this rise in temperature, forest-fire season starts earlier, ends later, and happens in areas where wildfires didn’t used to occur. Hot and dry weather can also lead to a decrease in precipitation and a drop in air quality."

If you'd like more in-depth look at Cziczo's research, he presents his area of expertise, particle and cloud research, as key to a human response to climate change in his July 2022 MEERTalk. He points out that humans are are heating up the atmosphere mostly through mixed greenhouse gases, but we are also cooling the planet with particle matter. Clouds form around tiny airborne particles called aerosols. Understanding how cloud formation influences our atmosphere is key to understanding and mitigating climate change from the stratosphere.

22 attorneys general urge federal court to reject 3M Co.'s $10.3 billion settlement offer for 'forever chemicals' pollution

Water sample testing for PFAS research at the EPA
(Photo by Joshua A. Bickel, Associated Press)

Twenty-two attorneys general argue that the proposed settlement 3M Co. has offered to resolve claims that it contaminated water systems with "forever chemicals" wouldn't be enough. The group "urged a federal court to reject a proposed $10.3 billion settlement . . . saying it lets manufacturer 3M off too easily," reports John Flesher of The Associated Press. They argue that the agreement needs to give water suppliers more time to compute what their portion of the settlement would be and compare it to "their costs of removing the compounds known collectively as PFAS, said the officials with 19 states, Washington, D.C., and two territories."

California Attorney General Rob Bonta, leader of the multi-state coalition, told Flesher, "While I appreciate the effort that went into it, the proposed settlement in its current form does not adequately account for the pernicious damage that 3M has done in so many of our communities." 3M spokesman Sean Lynch said, "It is not unusual for there to be objections regarding significant settlement agreements. We will continue to work cooperatively to address questions about the terms of the resolution."

3M's "forever chemicals" problems began with its use of "polyfluorinated substances — a broad class of chemicals used in nonstick, water- and grease-resistant products such as clothing and cookware, as well as some firefighting foams," Flesher reports. "PFAS have been linked to a variety of health problems, including liver and immune-system damage and some cancers." The American Chemical Society describes polyfluorinated chemicals as "toxic, extremely resistant to degradation, bioaccumulate in food chains, and can have long half-lives in humans."

Three hundred communities have sued 3M and other companies over water and soil pollution from their products. Flesher writes, "Although the company put its value at $10.3 billion, an attorney for the water providers said it could reach as high as $12.5 billion, depending on how many detect PFAS during testing the Environmental Protection Agency has ordered over the next three years."

The attorneys general disagreed with the deal's opt-out provision, which would "shift liability from 3M to water suppliers that don't opt out. That could enable the company to seek compensation from providers if sued over cancer or other illnesses in PFAS-affected communities," Flesher reports. "The attorneys-general filings said it would force nearly all public water providers nationwide to participate unless they withdraw individually — even those that haven't filed suits or tested for PFAS. 'Troublingly, they would have to make their opt-out decisions without knowing how much they would actually receive and, in many cases, before knowing the extent of contamination in their water supplies and the cost of remediating it, the officials said in a statement. . . . As such, the proposed settlement is worth far less than the advertised $10.5 billion to $12.5 billion."

Flora and fauna: Ladybugs; mushrooms and fires; wolves and ranchers; tomatoes; animal senses; Vermont loons

Painting by Ed Steed, The New Yorker

Aphid eaters and adorable, ladybugs, or Coccinellidae, are like little summertime friends. A "swarm of ladybugs is collectively called a loveliness," Françoise Mouly writes for The New Yorker. Mouly interviewed artist Ed Steed, who decked out the magazine's June ladybug cover, about "the joy of painting, an affection for the little things, and the luck of the ladybugs." Mouly asked him if each ladybug had its own personality. He told her: "That's the good thing about painting by hand. No matter how hard you try to make things look the same, each comes out unique. So each one ends up having its own character. Just like in real life, no two of anything can be the same."

Mushrooms could be an answer to megafire prevention. "Slash piles are an increasingly common sight in the American West, as land managers work to thin out unnaturally dense sections of forests. . . [The piles] have inadvertently increased the risk of devastating megafires," reports Stephen Robert Miller of The Washington Post. Hauling the slash piles out of the woods has been one solution. Letting mushrooms do the job is another. "Like a flame, saprophytic fungi break organic material into carbon compounds. Mycelium, the often unseen, root-like structure of the fungi, secretes digestive enzymes that release nutrients from the substrate it consumes. . . Whereas a flame destroys nearly all organic nitrogen, mycelium can fortify nitrogen where it's needed in the forest floor."

