First story from ProPublica's Local Reporting Network says nuclear lab workers may have been exposed to toxin

Los Alamos National Laboratory in New Mexico, the birthplace of the atomic bomb, may have exposed workers to harm after failing to keep track of a toxic metal used in nuclear weapons production. "The New Mexico lab’s failure to adequately track beryllium — small amounts of which can cause lung disease and cancer — violates federal regulations put in place to prevent worker overexposure, according to a report last week from the Department of Energy’s inspector general," Rebecca Moss reports for The Santa Fe New Mexican and ProPublica.

The story is the first from a year-long project, the Local Reporting Network, which ProPublica launched to support local and regional investigative reporting. Moss will be examining workplace safety issues at Los Alamos and other national laboratories that develop nuclear weapons for the DOE.

Los Alamos has had safety problems in the past. In October 2017, an independent federal safety board found that the lab's emergency preparedness plan was inadequate. Soon afterward the DOE investigated an incident in which a worker responded to an alarm by walking into an oxygen-deprived room, which could have killed the worker.

Los Alamos, which employs more than 11,000 workers, told the inspector general that the insufficient oversight is a result of staffing problems and the sheer number of the programs it oversees, but added that it is not aware of any workers having been exposed to beryllium. "Over the last decade, the inspector general has found issues with beryllium protections at Oak Ridge National Laboratory and Y-12 National Security Complex in Tennessee and Lawrence Livermore National Laboratory in California," Moss reports.

Oxycontin maker quietly but repeatedly tried to weaken laws that can help send corporate executives to jail

It's well known that Purdue Pharma made Oxycontin a popular drug through aggressive and misleading marketing tactics, which led to today's opioid epidemic. "What has not been previously revealed is that as the death toll mounted, officials at the company attempted to work behind the scenes to make it less likely that they could ever be successfully prosecuted for the carnage opioids were unleashing," Lee Fang reports for The Intercept.

Purdue quietly helped finance efforts to weaken the Responsible Corporate Office doctrine, a liability standard used to prosecute executives and directors of companies that affect public health and safety. Under the RCO doctrine, federal prosecutors could go after Purdue's higher-ups for their role in the opioid epidemic without having to prove they had knowledge of or motivation for wrongdoing. That happened in 2007, when three Purdue executives pleaded guilty in federal court to charges that the company had misled doctors and patients about the addictive nature of Oxycontin, and agreed to pay $634.5 million in civil fines.

"Purdue didn’t attach its name to the recent effort to weaken the Responsible Corporate Officer Doctrine," Fang reports. "Instead, the company provided funding to the Washington Legal Foundation, a legal nonprofit that litigates in support of business interests, to petition the Supreme Court last year to accept a case that would give it the opportunity to weaken the RCO doctrine. The foundation closely protects the names of its donors and the drugmakers’ ties to the group were unclear until recently."

The case is DeCoster v. United States, a suit that challenged the conviction of executives at Iowa-based Quality Egg LLC, who were found guilty after 56,000 people were sickened by salmonella-tainted eggs. In its petition, the foundation argued that an executive could be imprisoned for little more than being a supervisor, and urged the Supreme Court to revisit the RCO doctrine. The court declined to hear the case.

The foundation also went to bat for Purdue in 2014, when it petitioned the court to support the company in a bid to chip away protections for corporate whistleblowers under the False Claims Act, and "helped Purdue Pharma attempt to block the Centers for Disease Control and Prevention from issuing voluntary guidelines to discourage the over-prescription of opioid narcotics," Fang reports. The foundation, which routinely filed briefs in support of cigarette maker Philip Morris USA in the 1990s, has been accused of being a nonprofit legal front for corporations seeking to weaken public health and safety standards.

White House defends, explains lack of direct investment in rural broadband in Trump's infrastructure plan

"Amid criticism that President Trump's infrastructure spending plan -- $200 billion meant to seed more than $1 trillion in ultimate public/private investment -- earmarked no money specifically for rural broadband, the White House Friday was trying to explain just how rural broadband access would benefit from the plan," John Eggerton reports for Broadcasting & Cable.

