As health care insurance costs continue to climb, farm bureau health plans offer a lower cost alternative

Farm Bill health care plans have been offered in Tennessee
for over 75 years. (Tennessee Farm Bureau photo)

Affordable Care Act subsidies from the pandemic years made purchasing health insurance affordable for many Americans, but those tax credits expired at the end of 2025, leaving many individuals and families "confronting difficult choices because of rising Affordable Care Act premiums and other affordability issues," reports Michelle Andrews of KFF Health News. Farm bureau health care plans often offer a more budget-friendly alternative.

Farm bureau health plans tend to offer less comprehensive coverage and require physical exams to qualify; however, they can still provide substantial savings. Andrews explains, "Plan details vary by state, but they typically share many features of marketplace plans, including coverage of a wide range of services, a broad practitioner network, and a way to file complaints."

Fourteen states "allow health coverage through state farm bureaus, grassroots membership organizations that advocate for the agricultural industry and rural interests," Andrews explains. In general, anyone can join their state farm bureau, which typically costs $30 to $50. "With membership comes the option of buying into the health plan."

To help keep premium costs low, farm bureau health care plans screen their applicants through an underwriting process and will often deny coverage to sicker people. ACA plans have to take anyone who applies. Andrews writes, "In 2026, average ACA premium payments were estimated to increase by 114% for subsidized enrollees."

Because farm bureau plans can turn down people or exempt coverage for expensive or pre-existing conditions, their plans "may be 30% to 50% cheaper than unsubsidized marketplace plans," Andrews reports. For a healthier Americans, a farm bureau health plan presents a viable solutions to spiking premium prices.

Despite their stricter rules, farm bureau health plans are becoming more popular. Andrews adds, "Last year, Missouri was one of four states that passed laws permitting farm bureau health plans." Currently, farm bureau health plan coverage is allowed in Arizona, Arkansas, Indiana, Iowa, Kansas, Mississippi, Missouri, Nebraska, North Dakota, South Dakota, Tennessee, Texas, Ohio and Wisconsin.

Rural hospitals will be hurt the most from Minnesota Medicaid cuts

Government action, such as cuts to Medicaid in Minnesota, has an “outsized impact” on rural residents, Sarah Melotte reports for the Daily Yonder.

The Trump administration recently announced its intent to withhold $259 million from Minnesota’s Medicaid reimbursements due to fraud concerns. CMS Administrator Mehmet Oz said Medicaid funds in Minnesota were going to "bogus" centers for autistic children and a behavioral health organization that had bills showing doctors working 24 hours a day for more than 450 days.

Percentage of hospital revenue coming from low-income health insurance programs. (Map by Sarah Melotte, Daily Yonder, data from the Center for Healthcare Quality and Payment Reform, Click to enlarge)

Rural hospitals are disproportionately affected by these cuts. Melotte explains that rural hospitals are more likely to operate with negative profit margins than urban hospitals, and 39 of Minnesota’s 98 rural hospitals have negative operating margins. This means the rate of uncompensated care will increase even more in these rural hospitals.

Some of these hospitals are able to stay open using non-operating revenue, such as taxes or philanthropy, but this isn’t the case for all of them, reports Melotte. More than 100 rural hospitals throughout the U.S. have had to close in the last decade, causing rural residents to have to travel farther to access the care that they need.

One nonprofit in Minnesota that houses people with disabilities reported to Minnesota Public Radio that “any cuts to Medicaid funding will directly result in reduced services.”

Medicaid now accounts for around 19% of discharges in rural hospitals nationwide, Melotte writes. “In communities where hospitals operate on thin margins, even small cuts in federal spending can destabilize entire systems of care.”

The price of hospital services is driving health care costs and insurance premiums to climb nationwide

Patients and employers are impacted by increases health premiums. 
(Graphic by wildpixel/iStock/Getty+ via Conversation CC)

The American public may perceive hospitals as part of their community’s care network, but in reality, many hospitals and specialty clinics are businesses that strive to make a profit. 

As more medical systems in communities of all sizes have consolidated, hospital pricing has become the biggest driver of rising medical costs and steep health care insurance premium hikes.

“Health insurance premiums in the U.S. significantly increased between 1999 and 2024, outpacing the rate of worker earnings by three times, according to our newly published research in The Journal of the American Medical Association Network Open,” write economic experts Vivian Ho and Salpy Kanimian from Rice University in Houston, Texas, for The Conversation. 

Using federal information and data from the Kaiser Family Foundation, Ho and Kanimian found that “the cost of hospital services increased the most, while the cost of physician services and prescription drugs rose more slowly.”

Many hospitals, including those with nonprofit designations, often aggressively price their services and care well above their costs, Ho and Kanimian point out.