Gray wolves in California, where they are a recovering
endangered species. (Shutterstock photo)

In areas where ranchers and gray wolves must coexist, some states compensate ranchers for predator damages, reports Shea Swensen of Ambrook Research. "To aid the ranchers who deal with the impacts of wolf presence, states like New Mexico, Oregon, and California started programs that pay them back for the financial burdens of losing their animals. The programs offer reimbursement for direct livestock loss due to wolves or non-lethal on-ranch tools — like fences, guard dogs, or even extra staff."

Pink Pounder hybrid tomatoes
(Garden Plants online photo)

With names like Beefsteak, Big Beef, Bucking Bronco or Pink Pounder Hybrid, summer tomatoes are fun, but more importantly, they are delectable. Try out these meaty varieties. Rejoice in learning how to make all the best tomato recipes. Find out about the infamous Southern tomato sandwich. Enjoy!

Sometimes it can be hard for humans to grapple with the tremendous gifts other animals have. They don't go to school, YouTube it or read how-to manuals. "Pit vipers have infrared vision, bees can view ultraviolet light, and electric eels use their zaps to 'see' through the murky waters of the Amazon," reports Jason Bittel of Popular Science. He adds five animals that can sense things humans can't. They are just born that way.

A parenting loon gives the chicks a ride. Male and
female loons co-parent. (Shutterstock photo)

Vermont's oldest loon, known as "Neward Pond Male," died at age 31. For the past 45 years, The Loon Conservation Project "has helped bring the common loon back to lakes across the state and made huge strides in research, education and advocacy, reports Hannah Cho of the Valley News of West Lebanon, N.H., and White River Junction, Vt. "When Newark Pond Male was banded, the loon was still on Vermont's endangered species list (it wouldn't come off until 2005), but the population had already begun to rise."

Advocacy group says over 30% of rural hospitals are at risk of closing, many immediately; publishes financial data

Maps from Center for Healthcare Quality and Payment Reform; to enlarge, click on it.

More than 30% of the nation's rural hospitals are at risk of closing, partly because special financial aid they got from the federal government during the pandemic has ended, according to the latest analysis of their 2020-22 Medicare cost reports by the Center for Healthcare Quality and Payment Reform, a private group.

New York, Alabama and Mississippi have "the highest percentage of rural hospitals at risk of immediate closure," reports Devna Bose of Mississippi Today. In New York, 43% of rural hospitals (22) are considered at risk; it's 37% (19) in Alabama and 34% (25) in Mississippi. The report has numbers and percentages for each state.

A map with figures for each hospital is here (example screenshot below). The group said its analysis was based on examinations of hospitals' financial reports, with the main risk factors being on negative operating margins, losses on patient services and low financial reserves.

Rural hospitals' troubles are often blamed on low rates of reimbursement for Medicare and Medicaid patients, which are a majority of their admissions, but the group says "losses on private insurance patients are the biggest cause of their overall losses."

Here's part of the map that has data for hospitals in 2020-22, highlighting one in Kentucky:

Screenshot of map by Center for Healthcare Quality and Payment Reform at ruralhospitals.chqpr.org 

Opinion: The crisis in America's evangelical churches calls for spiritual revival, not nostalgia, leading Baptist writes

Photo illustration by Katie Martin from photo by Roberto
Schmidt, Agence France-Presse/Getty via The Atlantic

American evangelicalism is at a crossroads; it must choose between spiritual revival or continuing in its attempt to recreate the past, and it cannot have it both ways, writes Russell Moore, editor and chief of Christianity Today, in an opinion for The Atlantic.

"The No. 1 question that younger evangelicals ask me is how to relate to their parents and mentors who want to talk about culture-war politics and internet conspiracy theories instead of prayer or the Bible. These young people are committed to their Christian faith, but they feel despair and cynicism about the church's future. Almost none of them even call themselves 'evangelical' anymore, now that the label is confused with political categories. 'Sometimes I feel like I'm crazy,' one pastor said to me just days ago. 'Does no one see that the church is in crisis?'"

Moore recounts his years as head of the public-policy wing of the Southern Baptist Convention: "For years, I dealt with evangelical backlash, including from some of my closest allies and friends, over my opposition to Donald Trump and my views on issues such as racial justice and church sexual abuse. I hardly thought of myself as a 'dissident.' Instead, I believed I was just what I'd always been: a loyal Southern Baptist evangelical trying to apply what I'd learned from children's Sunday school onward about basic Christian morality and justice. Still, I felt like an outcast and a heretic. I felt homeless. And two years ago, I left the Southern Baptist world I loved."

Revival may need to be redefined, Moore suggests: It is "a concept with a long history in American evangelicalism, rooted in the Bible, that says a people who have grown cold and lifeless can be renewed in their faith. It is a kind of resurrection from the dead. . . . Yet the language of revival is now riddled with cynicism, and is associated with some of the worst aspects of American evangelicalism. Entrepreneurial American evangelicalism built a programmatic structure for 'revival'—whether in the spring- and fall-meeting schedules of little Bible Belt churches like the one in which I grew up, or in massive stadium events traveling across the country like rock concerts." Commercialized revival isn't what Moore has in mind, nor does he think returning to "a mythical golden age" is a good choice.

