In N.C., the $50 billion federal Rural Health Transformation Program won't eliminate health care deserts

North Carolina plans to use its RHTP money on hospitals
and clinics that are open. (KFF photo)

The $50 billion Rural Health Transformation Program Congress created in 2025 to ensure the passage of President Donald Trump's One Big Beautiful Bill Act may sound like it's made to help closed rural hospitals or hospitals on the brink of shuttering, but in reality, the act strictly limits the amount of RHTP grant money struggling hospitals can use to stay afloat.

The RHTP funding restrictions haven't stopped midterm-stumping politicians in North Carolina from touting the program as a salve for rural hospitals in financial straits, report Sarah Jane Tribble and Amanda Seitz of KFF Health News. "Republican candidates in competitive midterm elections are casting the fund as a lifeline that will shore up critical rural health services across America."

In Martin County, N.C., where lawmakers face competitive midterm elections, some residents believe RHTP funds will help reopen their shuttered hospital, Tribble and Seitz report. "Martin County won’t get direct relief from Trump’s rural health fund — because its hospital isn’t open." The state plans to use its $213 million in RHTP funds on "existing health and social service organizations."

Without rural hospitals, residents in states like North Carolina, where most citizens live in rural counties, are especially vulnerable. During a medical emergency, when every second counts, rural residents must survive the travel distance to get medical care. Some don't make it. Tribble and Seitz explain, "Martin County does not have paramedics on its ambulances, and it can be 20 miles or more to the closest — and often overcrowded — emergency rooms."

Brian Floyd, the chief operating officer for ECU Health, which operates out of Greenville, N.C., told KFF, "It’s a real healthcare crisis that has already proven itself to have lost lives that perhaps didn’t have to be lost. They just want to not die because there’s nowhere to go when you have an emergency."

New Medicaid work rules go into effect no later than Jan. 1, 2027. Federal guidance outlines exemptions.

CMS announced exemption guidance for Medicaid's 
new work requirements.

As the "One Big Beautiful Bill" continues to remake American safety net programs, guidance from the Centers for Medicare & Medicaid Services, released earlier this week, outlines "how states should carry out the work rules, including who would be exempt," reports Berkeley Lovelace Jr. of NBC News.

While the federal government will require states to roll out the new Medicaid work rules no later than Jan. 1, 2027, until now, states didn't know who could be considered for exemptions. Lovelace explains, "Pregnant women, parents of young children, veterans with disabilities and several other groups will be exempt from Medicaid’s new work requirements," according to CMS rules. "States will have discretion to determine which medical conditions qualify for exemptions."

The work rules do not require recipients to work full-time; instead, most adult Medicaid recipients must "work, attend school or volunteer for at least 80 hours a month to keep their coverage," Lovelace reports.

CMS will also allow exemptions for individuals who are considered too "medically frail" to work. The guidance also allows exemptions for people with "conditions that significantly limit their ability to work, such as cancer or substance use disorder," NBC reports. "The guidance doesn’t include an exemption for people who are homeless."

Before this week's announcement, Medicaid supporters worried that enrollees would lose their coverage while trying to prove their eligibility for an exemption; however, the guidance allows for that possibility. Lovelace reports, "During the first year, people will be allowed to attest — on their Medicaid applications or renewal forms — that they qualify for one of the exemptions rather than provide documentation."

The main thrust behind the work rules is to get more Americans to work. The National Bureau of Economic Research, a nonpartisan research group, found that Americans are working fewer hours than they did in previous decades, NBC reports. "The officials argued that government benefits reduce incentives to seek employment."

If you have health insurance or not, these tips can help lower medical bills

Discussing financial concerns during a medical visit can lead to cost-saving options. 
(National Cancer Institute photo, Unsplash)

Over the past five years, insurance premiums, deductibles, co-insurance and drug costs have all surged, leaving many Americans with medical debt or choosing to forego needed treatment or medication because it's too expensive. 

But there's a healthier approach to medical treatment that can lead to substantial cost savings -- talking to your doctor about your costs and the need to seek budget-friendly options whenever possible, write professors Helen Colby and Deidre Popovich for The Conversation.

"Why don’t more people have conversations about cost? One study shows that cost conversations occur in only about 30% of medical visits," Colby and Popovich explain. Talking to your doctor about costs "can be crucial when a recommended procedure has multiple alternatives. . . . Speaking up about price can help patients stay healthier and avoid the all-too-common trade-off between medical care and household expenses."