“One study found that for nonprofit health systems, the greatest pay increases between 2012 and 2019 went to hospital CEOs who grew the profits and size of their organizations the most,” Ho and Kanimian explain. In contrast, any emphasis on charity care by those systems was not linked to CEO pay. 

Ho and Kanimian suggest a way to help “ensure that nonprofit hospitals make the health of their local communities a top priority by requiring their boards to disclose their executive compensation guidelines for salary and bonuses, similar to the information that for-profit health care companies disclose to their stockholders.” Such a shift could help communities push for better care and lower costs for patients as determinants of executive pay and bonuses. 

Some economists suggest that “hospital prices should be regulated. This approach involves capping prices for health care services at the most expensive hospitals and restricting price growth for all hospitals,” Ho and Kanimian write.

What does it mean when cuts from the 'One Big Beautiful Bill Act' close a rural town's only health care clinic?

The OBBBA cuts billions in federal spending on rural
health care over the next 10 years. (Wikipedia photo)

After the only health care clinic in rural Churchville, Virginia, closed, residents in this 200-person community are struggling to adjust.

"Gone are the days of seniors walking down the road from their house to see the town doctor," reports Eva McKend of CNN News. "Augusta Medical Group cited the health care provisions in the One Big Beautiful Bill Act for closing the rural clinics in Churchville and two other locations."

Even when the clinic's closure means some residents have to drive an hour to Charlottesville to see doctors, community members are reluctant to say anything negative about President Trump or his signature OBBBA legislation.

Across from the town's coffee shop, and just a few feet away from the shuttered clinic, a bold banner waves with the words "Thank you, TRUMP, Save America Again."

Democrats are planning to make health care a "defining issue nationally in next year’s midterms," McKend writes. "But the environment in Churchville illustrates the challenges the party faces, particularly in rural communities."

Dale White, a Churchville resident and church administrator, says the "concerns about the clinic are overblown," McKend writes. White told her, "These are old-time rural farming folks, and they’ve been going to get medical care in Staunton and Fishersville, Waynesboro and Charlottesville since they can remember."

Many rural hospitals, clinics and providers that serve Medicaid patients were struggling to stay afloat before the OBBBA cuts. McKend reports, "The policy research organization KFF estimates that Trump’s bill will cut federal Medicaid spending in rural communities by $137 billion over the next decade."

Clinicians in rural Idaho brace for Medicaid cuts that 'are already creating hurdles'

Pregnant women in Idaho often drive hours for
prenatal care. (Adobe Stock photo)

New rules for Medicaid have Idaho clinicians predicting more emergency visits, fewer residents with health care coverage and more maternity care deserts, reports Madeline de Figueiredo for The Daily Yonder. The systemic Medicaid changes will be the hardest on rural residents who tend to be more reliant on Medicaid.

Many Idaho medical providers see new Medicaid work requirements, income checks and possible co-payments as "changes [that] are already creating hurdles and could lead to major coverage losses and reduced access to care," according to the article. 

Coverage losses often increase emergency room visits because people delay care until their symptoms are so severe that they have no choice but to go to the emergency room. Individuals can be left with costly ED bills for care that could have been affordable if it had been sought sooner.

Idaho is already facing rural hospital closures and provider shortages, both of which impact prenatal care for expecting mothers and their babies. Figueiredo reports, "Bonner General Health, the only hospital with OB-GYNs in Bonner County, closed its obstetrics services in 2023. . . . All four OB-GYNs from Bonner County told NBC that Idaho’s strict abortion laws influenced their decision to leave."

The lack of obstetric care throughout the state means pregnant women often have to travel hours for care. Many are told to purchase insurance for emergency medical flights. Amy Klingler, a primary care physician assistant in Stanley, Idaho, told Figueiredo, “We encourage everyone, really, in our community to have that [coverage]. . . . Helicopter rides are probably anywhere from $25,000 to $50,000."

Congress considers cutting billions in Medicaid spending by eliminating reimbursements to states for 'provider taxes'

The provider tax helps most states fund their
Medicaid programs. (Adobe Stock photo)

Congressional budget hawks could trim billions in federal Medicaid spending by restricting the use of a state tax on medical providers, reports Joseph Walker of The Wall Street Journal. "The levies can lead to higher federal spending on Medicaid."

The tax, which is commonly known as the "provider tax," is levied by states on hospitals, nursing homes and other facilities that provide medical care. When medical providers pay the provider tax, states funnel the payments into their Medicaid budgets. Because federal Medicaid dollars often match state dollars, the tax increases federal Medicaid costs.

If Congress ended the ability to use the provider tax to "finance Medicaid contributions entirely, it could save more than $600 billion over a decade," Walker explains. "That would go a long way toward achieving House Republicans’ plans to reduce federal spending by as much as $2 trillion to help offset the impact of extending President Trump’s income-tax cuts."