"A generation ago, one evangelical leader said that the goal of the religious right should be 1950s America, just without the sexism and racism. . . . The idea of revival as a return to some real or imagined moment of greatness is not just illusory but dangerous," Moore writes. "Crisis shakes up an old order—ripping apart, as the apostle Paul put it, what's made of 'wood, hay, stubble' (1 Corinthians 3:12). Now every moment is a possible apocalypse—in which what's been around us all the while is revealed—and thus every moment is an hour of decision."

The answer to the crisis is founded in God's recent actions, Moore says: "Those who wish to hold on to the 'Old Time Religion' must recognize that God is doing something new. The old alliances and coalitions are shaking apart. And the sense of disorientation, disillusionment, and political and religious' homelessness' that many Christians feel is not a problem to be overcome but a key part of the process. . . . The insight of evangelical Christianity, at its best, is that any pilgrimage cannot start with a road map of certainty but must begin with the cry of faith that says, like the noble disciple Thomas wrongly labeled as a doubter, 'Lord, we do not know where you are going. How can we know the way?' (John 14:5)." More says nostalgia "cannot protect religious faith, because it uses religion as a tool for worldly ends, leaving a spiritual void. The Christian Church still needs an organic movement of people reminding the rest of us that there's hope for personal transformation, for the kind of crisis that leads to grace."

Researchers say you live in an 'ambulance desert' if it takes more than 25 minutes to reach you; many places fit the bill

Callers to 911 in rural areas know they will have to wait longer than their city counterparts, but how much longer? And how long do you have to wait to have experts say you're in an "ambulance desert"? A first-of-its-kind study has some answers, including a definition of the desert wait: more than 25 minutee, and there may be far more ambulance deserts than you might think.

Some states are not represented on this map due to their uncertainty about ambulance locations.
(University of Southern Maine map, from Ambulance Deserts: Geographic Disparities study)

The study, by the Maine Rural Health Research Center, looked at every state's ambulance data, and "found a major disparity between rural and urban residents' proximity to ambulance stations, reports Liz Carey of The Daily Yonder. "While less than 1% of urban residents live in an ambulance desert, about 5% of rural Americans live in one. . . . Another way of understanding the rural disparity is that while about 14% of Americans live in a rural area, they make up more than half of the population that lives in an ambulance desert. Urban Americans constitute about 86% of the U.S. population but make up less than half of the population that lives in an ambulance desert."

Carey adds, "Researchers found the highest number of people living in ambulance deserts in the Southern Appalachian region, in Western states with mountainous terrain, and in the rural mountains of Maine, Vermont, Oregon, and Washington. Eight states west of the Mississippi had fewer than three ambulances covering every 1,000 square miles of land area. The states are Idaho, Montana, Nevada, New Mexico, North Dakota, South Dakota, Utah, and Wyoming."

The number of ambulance desertss can be explained in dollars and cents. Ambulance services are only reimbursed when a patient is transported to the hospital, which leaves many trips unpaid. Lead researcher Yvonne Jonk told Carey: "Hospitals and health-care systems are not going after ambulance services because they are not a lucrative service line. And that's a problem." She said the next step in her research will determine the impact ambulance deserts have on communities, including the prevelance of paramedics and funding options.

Researchers found that some states don't know where their ambulances are. Carey explains, "Part of the research effort was finding physical addresses for ambulance stations, rather than using post-office-box addresses. . . . In nine states, information either wasn't available or was so limited it wasn't included in the report."

U.S. Supreme Court greenlights Mountain Valley Pipeline

The Mountain Valley Pipeline has gone all the way to the U.S. Supreme Court and won, at least for now. Thursday the court overturned a lower appeals court and said work on it can resume, "potentially moving the project closer to completion as a legal fight continues," The Wall Street Journal's David Harrison reports.

U.S. Sen. Joe Manchin, D-W.Va., won "a provision in the bipartisan debt-ceiling bill signed into law last month [that] stripped the lower court of its jurisdiction over the natural-gas pipeline and mandated that it be completed," Harrison notes. "The environmental groups behind the suits argued that stopping legal challenges before the Fourth Circuit violated the separation of powers clause of the Constitution, in effect giving Congress the power to decide the outcome of judicial proceedings. The Fourth Circuit agreed to pause the project while it sorted out the effect of the debt-ceiling law, prompting [pipeline owner] Equitrans Midstream to appeal to the Supreme Court. As is typical in emergency orders, the Supreme Court didn’t explain its ruling. There were no noted dissents. The court’s ruling didn’t dismiss the legal challenges to the pipeline entirely, allowing project opponents to continue making their case before the Fourth Circuit," which had a hearing scheduled Thursday.