Instead of delaying treatment or going through with a treatment and then worrying about its cost when the bill arrives, Colby and Popovich suggest ways to ask your medical provider for help and flexibility to lower costs. 

Ask for a generic drug or an alternative medicine if no generic is available. They write, "Research on physician–patient cost conversations shows that switching to lower-cost, clinically similar alternatives within the same drug class is a common strategy for reducing out-of-pocket spending without compromising care." 

Ask your doctor or pharmacist whether any manufacturer coupons or co-pay assistance programs are available. Sometimes, being willing to have your medicine shipped by mail can also save money.

Seek out information about hospital programs or charity options that help cover costs. While some aid options may be linked to Medicaid programs, many are administered by state and county groups. "Patients can often find these programs through hospital or health system websites, which typically include financial assistance or 'charity care' pages," Colby and Popovich add. "Nonprofit organizations and patient advocacy groups may also offer or list assistance tailored to specific conditions or medications."

Don't be afraid to ask, "What will this cost me, and are there other options?" they advise. "This question also opens the door to alternatives. . . . A brief, honest conversation about cost can lead to more affordable and more sustainable care." 

Independent primary care doctors see banding together as one way to remain solvent and keep their autonomy

Valley Medical Group joined an IPA to help regain its
financial footing. (New England Public Media photo)

As the number of primary care doctors in the U.S. continues to decrease, the number of independent primary care practices has also fallen. A practice in the Connecticut River Valley, Valley Medical Group, has sought to maintain its independence while boosting its bottom line by joining with other independent primary physicians, reports Karen Brown of New England Public Media.

Founded during the 1990s, Valley Medical Group has become one of the "largest independent practices in western Massachusetts," Brown writes. But the practice's patient volume and focus on quality family medical care haven't shielded it from the financial pitfalls of the American insurance payment system, which rewards specialists and physicians who perform procedures over primary care.

Valley Medical Group owners found themselves stuck in insurance contracts that didn't pay well or accurately. "In January, the practice laid off 40 employees — 10% of its 400-person staff — mostly in support positions," Brown writes. "Thousands of primary care practices, a key gateway to the medical system, are fighting to remain financially viable — and independent."

VMG doctors also wanted to avoid selling their practice to a hospital, which would likely take away some of their clinical autonomy. Instead, the group opted to join an Independent Physician Association. Brown explains, "Like a union, an IPA combines individual primary care offices, giving them power in numbers when negotiating contracts with Medicaid, Medicare, and private insurance companies."

While not all IPAs are equal -- some are owned by hospitals or private equity funds -- most help level the financial playing field for smaller practices. According to Brown, when independent practices band together, they can accept insurance contracts that pay them a per-patient allotment rather than billing for each visit or procedure.

Chris Kryder, CEO of Arches Medical IPA in Cambridge, Massachusetts, told Brown, "If we keep people out of the ER, keep them out of unnecessary hospitalizations, we save money for the system. . . And we create more income for the primary care providers, which is dreadfully needed."

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.”

A startling look at the lack of dialysis treatment options for rural Americans experiencing kidney failure

For the roughly 240,000 rural Americans suffering from kidney failure, or End-Stage Renal Disease (ESRD), getting to a dialysis center that can deliver consistent, quality care is a struggle. The lack of reliable dialysis for rural ESRD patients has been exacerbated by too few providers within a drivable distance, with some rural residents facing travel across several counties to access dialysis.

The most common dialysis clinics near rural ESRD patients are often owned by DaVita, a "for-profit company with a documented history of kickbacks to doctors and involuntary patient discharges," reports Sarah Melotte of The Daily Yonder. Involuntary discharges are supposed to be extremely rare and regulated by the Centers for Medicare and Medicaid Services.

About 22.8 rural Americans – just over half of the total rural population – live in a county where either DaVita is the only clinic, or there is no clinic at all. (Map by Sarah Melotte, Daily Yonder, from CMS data)

In fact, for 6.1 million rural Americans, DaVita is the only Medicare-certified dialysis clinic in their county, according to Melotte's analysis of CMS data. Melotte reports. "Another 16.5 million rural Americans live in a county with no facility at all."

Overall, DaVita and its German competitor, Fresenius, "tend to have worse health outcomes compared to independent, non-profit clinics," Melotte writes. "Duke University’s research found that, after dialysis clinics were acquired by large, for-profit, companies, the likelihood of each patient being hospitalized each month increased by 4.5%."