But the change could prove devastating for medical providers and Medicaid recipients. Walker reports, "Hospitals often tend to get back more in payments than they shelled out for the original tax, which shores up their ability to care for Medicaid patients. . . . Nearly every state uses provider taxes to raise money to finance their Medicaid health insurance programs for low-income people and the disabled."

Republican budget cutters have "turned the provider taxes into a prime target.. [They say] states are gaming the system to artificially boost their Medicaid contributions and enrich politically powerful hospitals," Walker adds. "Defenders say cash-starved hospitals need the extra payments financed by provider taxes, because Medicaid reimbursement isn’t enough to cover costs."

President Trump promised during a February interview that there will be no cuts to Medicaid. Some lawmakers see the elimination of the provider tax as a possible go-around to cut Medicaid spending by more indirect means.

Medicaid decisions matter for small-town America where in 2023, 40.6% of children were enrolled in Medicaid/CHIP compared to 38.2% in metro areas. Any reductions would also hurt rural non-elderly adults covered by Medicaid.

Researchers explore bringing medical care to rural Vermonters by adding telehealth hubs to libraries

Almost two-thirds of Vermonters live in rural places.
(Adobe Stock photo)

A lack of rural health care providers often leaves residents with few ways to see medical providers without long-distance traveling. While telehealth services are an option in some smaller communities, a lack of reliable internet can get in the way. A new grant in Vermont aims to answer both challenges by exploring "the feasibility of offering telehealth services at the state’s 185 libraries," reports Chris Teale of Route Fifty. Library telehealth hubs would allow medical care in some of the state's most remote areas.

The research project, known as VITAL-VT, aims to remove obstacles Vermonters face when trying to access health care. Teale explains, "The majority are in rural communities located sometimes hours away from providers. . . . Accessing telehealth is also a challenge due to slow connectivity and gaps in understanding of how to use technology."

Along with a grant from the University of Vermont, the Vermont Community Broadband Board, which coordinates the state's broadband reach, is also supporting VITAL-VT. Robert Fish, VCBB’s deputy director, told Teale, “Everybody is pretty spread out. . . Most of the major health care providers [are in] larger towns, which makes getting access to good health care very difficult for rural Vermonters. . . . Telehealth reduces the need to do that, it's also access to experts around the world you can connect with. It also saves money for the provider, the outcomes can be better, it's better for the environment, there's less transportation, and it also allows more people to participate in care.”

FAIR Health, a nonprofit that looks to make health insurance and health care costs more transparent, "found that telehealth utilization and insurance claims have increased nationally and in every region of the U.S. except the West," Teale reports. "The Northeast region saw a 3.1% jump in telehealth claims." VITAL-VT hopes to pave new ways for telehealth services to reach and care for its residents even in the most rural parts of the state.

Medicaid cuts will hurt rural Americans. If Congress doesn't shrink Medicaid, how can $4.5 trillion in tax cuts be made?

Republican lawmakers had planned to
cut Medicaid to help balance tax cuts.

The health of many rural Americans depends on Medicaid coverage, but that safety net seems to be threatened as Republican lawmakers plan to slash Medicaid spending to pay for President Donald Trump's planned massive tax cuts. Meanwhile, during a recent interview, Trump insisted that Medicaid isn't on the federal budget chopping block, reports Margot Sanger-Katz of The New York Times.

"Trump said Tuesday night on Fox News that he wouldn’t make cuts to Medicaid, the federal-state health insurance program that mostly covers poor Americans," Sanger-Katz writes. "But making substantial cuts to Medicaid is a key part of congressional Republicans’ plan to extend the tax cuts."

Small Towns/Rural Areas include non-metropolitan counties with no urban areas of at least 50,000 residents. (Georgetown University map, from 2022-2023 American Community Survey data)

Medicaid decisions matter for small-town America where in 2023, 40.6% of children were enrolled in Medicaid/CHIP compared to 38.2% in metro areas. Lawmakers' suggested reductions would also hurt rural non-elderly adults covered by Medicaid. Mike Johnson, the House Speaker, "has been hard at work on a major bill that can balance various priorities of Trump and his caucus," Sanger-Katz explains. "The budget Johnson negotiated calls for around $880 billion in cuts to Medicaid. . . . Trump’s comments may make that carefully negotiated package moot."

Over the past four years, Trump repeatedly promised to leave Medicare relatively untouched. "But he has always been more open to changes to Medicaid, which has become the biggest health insurance program in the country," Sanger-Katz reports. Since Trump's first term, the program has grown to cover 72 million Americans, including 7.2 million low-income seniors.

If Republican lawmakers move to shrink Medicaid spending, the fallout won't only impact individuals and families. It will complicate state budgets that are dependent on federal Medicaid dollars. Sanger-Katz adds, "Cuts would put fiscal pressure on Republican governors, not just poor patients who need help paying for their health care."