The pipeline "has aroused controversy ever since it first was proposed almost a decade ago. Opponents, including adjacent landowners and environmental groups, have challenged the project’s environmental permits, delaying the project for years," Harrison notes. "Last year, the Biden administration struck a deal with Manchin: He would agree to provide the pivotal vote for the administration’s climate bill, and in exchange the White House and Senate Democratic leaders would support Manchin’s efforts to get the pipeline finished."

'Residents said they didn't realize how much they depended on the paper until it was gone,' AP reports from news desert

The final story remains posted on the paper's website.

When a rural newspaper closes, it leaves more than an empty building; it leaves an indelible hole where a sense of community and shared information used to thrive. McDowell County, West Virginia, pop. 19,000, is one of those places.

The Welch News, the only newspaper and "The Spirit of McDowell County," closed in March, and the town's residents miss it, reports Leah Willingham of The Associated Press. "Residents suddenly have no way of knowing what's going on at public meetings, which are not televised, nor are minutes or recordings posted online. Even basic tasks, like finding out about church happenings, have become challenging. The paper printed pages of religious events and directories every week, and that hasn't been replaced."

More than 2,000 newspapers have closed or disappeared in mergers since 2005, and most have been weeklies, which in rural areas provide profound connections, with their sharing presence like a heartbeat and their closings like deaths. In mountainous McDowell County, "Residents live miles apart in hollers connected by winding roads and no interstate access, leaving people isolated. Cell and internet service is inconsistent, or nonexistent, and there are no locally based radio or television stations," Willingham reports. "Residents said they didn't realize how much they depended on the paper until it was gone." The county is the state's poorest, "with some of the lowest graduation and life expectancy rates in the nation."

McDowell County (Wikipedia)

Sarah Hall, the first Black prosecutor elected in McDowell County in the 1980s, said it's tragic when any community loses its newspaper. But for communities like hers, it's detrimental." Hall told Willingham: "We're in a unique situation because our community is unique. We have no other substantial way of communicating." Willingham wriotes, "It bothers Hall not to know about decisions county commissioners are making with taxpayer money. She misses the legal notices the paper published informing residents about developments like utility rate increases. With the school year set to start, she's worried families won't know about a ministry program in early August providing free school supplies," Willingham explains. "Local crises, like the desperately needed upgrade of water and sewer systems, are going unreported. And there is no one to keep disinformation in check, like when the newspaper published a series of stories that dispelled the rumors of election tampering at local precincts during last year's May primaries."

Once the self-proclaimed "Heart of the Nation's Coal Bin," the Cumberland Mountains county has "lost big-box stores, schools, thousands of jobs and people. But it still had its newspaper — one that tracked government spending, published elections, spelling-bee and basketball-game results and spreads with color photos and biographies of every member of the graduating class," Willingham reports. When the paper closed, no local service replaced it, leaving residents to rely on unverified social-media sources or coverage from "national outlets that focus on the poverty rate, opioid use, infrastructure woes and the declining coal industry," Willingham adds. "The paper was a vital platform for residents to tell their story from their perspective — a lifeline for a community that's often been misrepresented and misunderstood."

Study: Over 1/3 of rural Americans skip care due to costs

Commonwealth Fund graph from Health Policy Survey data

Over a third of rural Americans will skip needed health care because they can't afford it, The Commonwealth Fund reports, based on its 2020 International Health Policy Survey. It "found that 36 percent of rural Americans did not get the care they needed due to costs, which is more than double the rate for rural residents in six other countries the study looked at," reports Lauren Sforza of The Hill. "Less than 10 percent of rural residents in the United Kingdom, Norway and Sweden reported that they did not get medical care due to costs."

Sfioza adds, "The survey found that nearly 25 percent of rural Americans reported serious problems with being able to pay their medical bills or not being able to pay them at all. In nine of the other countries, less than one in 10 rural residents reported the same thing. The survey noted that the 10 other countries looked at all had a universal health care system, which the U.S. does not have. The survey also pointed to census data that showed about 12 percent of the American rural population does not have health insurance as a reason why the U.S. fell short of what the other countries reported."

The study report says, "With affordability problems preventing Americans from seeing their doctor, it is no surprise that rural Americans also are more likely to have higher rates of chronic conditions and some of the highest rates of mental health conditions." The Commonweath Fund says its mission is "to promote a high-performing, equitable health care system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable."

More from National Summit on Journalism in Rural America: News startups, for-profit and not-for-profit, tell how they do it

By Al Cross

Professor and director, Institute for Rural Journalism and Community Issues, University of Kentucky

"People want local news." That's what I said after moderating one of the most interesting sessions at the National Summit on Journalism in Rural America, a panel of four women who started newsrooms and are finding success in markets no longer well served by chain-owned daily newspapers.