In a fact sheet sent out Feb. 23, the White House press office said Trump has helped facilitate rural broadband expansion with an executive order to streamline requests for creating rural broadband facilities. And though none of the $50 billion earmarked for rural infrastructure was dedicated specifically for rural broadband, the fact sheet says that states have the flexibility to spend all of that money on broadband.

Map shows how well your state is fighting the opioid epidemic with best practice, medication-assisted therapy

"There’s a simple way to understand how the opioid epidemic got so bad in America: In the U.S., it is much easier to get high than it is to get help for addiction," German Lopez reports for Vox. This is more true in some states than others, as illustrated by this map by health research firm Avalere Health, which shows the ratio of certified buprenorphine providers to opioid overdose deaths. Buprenorphine is one of three different medications for medication-assisted therapy (MAT), widely acknowledged to be the most effective form of treatment for opioid addiction. Lopez reasons that a state with  a low number of MAT providers and a high number of overdose deaths is not fully addressing its opioid crisis.

Avalere Health map; click on the image to enlarge it.

The Food and Drug Administration announced yesterday that it will loosen restrictions on MAT by allowing pharmaceutical companies to sell medications that curb cravings without fully stopping addiction, Sheila Kaplan reports for The New York Times. The move is a change of diredction; last year, then-Health and Human Services Secretary Tom Price suggested he was skeptical" of MAT, Politico Pulse reports.

Columnists say 'Let's spread some rural values' as America debates response to school shootings

Annette Tait and Katy Kassian

The recent school shootings in Florida and rural Kentucky have prompted debate all over the country about how to end the violence. A column in Ag Week says there are no easy answers, but applying rural values would help.

In rural America, people look out for each other, with needs big and small, write North Dakota marketing specialists Annette Tait and Katy Kassian: "We see it all the time. People and businesses alike donate meal fixings and items for silent auctions, and people give free-will donations that are far greater than the cost of the meal. Everyone chips in to make sure plenty of proceeds go toward getting the job done."

That kind of neighborly love is something we should all practice daily, and can help lonely people know that someone cares for them, they say: "This is why it's so important to connect. To invest time in families, friends and neighbors. To be the support system that guides our children to be responsible and accountable. To be listening ears when others need them, and to help those who are struggling become whole again. To be aware, and involved. We need to become the proverbial village — not just to raise our children, but to take care of all who live here." (Read more)

Governors Association meeting addresses broadband, opioids, farming; guns not on agenda, but discussed

Ariz. Gov. Doug Ducey spoke during a panel at the NGA
2018 meeting. (Associated Press photo by Jose Magana)

Several issues of rural interest were on the agenda at the National Governors Association 2018 winter meeting this weekend, including agriculture, broadband, and the opioid crisis.

Guns: Firearms weren't on the official agenda, though President Trump said at the conference's opening night black-tie ball that the recent school shooting in Florida was the top issue he wanted to discuss with the governors, Darlene Superville reports for The Associated Press.

Republican governors were skeptical about the possibility of arming teachers, which Trump has said would help deter future attacks. Nevada Gov. Brian Sandoval, the NGA chairman, met with Vice President Mike Pence Friday to discuss school shootings. Sandoval told reporters he supports Trump's proposal to ban bump stocks that make rifles automatic, but arming teachers "needs a lot more discussion. At first blush it concerns me . . . You've got to look and see what the other alternatives are. Perhaps we just need to secure the schools a little better," Gary Martin reports for the Las Vegas Review-Journal.