If Congress leaves Medicare, Medicaid and Social Security spending at their current levels, it's unclear how Johnson can produce a budget that includes Trump's "desire for $4.5 trillion in tax cuts," Sanger-Katz reports. "Hitting the target without Medicaid cuts would mean revising the bill’s language as well as enormous cuts to remaining programs."

Hundreds of rural hospitals are 'vulnerable to closure' and 46% operate in the red, new report finds

Many rural hospitals have dropped some type of
inpatient care to save money. (Adobe Stock photo)

Despite some limited improvements, the newest statistics on rural hospitals from healthcare advisory firm Chartis are startling. "The group’s latest report on the state of rural healthcare providers found that 46% of rural hospitals are operating at a loss while 432 hospitals are deemed 'vulnerable to closure,'" reports Dave Muoio for Fierce Healthcare. The 2024 report from Chartis "outlined 50% of rural hospitals operating in the red and 418 hospitals at risk of closure."

A rural hospital's median operating margin and Medicaid expansion status are among the factors Chartis used to determine financial health. "Nationwide median operating margin for rural hospitals currently sits at 1%, with 16 states having medians below 0%," Muoio writes. "In the 10 non-Medicaid expansion states, which hold 30% of all rural hospitals, 53% of rural hospitals [operate] in the red, with a median operating margin of -1.5%."

Rural hospitals that aren't in the red have often shuttered their obstetric units and shed inpatient care or other services to stay solvent. "Inpatient care access has ended across 182 rural communities since 2010, due to either closures or transitions," Muoio explains. "Between 2011 and 2023, 293 rural hospitals stopped offering obstetrics services. . . . A similar trend was evident regarding chemotherapy. . . from 2014 to 2023, 424 rural hospitals ended the service."

The report highlighted the "key hurdles for rural hospitals, such as a 2% Medicare reimbursement cut that 'will cost rural hospitals more than $509 million this year and result in over 8,000 jobs lost,'" Muoio reports. "Chartis’ dire national snapshot comes shortly after a Wipfli survey found sparks of optimism among rural healthcare organization leaders. . . .[But] some of their views may have already changed in light of recent weeks’ political developments."

Southern states spend millions on new clinics to serve rural residents. It's one way to avoid federal Medicaid expansion.

Clemson Rural Health serves rural Walhalla, S.C.
(Clemson University photo via KFF Health News)

Southern states made rural health a focus, but the sector's trendiness hasn't translated into Medicaid expansion plans. "State lawmakers nationwide are spending millions of dollars to address a rural health care crisis long in the making," reports Lauren Sausser of KFF Health News. For more than a decade most Southern states have refused billions in federal funds that would provide public health insurance coverage to more low-income adults."

Among the 10 states that refused Medicaid expansion, some have developed their own approaches to addressing rural health disparities with state dollars. Clemson Rural Health in South Carolina is a small primary care clinic run by Clemson University that "attempts to fill [rural health care] gaps by providing primary care. . .for uninsured patients free of charge or at reduced rates," Sausser explains. Clemson's clinic receives the largest part of its funding from the state Department of Health and Human Services.

Jonathan Oberlander, a professor and health policy scholar at the University of North Carolina, said "he doesn’t expect to see any of the remaining states rushing to fully expand Medicaid," Sausser writes. "Oberlander said conservative lawmakers often consider projects such as building new rural clinics more politically palatable than expanding Medicaid coverage."

Other southern states have followed suit. "The University of Georgia established a new medical school, partly to send more physicians into underserved and rural areas," Sausser adds. "The Georgia General Assembly kicked in half the cost of a new $100 million building for medical education and research in Athens. . . .The Tennessee General Assembly passed a budget last year that included $81 million for a variety of rural health initiatives." 

Bird flu has sickened wild birds, cats, cows and humans. As more people catch the virus, medical experts worry.

People working with livestock infected with 
avian flu are at risk. (Unsplash image)

While every American has seen the effects of avian flu on egg prices, bird flu, also know as H5N1, has the potential to become a greater risk to human health, too.

At the moment, avian flu poses the greatest threat to people working with livestock or wildlife. The disease has been found to have a devastating effect on poultry, but dairy cows have also had high infection rates. “Sixteen states and 927 dairy herds have been affected,” reports Claire Carlson of The Daily Yonder.

Farmers working with livestock can minimize their risk for infection by wearing personal protective equipment (PPE), and those infected can get treated with Tamiflu. Carlson explains, "But at commercial farms, PPE use is spotty at best, according to Investigate Midwest reporting. Their investigation found that one-third of states with active bird flu outbreaks in dairy herds were not tracking the distribution of PPE, leaving it up to the farmers to protect themselves and their workers"

The spread of bird flu in smaller or more remote towns could prove difficult to isolate. Dr. Nahid Bhadelia, an infectious diseases physician, told Carlson, “Our rural communities may not have the same kind of healthcare resilience [as cities], so if you have more than a couple of cases, my concern would be that we want to ensure that we can quickly make testing available.”