Two have for-profit papers: Lynne Campbell of The Community News in Macomb, Ill., and Debra Tobin of the Logan-Hocking Times in Logan, Ohio. Two have non-profit, digital-only news outlets: Jennifer P. Brown of the Hoptown Chronicle in Hopkinsville, Ky., and Nicole DeCriscio Bowe of The Owen News in Spencer, Ind., which is just getting started but has key community support.

The for-profits are in purely rural areas, and the nonprofits are in counties that lie within metropolitan areas (Bloomington, Ind., and Clarksville, Tenn.) but are still rural in character; Hopkinsville has 31,000 people and Spencer has 2,200 in a county of 21,000.

Nicole DeCriscio Bowe

DeCriscio Bowe started working at the Spencer Evening World soon before its employee owners sold it to Schurz Communications, which sold it to GateHouse Media in 2019. She was laid off but continued as a freelancer for what was “becoming a ghost newspaper,” which went from three full-time reporters and an editor to no local office and “no unique staff covering local events. It is at this point simply a reprint, almost, of the Bloomington newspaper,” the Herald-Times.

The main local information source became Facebook pages that stole or plagiarized content, and the local Chamber of Commerce reached out to DeCriscio Bowe to see what it would cost to start an online newspaper. She had already been talking with some other locals about a nonprofit publication, and the local community foundation committed $10,000 to the project “before we were even a nonprofit entity.” The foundation then secured a $10,000 matching grant from the John S. and James L. Knight Foundation.

So far, The Owen News is posting news only on Facebook, but its website has a survey to test readers' willingness to support it. “My board has been very specific, that they don't want to charge our subscribers. We want to have it strictly donation-based, and based in advertising,” DeCriscio Bowe said. “We have a separate journalism Advisory Board, consisting of journalists across the nation, to help guide us in editorial policy and style guides and all of the nitty, gritty journalism tasks. . . . We want mandatory training for our correspondents, so that we never fall into a position where our content can't be trusted.”

Jennifer P. Brown

Brown, next to speak, said “I really respect Nicole, and what she's doing, because it's pretty much the exact opposite of how I started out.” She left the daily Kentucky New Era, weher she had been editor, in 2016 without a plan. Two years later, she attended an auction of some downtown buildings, which she found very intriguing, especially because “there were only two people in the room that I didn't know.” She took notes, wrote a story, posted it on Facebook, started a group and asked, “Would you all be interested in more stories like this?”

“Immediately the response was very positive,” she said. “People wanted more local stories, and . . . within six months. We had our 501(c)(3) approved, we had a website, had a launch party at the brewery in downtown Hopkinsville. and we got going. Our vision was to advance the public good, promote a respectful dialogue among citizens, and raise awareness of business, arts, culture, and history that is unique to Hopkinsville. What I really wanted to do was give people stories where I could sort of flex my institutional knowledge of the community and provide context and background that maybe they felt like they weren't getting in other places.”

Brown said she worked for two years without a salary “while we focused on the journalism, improving what we could do before we got really serious about raising money. We were raising money, but not enough to pay anyone a salary.” Now she does pay herself, and a part-time helper. She participates in the NewsMatch program of the Institute for Nonprofit News, and says “being a member of INN is crucial for us. We wouldn't have much financing without INN.”

Brown said she has 25,000 average monthly unique visitors, up 40 percent from last year; 1,550 daily newsletter subscribers, up 47% from last year, with an open rate of 55% to 60%; and about 4,700 Facebook followers, up 41%; and we 256 donors, up 24%. “Our daily newsletters are really important,” she said. “A newsletter comes out late, I usually hear from people. They want to know what happened. Where is it? And I take that as a good sign.”

The New Era, bought a few years ago by Paxton Media Group, has no office open to the public but still has local coverage. Brown said, “I think it's important to know that I've learned that it really doesn't work for me to try to compete against the other local media. It's a lot of wasted energy. We do have the local newspaper still. unfortunately, they have reduced their publication days, and the newsroom is very small. It doesn't look anything like the newspaper that I worked in. We also, though, have two commercial radio stations that have news operations,” and the Chronicle partners with WKMS at Murray State University, which “got most of the other public radio stations in Kentucky to sign on to that agreement. It gave us an immediate sort of wire service, so that we could help Hopkinsville readers know more about what was going on with the state government. . . . People in Hopkinsville quite often know more about what's going on with Tennessee state government than they do Kentucky state government because we're in their media market.”

Lynne Campbell

The for-profit startups are owned by women who spent most of their careers working for chains. Campbell said she last worked for GateHouse as regional publisher in Southern Illinois: “I took the opportunity because I thought I was going to save the 26 small community papers. Or that is what Gatehouse sold me; and in six months later they started to lay off people and asked me to close or merge, and what was 26 papers in a year's time was less than 12. . . . So I made it my mission in life to save community newspapers.”