Using a CMS dialysis facilities dataset, in 300 counties, 190 of which are non-metropolitan, or rural, "DaVita runs the only clinics in the county," according to Melotte's anaysis. "In rural counties, about 31% of clinics are owned by DaVita."

In some rural regions, the lack of dialysis centers is even more dire. "About 59% of rural counties don’t have a single Medicare-certified dialysis clinic," Melotte writes. "In places like rural Central Nebraska or Western Kansas, patients might be several counties away from the nearest clinic."

Mental Health First Aid for Rural Communities trains laypeople to be the first line of help

Rural residents can help one another work through
mental crisis or illness by learning MHFA.

Mental health care in rural America has always been more challenging to ask for, find and afford than in more populated parts of the country. A program that trains laypeople may offer rural residents in mentally stressful situations or suffering from untreated mental illness the best path toward getting the help they need.

The National Council for Mental Wellbeing’s Mental Health First Aid for Rural Communities works with "people not necessarily in the health professions to give them the tools they need to recognize and respond to the signs of mental health or substance use challenges," reports Liz Carey of The Daily Yonder. The training teaches participants that while they are not there to treat or diagnosis mental health problems, they are equipped with the skills and knowledge to support a family or friend until professional care is available.

A community that adds this training to its safety net toolbox is spending time incorporating a process that makes a difference. Carey writes, "Studies have consistently shown that it works — more than 90 peer-reviewed studies over the past 15 years have shown that MHFA has a lasting impact."

Jamie Hagenbuch, program manager at the Mental Health First Aid at Madison County Rural Health Council in Cazenovia, New York, told Carey, "I think rural communities definitely don’t have the resources that cities and urban communities do, so having the initial skills to be able to recognize if somebody’s becoming unwell and how to approach them and know what resources do exist, as well as being able to navigate them to those resources, is critical."

Mental Health First Aid training can help "anyone in a rural community to spot the signs of someone struggling with a mental health issue and to be able to step in to help," Carey explains. "A study in 2021 of Cooperative Extension agents in Mississippi found that 62.5% of the participants in the MHFA training programs used their skills six months after training."

Individuals interested in getting training can find more information at https://mentalhealthfirstaid.org

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.

A Medicare pilot program will use artificial intelligence for prior authorizations. Doctors and lawmakers are alarmed.

Some prior authorization requests are already decided
by artificial intelligence. (Adobe Stock photo) 

A Medicare pilot program that allows private companies to use artificial intelligence to approve or deny medical care requested by their members has some doctors and lawmakers worried. Companies included in the pilot would get paid, "based on how much money they save Medicare by denying approvals," reports Anna Claire Vollers of Stateline.

The pilot, known as the Wasteful and Inappropriate Services Reduction (WISeR) Model, will launch after Jan. 1 in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. WISeR is more likely to impact health care treatments for rural Americans in those states because rural populations often skew older and sicker than their suburban and urban counterparts.

At its core, the WISeR model effectively introduces a prior authorization process into traditional Medicare. Prior authorization is already unpopular with many patients and doctors because it requires members or medical providers to request an insurance company's approval for certain treatments or medications before proceeding.

While some Medicare Advantage and private insurance companies have already deployed AI into some of their prior authorization processes, its use has "attracted intense criticism, legislative action by state and federal lawmakers, federal investigations and class-action lawsuits," Vollers explains. "It’s been linked to bad health outcomes. Dozens of states have passed legislation in recent years to regulate the practice."

The new program has "alarmed many physicians and advocates in the affected states," Vollers reports. In practice, the prior authorization process can create obstacles to care by requiring physicians to spend hours fighting with an insurance company to justify the care they believe their patient needs. At times, medical providers may avoid treatments that would be best because an insurance company is likely to deny them, at least initially.

Last month, congressional representatives from several states "introduced a bill to repeal the WISeR model. It’s currently in committee," Vollers reports. The program is scheduled to run from 2026 to 2031.

Rural hospitals in Arkansas find different ways to stay open and still serve their communities

Rural hospitals, represented by green dots, stretch across mid- to southern Arkansas counties. 

Rural hospitals in Arkansas continue to explore the best ways to serve their communities despite severe financial struggles. Some medical centers have found success by ending inpatient care in exchange for more Medicare dollars, while others keep their doors open by opting for other designations to continue providing vital care, such as inpatient stays, reports Tess Vrbin of The Arkansas Advocate. According to a 2023 University of Arkansas review, roughly 41% of Arkansas residents live in rural areas.