While dairy cows are having less deadly results from avian flu than chickens, the disease can also be passed through the consumption of raw milk from infected cattle. The Food and Drug Administration found that the virus is made “inactive through pasteurization.” Twenty-eight states are enrolled in a program that tracks the flu rates and addresses what states should do in the event of an outbreak.

As of Jan. 16, there have been "66 confirmed human cases of bird flu in the U.S., and one death," Carlson reports. Bhadelia told her, “The more chances we give this virus to potentially infect humans and to evolve within humans, it is possible that it might grow into something that’s a greater threat to humans."

Powerful pharmacy benefit managers are tasked with cutting costs, but their practices can undercut small pharmacies

PBMs increase profits when independent pharmacies
go out of business. (Adobe Stock photo)

The loss of independent pharmacies across the country has been a concern for rural residents, but who are the fabled PBMs, or pharmacy benefit managers, how do they operate and what do they gain when they force smaller pharmacies to close, ask Reed Abelson and Rebecca Robbins of The New York Times. "A New York Times investigation found PBMs, which employers and government programs hire to oversee prescription drug benefits, have been systematically underpaying small pharmacies, helping to drive hundreds out of business."

PBMs garner the power to underpay smaller pharmacies from "two main sources. First, the three biggest players — CVS Caremark, Express Scripts and Optum Rx — collectively process roughly 80 percent of prescriptions in the United States," Abelson and Robbins explain. "Second, they determine how much drugstores are reimbursed for medications that they provide to patients. . . . When local drugstores fold, the benefit managers often scoop up their customers, according to dozens of patients and pharmacists."

The process of how pharmacists purchase medicines, sell them to patients and receive reimbursements is undermined by PBMs who seek to add to their profits by undercutting smaller drugstores' drug reimbursements. The Times reports, "To take just one example: For a month’s supply of the blood thinner Eliquis, several pharmacists in different states said, the big three PBMs routinely paid them as much as $100 less than what it cost the pharmacies to buy the medication from a wholesaler.

"By contrast, the PBMs sometimes pay their own pharmacies more than what they pay local drugstores for the same medications. Independent pharmacies are powerless to fight back. As the unprofitable transactions pile up, some are unable to stay afloat. . . . [The closures] have disproportionately affected rural and low-income communities, creating so-called pharmacy deserts that make it harder for residents to get prescriptions and medical advice."

There is an inherent tension between PBMs and any pharmacy seeking drug reimbursements. The PBMs' purpose is to cut costs, which is accomplished by paying pharmacies less. Those savings can, "in turn, lower insurance premiums for workers and people covered by government programs like Medicare," Abelson and Robbins write. "But that apparent frugality often benefits the PBMs in ways that have nothing to do with their clients’ interests. . . .At the same time that PBMs are reimbursing pharmacies at rates below their costs, the benefit managers are often charging employers much higher prices and pocketing the difference, according to insurance paperwork reviewed by The Times."

With new technology, many 988 suicide and crisis hotlines will be able to use caller 'georouting' to help provide care

Many 988 crisis service calls will soon be aided by geolocation technology. (988lifeline photo)

Despite the 24/7 availability of the 988 suicide and crisis hotlines across the country, U.S. suicide rates have continued to climb, with rural states facing some of the highest losses. One of the 988 program's biggest shortcomings has been its lack of caller location services, but that's about to change, reports Deidre McPhillips of CNN. "Carriers have started to adopt a new technology that helps direct callers to 988 hotlines to help centers based on their physical location rather than their phone number’s area code."

Adding the new technology means 988 hotline counselors will be able to connect callers with services and follow-up support where they live. "Verizon and T-Mobile started rolling out the 'georouting' technology last week. . . . AT&T also plans to begin the process within the next couple months," McPhillips explains. "Next month, the Federal Communications Commission will vote on a rule that would require all wireless carriers in the U.S. to implement georouting for 988 calls."

Some mental health advocates have voiced concerns over caller privacy; however, georouting differs from geolocation in that "it does not provide a precise location for the caller," McPhillips adds. "Instead, it aggregates information about a caller’s location to help them reach local support while maintaining their privacy." 

The 988 lifeline began in July 2022, replacing the National Suicide Prevention Lifeline with "a broader focus and a simpler dial code," McPhillips reports. The lifeline now includes services such as "American sign language and Spanish. . . . a special veterans crisis line, and an LGBTQ+ youth and young adult line." 

Military community needs more access to the great outdoors; a new report explores obstacles and solutions

Yosemite National Park
(Photo by Johannes Andersson, Unsplash)

Spending time exploring nature has proven especially important for the U.S. military community's mental and physical health, which is why the Sierra Club Military Outdoors campaign and the University of Kentucky’s Community and Economic Development Initiative of Kentucky have been investigating how to make the outdoors more accessible for all armed services members, their families and veterans.