After buying and improving a paper in a bedroom community of Peoria, then starting one for a town just outside Galesburg, home of another GateHouse paper that was no longer covering it, people in Macomb kept asking when she was going to start a paper there against another Gatehouse (now Gannett) ghost. She sold her interests in her other papers to her partner, and “went all in on the Community News,” she said.

It started on a copy machine, distributed free three times a week at 40 locations, and “was full of brief bits of local news,” such as events, police logs and death notices, but not full obituaries. “It was a quick read, and we had it out before lunch hour, so people would grab them at the restaurants and read them while they're waiting on their food.”

When the pandemic hit, Campbell said, “We didn't have events to write about. So we turned to partnering with the health department, the hospital, all of the government agencies, the mayors in all the cities, and we formed a great relationship between everybody, and we became the source for information during the shutdown . . . and our advertisers stayed with us, except for the ones that were shut down. All the advertisers stayed with us because they knew people were going there to read everything, and they won. And so we didn't lose that much revenue.”

The paper kept growing, and Campbell turned the Friday edition into subscription-only in May 2022. By that fall, she had almost 1,000 subscribers, and this year she made the Monday edition part of the subscription paper, shifted it to Tuesdays, and kept one free edition, called the Midweek, “so that everybody could get a little bit of the local news.”

Campbell said the Community News is billing $40,000 a month, much of it in legal advertising, since the Gannett paper, now called the McDonald County Voice, “is down to less than a hundred subscribers” and no longer has a storefront. The county has 27,000 residents, most in Macomb.

Debra Tobin

Logan, Ohio, is a town of 7,200 in a county of 46,000. Tobin worked for Adams Publishing Group for many years, last at the Logan Daily News: “About 20 of us that walked out one by one over the course of three months,” and eventually she and six of them “got together and started the Logan-Hocking Times,” charging $7.99 a month for digital subscriptions. “Within six months we had 700. We're over a thousand. That wasn't good enough for me, though, because I wanted to do something else, because a lot of people don't have computers in my hometown. It's a very small, not good access to broadband or anything. So I decided to do a print newspaper,” distributed free on Fridays, the day after the digital edition, and is funded by advertisers who sponsor pages.

Tobin has a part-time reporter, a part-time sports reporter, a full-time paginator and full-time graphics person, and two advertising staffers who work on commission. She’s on Social Security and takes no salary. “We were told that we were nothing but a pipe dream. And here we are almost three years later . . .and we're growing so.” Earlier, she said, We all decided to do this because the company that we worked for did not care about the community. . . . We all grew up in Logan. We all went to school in Logan. We love that we're vested in that county.”

Tobin said her experience can be replicated: “I encourage people to try it . . . if you have a background in journalism, and you are thinking about starting a paper. It may seem scary at first, but if I can do it, I know anybody can do it.”

For video of the session (it's the last one on this video), click here; for audio, here.

From coal to the sun: Huge solar-energy project is planned for a huge reclaimed strip mine in Eastern Kentucky

The reclaimed mine is in southeastern Kentucky. (Google map, adapted)

A massive solar-energy installation is planned for a huge, reclaimed strip mine in Eastern Kentucky, reports Bill Estep of the Lexington Herald-Leader: "BrightNight, a renewable power company, plans to build on the former Starfire mine, which is in Perry, Knott and Breathitt counties. The project would turn a site that produced a product blamed for contributing to global warming to one that will help cut carbon emissions that cause warming, supporters said."

The first approved solar-powered facility on a reclaimed coal surface mine was in Harrison County, Ohio. It genertates 100 megawatts. The Starfire project will generate 800 mw. "The investment in the project would be $1 billion. It would be the largest solar project in Kentucky and one of the largest in the nation on a former surface mine," Estep writes. "Brightnight CEO Martin Hermann said the project will transform a coal mine, reinvest in a region that has been an energy leader and wants to continue that role, and show the power of corporate purchasing to drive the development of renewable energy." The project's inception partly came from the state's former elected auditor, Adam Edelen, who has another solar project in Martin County.

Renewables transportation company Rivian has committed to purchasing "enough power from the project to provide up to 450 million miles of driving with renewable power," Estep reports. "The Nature Conservancy and Rivian developed a guide on how companies can back projects aimed at boosting clean-energy projects, based on the principles of protecting the climate; conservation, including protecting habitat; and helping communities." The conservancy told Estep that Central Appalachia is a priority area for it to protect "because it is one of the most biodiverse places on the planet," he writes. Its CEO, Jennifer Morris, told him: "We need to make sure both people and the planet are central to these decisions, especially in communities like the Appalachians that have powered America for centuries and have tremendous natural resources."