Two years ago, DeWitt Hospital and Nursing Home was in financial straits and CEO Brian Miller chose to convert it into a "rural emergency hospital, which draws more federal funds to rural hospitals if they reduce or eliminate inpatient services and focus on emergency and outpatient treatment," Vrbin writes.

Beyond higher Medicare payments, the switch helped DeWitt lower costs while adding income from outpatient services, such as cardiology and wound care. The hospital is one of five Arkansas hospitals to sign up for the emergency rural designation.

But converting to an emergency triage-type care model doesn't work for every rural community. The Southwest Arkansas Regional Medical Center in Hope will not apply for rural emergency status because inpatient stays are needed for residents in surrounding counties. Its chief administrative officer, Shelby Brown, told Vrbin, "We want to be able to, if we need to admit someone, to put them in our hospital so they can stay home locally."

Instead of opting to convert to a rural emergency hospital, Southwest Arkansas Regional applied for and received approval to become "a critical access hospital, a federal designation for facilities located no fewer than 35 miles from other hospitals and maintaining no more than 25 beds," Vrbin explains. "Medicare subsidizes critical access hospitals for inpatient treatment of Medicare recipients."

For many rural hospitals in Arkansas, the choice between ending certain types of patient care or possible closure is difficult. Brown told the Advocate, "The big scheme of rural health in the state of Arkansas is in a crisis mode. . . . I would always think it’s better to have a rural emergency hospital versus no hospital.”

Kennedy pledged to protect Native American health, but staffing and funding cuts have already taken a toll

Navajo Nation leaders took turns hiking alongside Kennedy to detail
the tribal nation’s priorities. (Photo by Katheryn Houghton, KFF) 

Health and Human Services Secretary Robert F. Kennedy Jr. pledged to make Native American health a priority, but federal cuts have already sliced into plans and services tribal members need.

While Kennedy’s intervention saved the Indian Health Service from some government cuts, "health officials across tribal nations say those overtures are overshadowed by the collateral harm from massive cuts to federal health programs," report Katheryn Houghton, Jazmin Orozco Rodriguez and Arielle Zionts of KFF Health News.

Tribal members living in more remote areas will have the most difficulty accessing medical services not affiliated with the Indian Health Service. "Many tribal members don’t live near an agency clinic or hospital. And those who do may face limited services, chronic underfunding, and staffing shortages,” KFF reports. “To work around those gaps, health organizations lean on other federally funded programs.”

"Tribes have lost more than $6 million in grants from other HHS agencies, the National Indian Health Board wrote in a May letter to Kennedy," Houghton, Rodriguez and Zionts write. Across many Native American communities, HHS staffing and grant cuts have chipped away at overdose prevention programs, heat and cooling assistance, and vaccination initiatives.

Native Tribal leaders continue to voice deep concerns over the GOP’s “proposed cuts to Medicaid,” KFF reports. "About 30% of Native American and Alaska Native people younger than 65 are enrolled in Medicaid, and the program helps keep Indian Health Service and other tribal health facilities afloat.”

“Some tribal leaders say the recent cuts, and the way the administration made them, violate treaties in which the U.S. promised to provide for the health and welfare of tribes in return for taking their land,” KFF reports. “Tribal consultation is legally required when federal agencies pursue changes that would have a significant impact on tribal nations."

Rural health care clinics scrape by or close as the federal funding freeze ripples through community health sector

Bermuda Medical Center, Va., closed over access to funds.
(Photo by Adrienne Hoar McGibbon, Va. Public Media)

With federal funding suddenly unavailable, some rural medical clinics have turned to rescue dollars from private donors, cut services or closed their doors, report Shannon Pettypiece and Bracey Harris of NBC News. "Across the country, health clinics and nonprofit organizations largely serving rural and low-income patients have found themselves unable to access previously allocated federal funds, as a short-lived government funding freeze has continued to disrupt daily operations."

Early last week, the Office of Management and Budget instructed all "federal agencies to temporarily 'pause all activities related to obligation or disbursement of all federal financial assistance' that could conflict with President Donald Trump’s agenda," Pettypiece and Harris explain. "A judge blocked the funding freeze, but organizations say they are still unable to access the money they urgently need to pay for salaries, utilities, supplies and other expenses."

The freeze and continued confusion have left health clinics and nonprofits that rely on federal funds in a lurch. The financial ripple directly impacts rural American's access to health care. They write, "Community Health Centers serve as the primary care home for nearly 10 million rural patients (1 in 5 rural residents). . . . Three Virginia health clinics have shut their doors. And a network of health centers in rural Mississippi is facing a deficit of $500,000 and may have to scale back services."