The partnership just released its initial report and will host a virtual briefing at 1 p.m., E.T., on Wednesday, Aug. 28, to go through the report, provide community reactions to the findings and offer a space for questions. Register for the briefing at https://sc.org/SCMOReportBriefing.

Particularly for veterans, spending time outside walking or participating in activities can supplement treatment for injuries and disabilities, including post-traumatic stress disorder. However, safely accessing the outdoors is not always easy for the military community, and barriers such as cost, transportation, experience level and mobility can interfere. These obstacles and how plans could be enacted to remove them prompted the report.

To research outdoor uses and accessibility, the SCMO conducted a series of in-person listening sessions in California, Florida and Georgia, as well as a virtual listening session for women veterans and a nationwide online survey that drew respondents from 48 states. The report combines research from the listening sessions and survey results.

Overall, the report's recommendations include improving equitable access with a new grant program supporting outdoor access programs focusing on underserved veteran populations, establishing an Office of Outdoor Recreation that would coordinate and support efforts around outdoor access for veterans and military, and expand and fund the new Military Families Outdoors Program, which generates programming and initiatives on public lands to improve the health of the military community.

Oregon is using visiting nurses to help curb infant and new mother mortality rates; visits may have other benefits

Why babies do what they do is often a mystery.
(Photo by Chris Anderson, Unsplash)

Some of the most complicated human beings to deal with are the tiniest: babies. Often referred to as "bundles of joy" or "little miracles," babies can be cranky, impossible to calm and impervious to sleep.

With that backdrop, it's fair to say new parents have it tough, and many lack the resources they need to confidently care for a newborn, which can lead to stress, emergency department visits, and even neglect or abuse. To address these needs and provide a response to high infant and mother fatality rates, the state of Oregon implemented an evidence-based program called "Family Connects" that makes life with a newborn better for everyone, reports Cory Turner of NPR. "The program offers any family with a new baby up to three no-cost visits at home with a trained nurse."

After the birth of their first child, Matt and Amber Luman from rural Jefferson County, Oregon, chose to participate in Family Connects. Turner writes, "Matt and Amber seem genuinely relieved when [Nurse] Ibrahim arrives for her second home visit with them." After baby Esserley gets a thorough medical check, "comes the beating heart of any Family Connects visit: the chance for new parents to ask a registered nurse whatever they want. . . . Some share their confusion or frustration. Others are eager for advice or comfort in those early weeks of a baby’s life when new parents are most likely to feel exhausted and adrift."

Most new parents need all the help they
can get. (Photo by T. Heftiba, Unsplash)

The Oregon Health Authority based the state's program on a small, successful Family Connects model developed in Durham, N.C. "Research from its smaller rollout there found it was associated with a handful of significant benefits, including a big drop in the number of trips new parents were making to the emergency room," Turner reports. "A study of Family Connects in Durham found mothers in the program were 30% less likely to experience possible postpartum depression or anxiety."

Oregon policymakers used the Durham program model and expanded it to a statewide outreach. "Every nurse acts as a kind of human clearinghouse of local and regional support for caregivers," Turner explains. "If a family is struggling with housing or food insecurity or addiction, the nurse will connect them with local groups and agencies that can help. Mental health counseling, marriage counseling, child care while mom or dad finishes their degree online."

In Durham's smaller rollout, the program "suggested a real return on investment," Turner reports. "Rolling out Family Connects in Oregon has been a costly struggle." From the pandemic to the nursing shortage to trying to cover a state that can be widely rural, Oregon's program has been expensive. It remains to be seen if the "benefits of Family Connects will outweigh the costs."

When relatives want to age at home, family caretakers struggle with two jobs. It's more difficult for rural residents.

Responsibility for aging family members can take a toll
on home caretakers. (Adobe Stock photo)

A growing number of Americans are working two jobs: one to pay the bills and a second unpaid job caring for an aging family member. "The double shift can come at a career cost. Caregivers who are also working full-time report turning down promotions or seeking less-demanding assignments," reports Clare Ansberry of The Wall Street Journal. "Some switch companies or say they've had to choose care duties over their careers." Even if the older relative still lives independently, the juggling still can be taxing.

In rural communities, aging residents prefer to have family members care for them, but they have additional challenges. "Like older adults across the country, rural seniors tend to want to age in their communities, amid familiar people and places," report Martha Hostetter and Sarah Klein for The Commonwealth Fund. "But with fewer health care providers, fewer professional caregivers, and fewer young people than in urban areas, rural communities struggle to care for aging residents."