Outgoing Tennessee Gov. Bill Haslam told Politico, "I’m not certain I see arming teachers as being the answer because I think there’s a very small percentage of teachers who say 'Yes, I want to do that.'" And Arizona Gov. Doug Ducey told Politico that he prefers only resource officers to have guns in school so teachers can focus on teaching. "Vermont Gov. Phil Scott, a Republican in a relatively liberal state, pled with his legislature last week to fast-track a bill that would remove guns from people deemed a threat. He said he’s 'changed completely' on gun issues since the Parkland shooting," Politico reports. Florida Gov. Rick Scott is urging his legislature to raise the age on gun sales to 21, ban bump stocks, and spend at least $450 million on mental health and enhancing security in schools.

Broadband: Microsoft announced its first rural broadband partner, Packerland Broadband, to bring broadband internet to about 82,000 people living in rural northern Wisconsin and the Upper Peninsula of Michigan in the next four years. The initiative is part of a coalition between Microsoft and a host of rural broadband and tech groups called Connect Americans Now, aimed at eliminating the digital divide in rural America by using the "white spaces" between TV channels. During his NGA address, Microsoft President Brad Smith criticized the Federal Communications Commission's failure to generate reliable data on broadband availability.

Agriculture: Zippy Duvall, president of the American Farm Bureau Federation, told the governors that the agricultural economy hinges on infrastructure, reports Eleanor Lamb of Transport Topics: "Roads, bridges, dams and locks are so important," Duvall said. "What sets us apart from the rest of the world is our infrastructure. Yes, it is crumbling, but we have a president who wants to rebuild it." Duvall also said preserving the North American Free Trade Agreement is necessary, though parts of it could be reworked. NAFTA negotiations are now in their sixth round.

Opioids: Health and Human Services Secretary Alex Azar said at the meeting that the Food and Drug Administration plans to expand medication-assisted treatment by allowing pharmaceutical companies to sell medications that help curb cravings, even if they don't completely stop addiction. HHS will issue draft guidelines for the proposal in the next few weeks, Sheila Kaplan reports for The New York Times. Azar's remarks were "different from the tone struck by his predecessor Tom Price, who last year suggested he was skeptical of medication-assisted treatment," Politico Pulse notes.

Earlier this month, the NGA announced two projects aimed at the opioid epidemic. "Participating states will travel to Kentucky to learn about how that state is addressing the increased risk of infectious disease through public-health surveillance and community prevention efforts," said an NGA press release. "In the second, states will learn from Ohio’s efforts to better serve pregnant and post-natal women with opioid use disorder and improve health outcomes for their babies." 

Ex-con coal baron's bid for W.Va. Senate seat gains traction

Convicted misdemeanant at his campaign kickoff in January
(Associated Press photo by Steve Helber)

Don Blankenship's campaign for a U.S. Senate seat in West Virginia would have sounded like a pipe dream last year. After all, the former Massey Energy CEO just got out of prison for his role in 2010's Upper Big Branch coal mine explosion that killed 29 men. But "opponents who once dismissed his candidacy now see him as a credible threat in the Trump era, positioned to appeal to many West Virginians’ resentment of elites of any kind," Trip Gabriel reports for The New York Times.

Blankenship' events have drawn protesters, but some in coal country support his claim that he is a former "political prisoner," unfairly targeted by federal prosecutors and safety inspectors. No evidence has been found to back up those claims, but Gabriel notes that Blankenship "is running for office in an era of nationwide voter credulity for conspiracy theories." That dovetails with many West Virginians' belief that the federal government, especially Barack Obama, is to blame for coal's decline, despite experts' belief that a larger factor was cheap, plentiful natural gas that stole coal's prime market, power generation.

West Virginia has a long history of miners vs. mine operators, but once non-union operators began paying union wages, the United Mine Workers union weakened, and when the miners and operators found a common foe in Obama's anti-coal policies, they became allies and operators were seen as job creators. R. Booth Goodwin II, who prosecuted Blankenship as U.S. attorney and then ran for governor unsuccessfully in 2016, told Gabriel: "I have heard people say, 'When Don was in charge, we always worked.' . . . The coal industry is still perpetuating a lie that coal mining is coming back, and it’s going to be just like it was before, when all objective evidence is to the contrary."