A spokesperson for HHS "acknowledged that some grant recipients have experienced issues accessing their federal funds and attributed the delays to technical issues the agency’s website has been having," NBC News reports. "HHS is working to 'help expedite resolutions as quickly as possible,' the spokesperson said in a statement."

Three ways the new administration could help rural America meet its challenges

Helping younger farmers helps local land stay
locally owned. (Abobe Stock photo)

Seeking a voice and change small-town America needs, many rural voters rallied for President Donald Trump to return to the White House. Now that he's back in the Oval Office, there are three ways his administration could work with Congress to help rural America face its challenges, write Randolph Hubach and Cody Mullen for The Conversation.

Health care is a good place to start.
Rural Americans are more likely to receive Medicaid or Medicare health care coverage and more vulnerable to negative impacts from policy or funding changes. "Funding from those federal programs affects rural hospitals, and rural hospitals are struggling," Hubach and Mullen explain. "Nearly half of rural hospitals operate in the red today, and over 170 rural hospitals have closed since 2010."

They recommend government funding continue for the Low-volume Hospital Adjustment Act and the rural emergency hospital model because both programs address rural health care providers' financial needs. Additional support and expansion of rural telehealth services is also needed.

Help small towns address affordable housing.
Like much of the country, rural communities lack affordable housing. To help small towns create housing solutions, the new administration should support the "bipartisan Neighborhood Homes Investment Act, which calls for creating a new federal tax credit to spur the development and renovation of family housing in distressed urban, suburban and rural neighborhoods," Hubach and Mullen add. "The Section 502 Direct Loan Program through the Department of Agriculture could be expanded with additional funding to enable more people to receive subsidized mortgages."

Keep local lands locally owned.
Rural businesses and landowners tend to care about the communities they call home. Congress could support rural land ownership through the "proposed Farm Transitions Act [that] would establish a commission on farm transitions to study issues that affect locally owned farms and provide recommendations to help transition agricultural operations to the next generation of farmers and ranchers," Hubach and Mullen add.

The Trump administration also could continue assistance for young farmers. "About 30% of farmers have been in business for less than 10 years, and many of them rent the land they farm," they write. "Programs such as USDA’s farm loan programs and the Beginning Farmer and Rancher Development Program help support local land purchases and could be improved to identify and eliminate barriers that communities face."

Flora & Fauna: Officer coaxes tutu-clad monkey to safety; plant of the year; the Chile Pepper Institute; meet Poppy!

This little monkey let herself out the door and headed to
the highway. (Jefferson County Sheriff Office photo via AP)

Every job has its challenges, but most employees aren't tasked with apprehending a tutu-clad spider monkey. "The spider monkey was spotted at the intersection of two highways near the small town of Otto, Missouri," reports Heather Hollingsworth of The Associated Press. "The monkey had been staying at a nearby home when it managed to open a door and get outside. . . . The local sheriff's office said the capture was ‘bananas.'"

U.S. health professionals often experience on-the-job mental stress, which can cause high rates of depression, anxiety, stress, suicidal ideation and burnout. In response, some employers hired furry "stress-reliever" employees to buoy their staff and cheer their patients, reports John Daley of Colorado Public Radio. "A pair of dogs, tails wagging, had come by a nearby nursing station, causing about a dozen medical professionals to melt into a collective puddle of affection. A yellow Lab named Peppi showered nuzzles and kisses."

Some horse lovers spend years hoping to one day own their very own horse. The federal government has a plan to help make their dreams come true. "Adopting a wild horse or burro can be intimidating — how do you tame them? But a new $25 million BLM grant aims to help with gentling and finding long-term homes," reports Lena Beck of Ambrook Research. "The goal of this funding is to help whittle away at the bottleneck of horses and burros that live at BLM holding facilities — over 60,000 animals — stuck in limbo. . . .The BLM estimates this award can help place an additional 11,000 horses and burros."

A Monstera plant basks in the limelight.
(Lancaster Farming photo)

The Monstera plant has always been an overachiever, and this year its self-promotion has paid off. "Each year, the National Garden Bureau selects a 'Year of the Plant' in each of six categories — annuals, edibles, perennials, bulbs, shrubs, and houseplants," reports Susan Marquesen for Lancaster Farming. "For houseplants, the bureau deemed 2025 the 'Year of the Monstera. . . . Monstera is commonly known as split-leaf philodendron, cut-leaf philodendron, and Swiss cheese plant, due to the structure of its leaves."