Construction is to begin in 2025, with the first electricity generated in 2027. "Hermann said the project would create an estimated 250 direct construction jobs in each of the four phases, as well as related jobs," Estep reports. "Rebecca Goodman, secretary of the Kentucky Energy and Environment Cabinet, said the state would like to see more solar projects on reclaimed mine sites," Estep writes. "The site for the solar array is near the Olive Branch community being developed to provide homes for people displaced by devastating flooding in the Hazard area on July 28, 2022."

Senate adds amendment to defense bill to restrict China, Russia, North Korea and Iran from purchasing U.S. land

In another sign of U.S. tensions with competing countries, the U.S. Senate "voted overwhelmingly to prohibit China, Russia, North Korea and Iran from purchasing U.S. agricultural land and agricultural businesses," reports the Food and Environment Reporting Network. "The language was added to a military spending bill that was sure to pass the Senate and then be reconciled with a House version."

The amendment by Sen. Mark Rounds, a South Dakota Republican, "would instruct the powerful Committee on Foreign Investment in the United States, an interdepartmental panel led by the Treasury Department, to prohibit such purchases," Ag Insider reports. "The Russian invasion of Ukraine and a heightened Sino-U.S. rivalry have fueled concern about foreign ownership of U.S. assets."

Despite concerns, Chinese and Russian interests do not own much American soil. Ag Insider reports, "Foreign entities own 40.8 million acres of U.S. agricultural land, or 3.1% of the privately owned land in the nation, according to USDA data. Half of the foreign-owned land is forests. Canada accounts for one-third of the foreign-owned land. . . . China owns 347,000 acres at latest count."

Hotly debated 'Try That in a Small Town' became a roaring success after CMT publicly took the video off its playlist

Jason Aldean performs in Twin Lakes, Wisconsin.
(Photo by Joshua Applegate, Getty Images, via Axios)

If there ever was an example of "all publicity is good publicity," it's Jason Aldean's controversial tune "Try That in a Small Town." The song sits at No. 2 on Billboard's all-genre Hot 100 chart. The heated backlash is the propulsive force behind the song's climb to the top, reports Adam Tamburin of Axios Nashville. "The song depicts an exaggerated urban-rural divide in which cities are dominated by unrest that isn't tolerated in small towns."

The song dropped without drama in May, but when the video aired in mid-July, a maelstrom of criticism hit Country Music Television. CMT publicly yanked the video from its playlist, and the controversy hit the charts. Kurt Bardella, a Democratic strategist who runs the country music tipsheet The Morning Hangover, told Tamburin,"You couldn't ask for a better gift when it comes to promoting a record, especially for that core Jason Aldean audience, than what CMT did."

The song's ubiquity proves Bardella's point. Tamburin writes, "Billboard reports the song sold 228,000 digital singles last week, the largest sales week for a country song in more than a decade. It logged 11.6 million streams, a 547% jump from the week before. . . . The video remains popular on YouTube, where it has logged more than 18 million views since its July 14 release."

Critics claim the video is racist, encourages lynching and promotes gun violence. Factually speaking, "The video features a performance in front of Tennessee's Maury County Courthouse, which was the site of a 1946 race riot and a 1927 lynching," Tamburin reports. "Aldean has defended the song, tweeting that 'there is not a single lyric ... that references race or points to it.' At a concert last week, Aldean said his fans had pushed back against 'cancel culture'. . . . Bardella says the situation mirrors broader political debates over cancel culture, with country fans ultimately feeling defensive and entrenched. A better approach, he says, would be to discuss the context of the video without trying to keep people from seeing it." As of July 25, the Black Lives Matter images in the video were removed.

"Song of the day" picks from the Axios Nashville staff:
Nate's song of the day is "Small Town" by John Mellencamp.
Adam's song of the day is "Small Town Saturday Night" by Hal Ketchum.
Axios southern bureau chief Michael Graff's song of the day is "Elderly Woman Behind the Counter in a Small Town" by Pearl Jam.
Copy editor Katie Lewis' song of the day is "Small Town Hypocrite" by Caylee Hammack featuring Chris Stapleton.

Mountain Eagle editor and reporter win Al Smith Award for public service through community journalism by Kentuckians

Reporter Sam Adams,  left,  and Editor-Publisher Ben Gish hold the first two of the six weekly, free-circulation editions of The Mountain Eagle that were published after the record flood in southeastern Kentucky one year ago this week.

Ben Gish and Sam Adams of The Mountain Eagle in Whitesburg, Ky., which set a new standard for disaster coverage by a weekly newspaper after last year's flood in southeastern Kentucky, are the winners of the 2023 Al Smith Award for public service through community journalism by Kentuckians.