Opioid epidemic has reduced the size of the workforce

The opioid epidemic is paralyzing the workforce. Even with 6 million open jobs across the country, rampant drug abuse has "incapacitated thousands of working-age people whom employers would otherwise be eager to hire," Lydia DePillis reports for CNN.

Research published in September by Princeton University economist Alan Krueger found that the rise in painkiller prescriptions  from 1999 to 2015 led to a 20 percent drop in men’s workforce participation and 25 percent decline in women’s participation, especially in Appalachia, the Rust Belt, coastal Washington, northwest Arkansas, and central Maryland. 

As a result, "Some employers that typically screen drug users out through testing are starting to become less picky," DePillis reports. "Such tolerance is not an option for all employers. Jobs that involve working with children typically bar people with criminal records. . . . Construction companies, too, are less likely to take the risk of hiring someone who might come to work high and make a fatal mistake while on a ladder or using heavy equipment."

In its annual economic report, President Trump’s Council of Economic Advisers wrote "curbing the opioid crisis is of critical importance for ensuring a stable or growing employment rate among prime-age workers."

Quick hits: appraiser shortage hurts rural market; N.M. is a black-lung hot spot; checklist to keep kids safer on the farm

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

The latest episode of Banking Journal, a podcast from the American Bankers Association, tackles a little-recognized problem for rural America: the shortage of qualified appraisers. It's hard enough to get people and businesses to move to rural America, but those who want to buy a farm or commercial real estate in rural America can face waits of several months while lenders wait for the appraisals. It can harm younger would-be farmers who want to buy in, since sellers might sell for a lower price to an older farmer who has more cash up front. There are significant barriers to entry for potential new appraisers as well. Read more here.

Black-lung disease is often thought of as something that mostly hits Appalachian coal miners, but New Mexico is seeing a surge in the disease as well. Dr. Akshay Sood, the Miners’ Colfax Medical Center Endowed Chair in Mining-Related Lung Diseases at the University of New Mexico, said "We’re not only a hotspot for black lung; we’re also a hotspot for silicosis, other pneumoconiosis, sarcoidosis, and interstitial lung disease." Read more here.

Children often help out around the family farm, which can lead to injuries. The National Children's Center for Rural and Agricultural Health and Safety has published a handy printable checklist for parents to help keep kids safe on the farm. Find it here.

President, NRA start debate with idea to arm teachers

In the wake of recent school shootings, the idea of allowing teachers to carry firearms has gained steam, thanks largely to President Trump, whose Feb. 22 remarks "closely mimicked a speech" delivered earlier that day by National Rifle Association president Wayne LaPierre, writes James Hohmann of The Washington Post. He did likewise in a speech Friday to the Conservative Political Action Committee conference. In Butler County, Ohio, just north of Cincinnati, Sheriff Richard Jones says he will offer a free concealed-carry gun class to teachers, as well as training on school shootings, Sarah Hager reports for the Cincinnati Enquirer.

The idea has appeal in rural areas, where many teachers and parents are gun owners, but there are many obstacles to turning teachers into guards. Many gun-violence experts, educators and school safety advocates have panned the idea. David Hemenway, a professor of health policy at the Harvard School of Public Health and an expert on the public-health impact of gun violence, said "It's a crazy proposal" and some teacher with firearms training would likely injure an innocent student by accident, Elizabeth Chuck and Corky Siemaszko report for NBC News. Teachers may also injure themselves with an improperly secured firearm. That happened recently when a Utah elementary school teacher, who had a legal permit to carry a firearm in school, accidentally shot herself in the leg while she was in a faculty bathroom. No students were injured.