When it comes to extreme pepper experts, there's really only one place to go -- New Mexico State University's Chile Pepper Institute. "It's the only research institution in the world solely dedicated to chiles," reports Anne Ewbank for Atlas Obscura. "The center’s roots go back to the school’s first horticulturist, Fabian Garcia, whose influence on spicy, pepper-bearing foods and products was seminal." Garcia created the New Mexican chile pepper." Caliente! 

She's so cute! One of us at The Rural Blog can't stop watching her video. Meet Poppy the pygmy hippo. Poppy was "named by 116,000 fans worldwide. . . . a tribute to her mom, Iris," reports CNN. Iris and Poppy live at the Metro Richmond Zoo in Virginia where they spend their days exploring, swimming and entertaining their doting fans. Poppy was born on Dec. 9 to parents Iris and Corwin.

Mental Health Association launches hub dedicated to improving rural mental health access and education

Rural health includes mental health care.
(Mental Health Association photo)

The Mental Health Association launched a new hub with information and free resources to help rural residents access mental health treatment, reports Liz Carey of The Daily Yonder. The site also provides community members with tools for supporting mental health care in their area.

MHA built its hub to help address the drastic need for improved mental health treatment and education in smaller communities. Carey reports, "About 7.7 million rural adults, or about a quarter (23%) of all nonmetropolitan adults in the U.S., reported having mental illness in 2022, according to the Substance Abuse and Mental Health Services Administration. Additionally, about 1.6 million, or nearly 5%, of nonmetropolitan adults reported having serious thoughts of suicide that year."

While the hub contains many options, its conversational style and easy-to-use format make it approachable. The site's landing page features a "Get Help" drop-down list of information with links on managing a mental health crisis. The site features online mental health tests and surveys to help residents determine what kind of help might fit their situation.

America Paredes, MHA’s chief social impact officer, told Carey, "Based on an individual’s screening results, they have access to a self-guided platform that helps them navigate their mental health journey based on their experience and where they are in their journey."

Resources for communities working to help residents or families cope with mental illness are also available. Paredes told Carey, “We hope this hub serves as a first step for individuals who may feel alone in their experience and organizations looking to support these communities by providing them with free resources.”

Through the hub, MHA introduces rural residents to various care options, including telehealth, which can help them access care from mental health professionals they would otherwise have to drive long distances to see. Joy Jay, executive director of MHA-SC, told Carey, "The acceptance of telehealth has helped others in rural areas reach the help they might not have otherwise had access to."

Hospital monopoly in Appalachia doesn't meet benchmarks; some residents say they're scared to seek care

Ballad Health's Indian Path Community Hospital has an
average ER wait time of 43 minutes. (Ballad Health photo)

The lack of choices for hospitals in parts of northeastern Tennessee and southwestern Virginia has left some residents fearful of getting care at its facilities, but hospital officials deny many patient complaints and tie their quality of care troubles to Covid-19 and nursing shortages, reports Brett Kelman of KFF Health News. "Ballad Health is the only option for hospital care in a large swath of Appalachia. . . .Lawmakers in both states "waived federal antitrust laws so two rival health systems could merge," which made Ballad Health the "largest state-sanctioned hospital monopoly in the nation."

Six years ago, lawmakers allowed the merger to prevent more hospital closures. To than end, Ballad Health has kept most of its facilities open; however, the system has "fallen short of about three-fourths of the quality-of-care goals set by the states over the last three fiscal years," Kelman explains. Those shortcomings include "failing to meet state benchmarks on infections, mortality, emergency room speed, and patient satisfaction."

Ballad's lack of consistent care has left "residents wary, afraid, or unwilling to seek care at Ballad hospitals. . according to written complaints to the Tennessee government and state lawmakers, public hearing testimony, and KFF Health News interviews," Kelman reports. "Many of those who submitted complaints or were interviewed allege that paper-thin staffing at Ballad hospitals and ERs is the root cause of the monopoly’s quality-of-care woes."

Ballad Health CEO Alan Levine defended the system's record and "said the hospitals are rapidly recovering from a quality-of-care slump caused by Covid-19 and a subsequent rise in nursing turnover and staff shortages," Kelman adds. "These issues affected hospitals nationwide, Levine said, and were not related to the Ballad merger or the monopoly it created."

Local government officials from Tennessee joined Levine during his KFF Health News interview. "As Levine spoke in a boardroom at Ballad’s hilltop headquarters, he was flanked by three local mayors who voiced support for the hospitals and said complaints came from a vocal minority of their constituents," Kelman reports.