Both rural and urban families struggle to balance elderly care with life's other duties. "An estimated 29 million workers, from senior managers to retail clerks, work while also caring for an adult family member, according to research by AARP and the National Alliance for Caregiving," Ansberry writes. "Care demands on workers are growing because people are living longer with chronic illness. . . . A large share of people want to age at home but need lots of help from family members to do so."

Many companies don't offer eldercare options, so employees often have to sandwich in a loved one's medical appointments during breaks and use vacation time. "Some working caregivers have been called in to talk with their bosses about performance. Others say they haven't used a vacation day for an actual vacation in years," Ansberry reports. "Tensions can run high between employees and employers over caregiving."

Rural communities are working on ways to help residents get to appointments and social events without solely relying on family members. "St. John's United, a member of the Rural Aging Action Network, provides senior housing in and around Billings, Montana," Hostetter and Klein report. "In 2019, St. John's launched 'At Home' services for clients living in their own homes. This monthly subscription service is offered on a sliding scale and provides seniors with rides to medical appointments, help with household tasks, social outings, and other supports."

For information on aging in place and what creative solutions and resources exist or can be cultivated, click here. 

Plagued by EMS worker shortages and poor funding, rural EMS services in Minnesota get some much-needed help

Lawmakers approved a new pilot program to address the
state's rural EMS response times. (Adobe Stock photo)

Rural ambulance services have been short-staffed for years, but in Minnesota, the situation has become so extreme that lawmakers have stepped in with financial support and a 'sprint' pilot program. "The 'EMS emergency' declared by Minnesota lawmakers is far from over, but rural services in the state recently got some good news," reports Elizabeth Daigneau of Route Fifty. Legislators approved a $30 million aid package for rural emergency medical services.

The bill provides $24 million in emergency aid for EMS providers and focuses on providing relief to the state's non-urban regions. "It would also create a new Office of Emergency Medical Services to oversee Minnesota's EMS network," Daigneau explains. "Most notably, it would provide $6 million to launch a 'sprint medic' pilot program in three counties in northern Minnesota."

The sprint medic concept is meant to streamline EMS responses by "sending out a single paramedic in a car or truck directly to an emergency to begin treatment," Daigneau reports. "The idea is that these roving paramedics who would be patrolling the area have more training than the current emergency medical technicians. . . . They could reach emergencies more quickly. . . and, in some cases, resolve calls to keep ambulances with advanced life support equipment from being dispatched unnecessarily."

While $30 million won't solve all the EMS struggles, it will help response times. David Kirchner, evaluation coordinator for the Minnesota Office of the Legislative Auditor, told Daigneau, "In some communities, the situation is becoming dire enough that not only are the ambulances not sufficient, but there's not even someone to answer the phone when 911 calls the ambulance company."

The bill was routed to Gov. Tim Walz’s desk for approval. While it isn't the $120 million originally requested, Daigneau adds, "supporters say it still provides some much needed relief."

Early week quick hits: Addressing mental health issues; finding funny stories; using lasers to make birds leave

Colorado Department of Agriculture photo via Successful Farming

Farming and ranching are two livelihoods that are tough on the human body and mind. For men and women in either or both professions, seeking help for mental stress can mean overcoming social stigmas and a lack of access. A new film, Legacy, from the Colorado Department of Agriculture and Colorado Farm Bureau aims to break down social barriers for farmers and ranchers who experience isolation and mental health issues, reports Lisa Foust Prater of Successful Farming. The film takes viewers into the stories of "several farmers and ranchers who share glimpses into their lives, including losing a loved one to suicide or facing their own struggles with mental health. . . .They speak candidly about the struggles faced by those working in agriculture and the difficulties with finding help." Watch the film here.

Cancer used to be a disease people mostly over 50 had to worry about. Now, many younger people are turning up with aggressive cancers, and researchers can't yet explain what has changed. "Adults in the prime of their lives, often otherwise outwardly healthy, are dying of cancers that appear to develop more quickly and be more deadly than in the past, for reasons that scientists cannot adequately explain, reports Dylan Scott of Vox. "Scientific authorities around the world see this as one of the most pressing questions for modern medicine."

Reading a funny book can make life sweeter.
(Adobe Stock photo)

One of The Rural Blog writers insists that the world needs more laughter. With that idea in mind, here are 22 books that could help you giggle, guffaw, chortle and even snort out loud. "The humor these authors embrace traverses the gamut, from sardonic to screwball, mordant to madcap, droll to deranged," report Dwight Garner, Alexandra Jacobs and Jennifer Szalai of The New York Times. "The critic Albert Murray understood that wit is power, and that knowing where the funny is takes us closer to the nub of things. Best of all, it's available to anyone. As Murray wrote, 'It is always open season on the truth.'"

As many rural hospitals and clinics have closed or limited services, getting medical care or chronic health treatment services has become an uphill battle for residents. The American Heart Association visited Alaska, Kansas, Kentucky, the Dakotas and West Virginia to shed light on rural health challenges and how residents and communities are working to overcome obstacles. Their exploration and discussions are presented in the docuseries, "Health Wanted: Find Care in Rural America." Click here for each state's episode.