Another factor not often considered: arming teachers could cause schools' liability insurers to either raise rates sky-high or cancel policies entirely. When Kansas made it legal for teachers to carry firearms in 2013, the liability insurance provider for 90 percent of the state's school districts decreed that any school permitting employees to carry concealed handguns would be denied coverage, Steven Yaccino reports for The New York Times.

Trump calls meeting to get agreement on biofuel policy

"President Donald Trump has called a meeting early next week with key senators and Cabinet officials to discuss potential changes to biofuels policy, which is coming under increasing pressure after a Pennsylvania refiner blamed the regulation for its bankruptcy, according to four sources familiar with the matter," Jarrett Renshaw reports for Reuters.

The question of how much ethanol and other biofuels to include in the nation's fuel supply is a political minefield for Trump, whose Republican allies hail from oil-producing states and corn-producing states. The Environmental Protection Agency had proposed rolling back the biofuels requirement in the Renewable Fuel Standard last year, but faced intense scrutiny from corn-state Republicans. The compromise left the conventional renewable biofuels levels as-is, which displeased both oil states and corn states (the fact that neither side was happy was, as Dino Grandoni of The Washington Post noted, probably a sign that it was a good compromise).

Next week's meeting is an important sign because "in Congress and the administration, we're seeing the most action in years on efforts to end the longstanding stalemate on biofuels policy," Ben Geman reports for Axios.

USDA launches website with resources to help rural communities address opioid crisis

The U.S. Department of Agriculture has launched a website with resources to help rural communities fight the opioid epidemic. The website is one result of the recommendations presented to President Trump last month by the Interagency Task Force on Agriculture and Rural Prosperity, which he had asked to identify legislative, regulatory and policy changes to help rural America. It recommended, among other things, modernizing and improving health-care access.

The website includes links to three programs it says will help fight the opioid crisis: the Community Facilities Loan and Grant Program, which awards loans and grants that can be used to build or fix up important community facilities like hospitals, mental health clinics, and more; the Distance Learning & Telemedicine Grants Program, which awards grants that can be used to buy and install broadband equipment used for telemedicine; and the Rural Health and Safety Education Competitive Grants Program, which awards grants for projects to develop or implement health education programs.

The website also showcases three health care facilities around the country that are employing best practices for helping combat the opioid crisis, as well as links to a slew of relevant federal programs in different departments.

SNAP benefits don't cover food expenses for the poorest in most counties; how does your county stack up?

Urban Institute map; click on the image to enlarge, or see the interactive map here.

An Urban Institute study released this week found that, in 99 percent of U.S. counties, food-stamp benefits are not enough to cover the full cost of an inexpensive meal, even for those who have no net income. In President Trump's proposed 2019 budget, the Supplemental Nutrition Assistance Program would lose $213 billion in funding over the next decade.

"The average cost of a low-income meal, which is defined as part of the study, was $2.36. That cost is 27 percent higher than the maximum SNAP benefit per meal of $1.86," Bill Lucia reports for Route Fifty. "Over the course of a month, benefits were shy of average meal costs by $46.50 per person."

SNAP benefits aren't meant to cover the full cost of meals for a household except those that have no net income, usually because of a lifelong disability. But for those households, which totaled about 37 percent of SNAP recipients in fiscal year 2016, SNAP is the only way to pay for meals.

The study found that the biggest gap between SNAP benefits and food prices were in expensive urban areas like San Francisco and smaller rural counties, some with tourist attractions. The report concludes that SNAP will be more effective if the government can better match up benefits to the local cost of food. The Department of Agriculture's Food and Nutrition Service, which oversees SNAP, told Lucia that the agency will review the study and consider its recommendations.

Start planning for Sunshine Week, March 11-17

This year marks the 13th anniversary of Sunshine Week, a celebration of access to public information and how it impacts your community. Led by the American Society of News Editors, this year's event runs from March 11-17.

With public trust of the news media at an all-time low, Sunshine Week has never been more important. Major publications are working on a special reporting package free for anyone to publish in print or online.