But not every government entity echoes that support. Kelman explains, "The Tennessee Department of Health, which has the most direct oversight over Ballad Health. . . has attempted to hold Ballad more accountable for its quality of care in closed-door negotiations." The TDH declined all of KFF's requests to discuss Ballad's record.

Given the system's long list of woes, some residents wish the merger had been rejected. "Joe Macione, who for years was on the board of Wellmont Health System, one of the rival companies that became Ballad, once publicly advocated for the merger. . . . Macione said state leaders should have admitted years ago that the monopoly was a mistake," Kelman reports. Macione told him, "It has not worked."

A high school public health care boarding school is planned in Alabama; part of its mission is to serve rural counties

Alabama will launch a high school focused on health
care. (Adobe Stock photo)

Amid national health care provider shortages, Alabama is investing in a high school public health care boarding school "to address [the state's] health care staffing crisis, particularly in rural parts of the state, by training students for roles across the medical field," reports Alander Rocha of the Alabama Reflector. The board "overseeing the creation laid the groundwork to select a leader and prepare a curriculum."

With planning under way, the school "is scheduled to enroll its inaugural ninth-grade class in 2026," Rocha writes. "Rob Pearson, interim president of the Alabama School of Healthcare Sciences Foundation, said that the school will offer 'certification levels beyond what’s currently available in Alabama high schools for those looking to become health care professionals.'"

Health disparities between the state's rural and urban populations, which are particularly dire along the Black Belt, motivated health care leaders and stakeholders to work creatively to increase health care access in rural areas. Rocha reports, "The Black Belt experiences some of the state’s worst health outcomes, and Alabama already ranks among the lowest nationally. Life expectancy in every Black Belt county is below the state average of nearly 75 years."

Demopolis is in Marengo
County, Ala. (Wikipedia)

True to its rural service mission, the new Alabama School of Healthcare Sciences will be built in Demopolis, a small town with roughly 7,000 residents in west-central Alabama. State Superintendent Eric Mackey "said the school’s recruitment strategy will focus on drawing students from across the state to build a workforce pipeline beyond those wanting to attend medical school, like nursing," Rocha reports. The school "will join a network of specialized boarding schools, including the Alabama School of Cyber Technology and Engineering."

Through their initiative to establish high schools focused on health care, Bloomberg Philanthropies "is providing $26 million of the estimated $80 million needed," Rocha adds. "A groundbreaking expected by mid-2025. . . . The school is the only rural residential school funded by Bloomberg."

Some public schools continue to increase the number of vaccination exemptions given to kindergartners

Graph by Kavya Beheraj, Axios, from CDC data

Even before the pandemic years, the number of vaccination exemptions issued for kindergartners entering public schools was on the rise. According to estimates from the Centers for Disease Control and Prevention, when allowances from school years ending in 2012 to 2022 were tallied, the "nationwide median rate of kindergartners with vaccine exemptions nearly doubled," report Alex Fitzpatrick and Kavya Beheraj of Axios. The political debate over Covid-19 vaccinations could be adding to "vaccine skepticism among a relatively small but growing number of parents."

Schoolchildren are vaccinated to "reduce the spread of childhood illnesses — some potentially fatal — that once plagued the country, such as polio," Fitzpatrick and Beheraj explain. To be admitted to public school, children are required to have several vaccinations; however, "exemptions can be given for both medical and non-medical reasons." Some studies have "found an increased risk of infection from vaccine-preventable diseases among exempt children."

The number of exemptions public schools give varies by state, and the primary push to question vaccination requirements is driven by Republicans. Axios reports, "As of 2022, Idaho (9.8%), Utah (7.4%) and Oregon (7%) had the highest median kindergarten vaccination exemption rates. Mississippi, New York and West Virginia were tied for the lowest, at 0.1%. . . .with 85% of Democrats agreeing with such a requirement compared to 57% of Republicans. . . .While Democratic support for vaccine requirements held steady between pre- and post-pandemic years, Republican support took a remarkable nosedive, falling from 79% in 2019."

Despite the increase in parents seeking vaccination exemptions for their children, the number of students who aren't vaccinated remains relatively low. The nationwide median kindergarten vaccine exemption rate has "stayed at 2.5% or higher since 2020, coming in at 2.7% in 2022, the latest year for which data is available," Fitzpatrick and Beheraj write.