The award is given by the Bluegrass Chapter of the Society of Professional Journalists and the Institute for Rural Journalism and Community Issues at the University of Kentucky, publisher of The Rural Blog. It will be presented Oct. 26 at their annual Al Smith Awards Dinner in Lexington, with Susan Page of USA Today as the keynote speaker.

Ben Gish is editor and publisher of The Mountain Eagle, which became known for overcoming adversity to provide outstanding rural journalism in 50-plus years of ownership by his parents, Tom and Pat Gish, who died in 2008 and 2014, respectively. Sam Adams is the paper's reporter and did most of the coverage of the flood that devastated much of Letcher County and Kentucky counties downstream on the night of July 27-28, 2022.

"The Eagle's comprehensive coverage of the flood and its aftermath is an amazingly broad and deep example of public service through community journalism," said Al Cross, director of the institute and extension professor of journalism at UK. "So is the newspaper's decision, in the six weeks after the flood, to forgo the $1 charge for its single-copy sales, which constitute most of its circulation."

SPJ Bluegrass Chapter President Tom Martin said, "The Mountain Eagle, in its continued reporting of developments pertaining to the flood of '22, has served as a reminder of the vital nature of a genuine, independent community newspaper. The paper's reporting on post-flood decision-making by local officials, debris cleanup, the relocation of survivors to higher ground homes, as well as efforts of neighbors lending helping hands to neighbors has reached well beyond the borders of Letcher County, Kentucky." Martin produces “Eastern Standard” for WEKU-FM, which worked with the Eagle on its “Rise Eastern Kentucky” series after the flood.

The Eagle was nominated by Dee Davis, founder and director of the nonprofit Center for Rural Strategies in Whitesburg, who wrote, "After initial stories about the devastation, the paper dug into the short- and intermediate-term response to the flood: temporary shelter for the displaced, the performance of debris-removal contractors, the complexities of FEMA aid, and more. The newspaper’s exemplary journalism has informed the county and held political leaders accountable for their response to the flood."

Adams, a native of Letcher County and a University of Kentucky graduate, began working for the Eagle in 1986. He has been environment writer at The Daily Independent in Ashland, assistant city editor of the Messenger-Inquirer in Owensboro, and a freelancer; his essay, “Appalachia: Gathered at the River” appears in Water in Kentucky: Natural History, Communities, and Conservation, published by the University Press of Kentucky.

The award recognizes not only Adams' flood coverage, but Gish's preservation of his parents' legacy. The Eagle has continued to comfort the afflicted and afflict the comfortable, who sometimes strike back, as certain political interests did the day before the 2008 election, when they bought or stole most of the that week's single copies from newsstands. The Eagle has closely followed the plight of coal miners with black-lung disease, railed against coal companies and their regulators after mine disasters, defended immigrants from political attacks, and showed the promise of using reclaimed strip mines for animal agriculture.

Soon after he graduated from UK, Gish started "Speak Your Piece," a weekly feature in which readers could have their say anonymously in a county where intimidation is common. Some journalistic purists frowned on that, but Gish said "Politics can be rough here, and some politicians give letter-writers a hard time. In the early 1970s, police beat up the kids of parents who wrote letters criticizing police brutality. Or someone wrote a letter criticizing the coal industry or a politician and their family members would lose their jobs." Also in the 1970s, the Eagle's office was torched, and a Whitesburg policeman was found responsible.

Al Smith, 1927-2021

The Al Smith Award is named for the late Albert P. Smith Jr., who was the driving force for creation of the Institute, headed its advisory board and was its chair emeritus until his death in 2021. He published newspapers in Western Kentucky and Middle Tennessee, was founding producer and host of KET’s “Comment on Kentucky,” and federal co-chair of the Appalachian Regional Commission. He was the first winner of the award, in 2011.

The award will be presented at the Al Smith Awards Dinner Oct. 26 at the Embassy Suites Lexington on Newtown Pike, near Interstate 64/75. Winners of the Institute’s national Tom and Pat Gish Award for courage, tenacity and integrity in rural journalism, to be announced soon, will also be recognized at the event, along with winners of chapter scholarships and Institute fellowships.

Besides Smith, previous winners of the Smith Award, and their affiliations at the time, are:
2012: Jennifer P. Brown, Kentucky New Era; and Max Heath, Landmark Community Newspapers
2013: John Nelson, Danville Advocate-Messenger
2014: Bill Bishop and Julie Ardery, The Daily Yonder
2015: Carl West, The (Frankfort) State Journal
2016: Sharon Burton, Adair County Community Voice and The Farmer’s Pride
2017: Ryan Craig, Todd County Standard, and the late Larry Craig, Green River Republican
2018: Stevie Lowery, The Lebanon Enterprise
2019: David Thompson, Kentucky Press Association
2020: Becky Barnes, The Cynthiana Democrat
2021: WKMS News, Murray State University

2022: Chris and Allison Evans, The Crittenden Press