There's a full week of scheduled events you can participate in, starting March 9 with a free online discussion called "Sunshine Week 2018: Fighting for Transparency and Freedom of Information." ASNE has also published an idea bank with examples of "Bright Ideas" to inspire your coverage.

New model shows impact of climate change on rangelands

U.S. rangelands; click the image to enlarge it. (Wikipedia map)

"Rangelands are the dominant land type across the planet and millions of people rely on the natural goods and services and food security the lands provide. A recently released model, G-Range, allows scientists and policymakers to understand how changes in climate will potentially impact rangelands by running global simulations in a single process, rather than repeating hundreds or thousands of processes," Rob Novak reports for Colorado State University's public-relations office.

CSU researcher Rich Conant, who co-authored the study introducing G-Range, said it fills a critical gap in the current toolbox: "There are already a whole host of models for agricultural and forested systems, but grazing lands often fall between those things . . . G-Range is an important step to assess environmental issues in those systems that so many people are dependent on."
 
G-Range is based on an existing model called Century, which was also developed at CSU's Natural Resource Ecology Laboratory. It will soon be available to anyone who wants to use it as an open-source system.

Southern Poverty Law Center updates its Hate Map

SPLC map; click on the image to enlarge it, or click here to view the interactive version.

The Southern Poverty Law Center has updated its Hate Map, an interactive map of hate groups in the United States, along with an analysis of hate group activity in 2017. SPLC identified 954 hate groups in the U.S. targeting one or several of the following populations: immigrants, minorities, Caucasians, the LGBTQ community, Muslims, Jews, women, and more.

In an accompanying story, the SPLC says 2017 "was a year that saw the “alt-right,” the latest incarnation of white supremacy, break through the firewall that for decades kept overt racists largely out of the political and media mainstream." These groups usually rise during Democratic presidencies because of fears about gun control and federal action against them, but the total number of hate groups in the U.S. rose 4 percent from 2016.

White supremacists felt emboldened because Trump appointed Steve Bannon as an adviser, SPLC says. Bannon boasted that his website, Breitbart News, was the platform of the alt-right movement. After the white-supremacist rally in Charlottesville, Va., former Ku Klux Klan leader David Duke said the rally was a "turning point" and promised that white supremacists would "fulfill the promises of Donald Trump" to "take our country back," SPLC writes.

KKK groups fell from 130 to 72, but other white supremacist groups grew, which SPLC writes is a "clear indication that the new generation of white suprem­acists is rejecting the Klan’s hoods and robes for the hipper image of the more loosely organized alt-right movement."

Black nationalist groups grew from 193 in 2016 to 233 in 2017, but lag far behind the more than 600 white supremacist groups and have far less mainstream political influence.

Anti-Muslim groups grew for the third straight year in a row, and the anti-government movement is surging, with 689 active groups in 2017 compared to 623 in 2016. Of those, 273 were armed militias, SPLC says.

Trump's proposed budget cuts environmental programs, including tax-funded program for abandoned mines

President Trump's proposed 2019 budget calls for eliminating 14 environmental programs that focus on conservation, climate change and sustainable practices, some of which would impact rural areas, John Platt reports for Reader Supported News.

One is the Abandoned Mine Land Grants program, which helps clean and redevelop former coal mines. The $105 million budget for this program comes from fees paid by coal operators on each ton mined. Senate Majority Leader Mitch McConnell of Kentucky will likely defend the AML, so it's unlikely to be eliminated.

Another program slated for removal is the U.S. Department of Agriculture's Rural Business-Cooperative Service, which provides financial, technical and educational support for rural entrepreneurs to start and grow businesses in the agriculture and outdoor recreation industries, especially those that employ sustainable practices or use renewable energy. The service, which has a $103 million budget, also seeks to increase access to rural broadband.