Most Americans support the national childhood vaccination program. A Pew Research Center survey revealed that "when it comes to the measles, mumps and rubella shot, 88% of Americans said the benefits outweigh the risks, compared to 10% who feel the opposite," Axios reports. "The share expressing confidence in the value of MMR vaccines is identical to the share who said this in 2019, before the coronavirus outbreak."

Both parties agree medical debt is a burden for many Americans and are working to pass laws that offer relief

Solving Americans' medical debt problems has
bipartisan support. (Photo by K. Sikkema, Unsplash)

Lawmakers from both parties agree too many Americans are saddled with medical debt and the problem requires bipartisan intervention. "Democrats and Republicans in statehouses around the country have been quietly working together to tackle the nation’s medical debt crisis," writes Noam N. Levey of KFF Health News. Florida House Speaker Paul Renner, a conservative Republican, told Levey, "Regardless of their party, regardless of their background . . . any significant medical procedure can place people into bankruptcy. This is a real issue."

Some states have passed laws banning unpaid medical bills from consumer credit reports and "restrict medical providers from placing liens on patients’ homes," Levey writes. A significant medical debt can cause a financial spiral for people who end up "draining savings, taking out second mortgages, or cutting back on food and other essentials."

States are trying different approaches to address the problem. "When Arizona consumer advocates put a measure on the ballot in 2022 to cap interest rates on medical debt, 72% of voters backed the initiative."

Legislative efforts to bar medical debts from consumer reports or to limit a hospital's collection activity vary from state to state. "When Colorado last year became the first state to bar medical debt from residents’ credit reports, just one Republican lawmaker backed the measure," Levey writes. "New Mexico state Sen. Steve Neville, a Republican who backed legislation to restrict aggressive collections against low-income patients in that state, said he was simply being pragmatic."

Quick hits: Canned bread nostalgia; loneliness primer; python teeth inspire improved shoulder repair; fall skies

B&M introduced canned bread to America in 1928.
(Photo by Kaleigh Brown, The Takeout)

Canned bread might fit nicely on a list of non-perishables that are nostalgic and still worth making or buying. "Canned bread's legacy is tied to the survival instincts of early New Englanders," writes Kaleigh Brown for The Takeout. "When the first settlers arrived in Massachusetts, they hoped to grow wheat, but the local climate made it difficult. Instead, they turned to more affordable and resilient grains like rye and corn. . . .Lacking ovens, they steamed their bread over open fires, often using cans as makeshift molds."

Loneliness is a common experience across the United States, but some Americans are more susceptible to the harm long bouts with the emotion can cause. "Loneliness is more than just isolation: It’s the subjective experience of craving more social interaction than you currently have. It isn’t binary, either, and no one is immune," reports Allie Volpe of Vox. "Chronic loneliness has severe negative physical and mental effects. . . . Rather than point to certain populations as explicitly lonely, understanding what increases someone’s risk for loneliness can help address it on a population level."

Python teeth are uniquely curved and sharp, which helps
them grip their prey without tearing. (A.S. photo)

Picking fruit, baling hay and moving or handling food animals can all end in a farmer or farm worker tearing their rotator cuff, which hurts like heck and normally requires shoulder surgery to repair. The surgery is tricky and often fails, which is why a "python-like surgical implant" could help, reports Eric Niiler of The Wall Street Journal. "Medical researchers at Columbia University designed and built a python-tooth-inspired implant to better mend rotator cuff tear. . . . [The snake's] prey-grabbing method was the inspiration for the device."

Failing to have end-of-life discussions can leave important decisions to a time when there is no time. "Morbidity, mortality, and the many grey zones in between are ever-present in healthcare, writes Nidhi Bhaskar for MedPage Today. "I believe it is crucial to equip future physicians with the skills to navigate these conversations, especially in acute situations where time is limited and patient capacity for decision-making can quickly change. . . . Multiple studies have highlighted the positive impact that early exposure to palliative care and end-of-life goals can have on patient satisfaction at the end of life."

Remember to star gaze this fall; there's going to be a lot to marvel at. Mars and Jupiter will be easily visible on Aug. 27 and "will be accompanied by the crescent moon, creating a dazzling pack in the sky, according to NASA," reports Juliana Kim of NPR. If you missed August's super 'blue' moon, don't despair, "next month’s supermoon will be on Sept. 18. It will be a super harvest moon. It’s called a harvest moon because of its proximity to the autumnal equinox: An equinox is when the Earth’s equator is most directly in line with the sun. This supermoon will also undergo a partial lunar eclipse, reports Mansee Khurana of NPR. "The next two supermoons will occur on Oct. 17 and Nov. 15."