Lasers can deter birds.
(Bird Control Group photo via SF)

Some Wisconsin farmers use lasers to keep wild birds away from their animals, reducing their chance of avian flu exposure. "When the human eye examines one of Craig Duhr's lasers at a Wisconsin farm, only a green dot is visible. But to birds, a variety of green beams and shifting patterns appear," reports Jonah Beleckis of Wisconsin Public Radio. Laser beams do not harm birds, but the birds "simply see the lasers as a threat and leave the area. . . . Wisconsin's agriculture department recommends farmers use biosecurity measures, such as lasers, to protect poultry flocks."

Maine Monitor analysis,
from State Fire Marshal data

Maine firefighters have the cool trucks and trademark hats, and some even have a station dog. But fighting fires is not what they spend most of their time doing. Amber Stone of The Maine Monitor reports, "A mere 4.5 percent of the 160,435 calls for service in 2022 were for fires, according to a Monitor analysis of State Fire Marshal data. Seventy percent of those calls were for emergency medical response. More than half of Maine's 338 registered fire departments are also licensed at some level to provide emergency medical services, according to Maine EMS, and more are considering doing so."

Adding dental care to regular checkups is helping people with little access to dentists get needed care and referrals

Dr. Braun, left, and dental hygienist Valerie Cuzella work in tandem
to add dental care to regular medical checkups. (KFF photo)

As the number of dentists who serve low-income and Medicaid patients dwindles, primary care providers such as pediatrician Patricia Braun and her team are stretching their skills to include dental care, reports Kate Ruder of KFF Health News. "Braun is part of a trend across the United States to integrate oral health into medical checkups for children, pregnant women, and others who cannot afford or do not have easy access to dentists."

Private and federal money has financed more options for medical providers to deliver dental care during routine medical checkups. Braun and her colleagues launched their integration with help from a five-year, $6 million federal grant. The collective group "has helped train 250 primary care providers in oral health in Colorado, Montana, Wyoming, and Arizona," Ruder writes. "Similar projects are being funded by the federal Health Resources and Services Administration’s Maternal and Child Health Bureau in Illinois, Michigan, Virginia, and New York. . . . Embedded dental hygienists become part of their practice."

Ruder reports, "Having doctors, nurses, and physician assistants who assess oral health, make referrals, and apply fluoride at community health centers is critical for the many children who lack access to dental care, said Tara Callaghan, director of operations for the Montana Primary Care Association, which represents 14 federally qualified health centers and five Urban Indian organizations."

In big, more rural and sparsely populated states, having a primary doctor address dental needs is ideal. "Because of Montana’s large geographic area and small population, recruiting dental professionals is difficult, Callaghan said. Some counties don’t have a single dentist who takes Medicaid," Ruder reports. "Montana ranks near the bottom for residents having access to fluoridated water, which can prevent cavities and strengthen teeth."

To address its lack of dentists, "Colorado enacted a law to alleviate workforce shortages by allowing dental therapists — midlevel providers who do preventive and restorative care — to practice," Ruder reports. "But Colorado does not have any schools to train or accredit them."

Rural residents with diabetes are more likely to suffer from disease complications -- lack of access to care could be why

Diabetes requires continuous care.
(Photo by T. Barbhuiya, Unsplash)

Past studies have shown that rural Americans are more likely to develop type 2 diabetes, and they experienced more struggles trying to manage the disease than their more urban counterparts. In a new study, researchers from the University of Maryland School of Medicine took a closer look at rural residents experiencing diabetes complications such as heart and kidney problems. Their research, which was published in the journal Diabetes Care, showed that these rural populations are at significantly higher risk of suffering from end-stage kidney disease, heart failure and heart attacks, all of which could caused by a lack of access to medical care.

The study's corresponding author, Rozalina McCoy, told UM news: "Those who live in rural areas have a greater risk of experiencing eight out of the eleven complications that we measured compared with those living in cities. . . .They were 15 percent more likely to have dangerously low blood sugar levels, which clearly indicates that their diabetes is not being managed properly."

The study's co-author, Elsa Davis, added, "While our study didn't address why these differences exist, we do know that people living outside of city areas are less likely to receive care from diabetes specialists, to receive diabetes self-management education, and to be monitored for diabetes complications."

While the study encompassed varying degrees of rural populations, it "relied on insurance information to identify diabetes complications," UM reports. "If people could not access medical care, that complication would not be captured. Dr. McCoy noted that this finding further underscored the barriers to care in remote areas: patients are likely having high blood sugar emergencies and heart failure but cannot get to the emergency department or hospital to have them diagnosed and treated." Study authors added that further research should investigate reasons why these disparities exist.