The Low Income Home Energy Assistance Program is also on the chopping block again. Trump tried to kill the popular program last year because he said it was rife with fraud and abuse, but encountered resistance from Congress. In October he released nearly $3 billion, or 90 percent of its funding. The program provides assistance for heating bills for poor families via grants to utilities, and has a budget of $3.39 billion.

The Chemical Safety Board would be eliminated, to the tune of $11 million. It investigates major industrial accidents, such as the 2014 chemical spill that tainted drinking water in West Virginia, or the explosion at a natural gas well in Oklahoma this January.

Feb. 26 is extended deadline for entries in Sigma Delta Chi Awards, which usually have some non-metropolitan winners

The deadline for entries in the Sigma Delta Chi Awards, which have categories won in the past by journalists in non-metropolitan news media, has been extended to 11:59 p.m. Monday, Feb. 26.

In the contest, newspapers have a division for those with circulations under 50,000; last year the public-service prize was captured by Jonathan Austin, then of the Virgin Islands Daily News, for an expose' on official travel, and Sarah Butrymowicz and Jackie Mader of The Hechinger Report, an education news site, won for investigative reporting in the division for a series on child care in Mississippi.

Several rural-oriented reports won Sigma Delta Chi awards in broadcasting, which has a division for smaller markets. Alabama Public Radio won for a series on justice and prison reform, and North Country Public Radio in upstate New York won for public service in radio journalism for a series on a murder and its investigation.

The awards are sponsored by the Society of Professional Journalists and its Sigma Delta Chi Foundation. For information, click here.

Billy Graham: Born a rural Southerner, he was leavened by the suburban Midwest, and he left a rural legacy

Billy Graham in 2006
(C. Ommanney, Getty Images)

The best obituaries tell readers how a life was lived and why it mattered. For Billy Graham, who died this morning at 99, in his home on a North Carolina mountain, two good ones are from The Charlotte Observer, his hometown paper, and the Star Tribune in Minneapolis, where the Billy Graham Evangelistic Association was based for more than 50 years, until 2004.

"Growing up on a dairy farm" at what was then the south edge of Charlotte, "Graham’s first idea of heaven was playing baseball and courting girls," the Observer's Tim Funk writes, with help from former religion editor Ken Garfield. "But after answering the altar call at a revival during the Depression, he went on to become a pastor to U.S. presidents and a globe-trotting preacher whose crusades altered lives."

The StarTrib cobbled together an obit written largely by former staff writer Martha Sawyer Allen with updates from current staffers and The Associated Press. It says Graham "took that peculiarly historic American theological concept — decision theology, honed by fire-breathing circuit-riding preachers — and made it palatable in the middle-class, suburban America of the 1950s."

Funk writes, "Evangelical Christians who had been ridiculed since the Scopes Monkey Trial of the 1920s for believing in the literal truth of the Scriptures suddenly saw Graham – one of their own – reading the Bible in the White House with President Eisenhower." Funk notes that newspapers played a role: William Randolph Hearst, "who liked Graham’s strident anti-communism and religious zeal," told his publishers: “Puff Graham.”

From the StarTrib: "Graham walked that narrowest of American cultural lines, right down the middle between religious liberals and conservatives. He brought Christian evangelism into the mainstream of American political and social consciousness, yet was scolded by many conservatives for being too liberal." But he "refused to speak to racially segregated crowds," Funk notes, and that began in 1953, before the civil-rights movement really began.

Graham's portfolio included journalism; he was a founder of Christianity Today, a conservative magazine "that enjoys praise from liberals," the StarTrib notes. "It was started as a counter to the Christian Century, which had been started in 1900 by America’s Protestant mainstream theologians." The magazine released a special issue on Graham, with an article by Duke Divinity School's Lauren Winner on his rural youth.

Graham also left a rural legacy, at Wheaton College in suburban Chicago, where he earned an anthropology degree in 1943 and then pastored a suburban church. The school has a Billy Graham Center with a Rural Matters Institute, which says "There is an emerging movement to plant churches in rural areas. As more people and resources move to urban settings, the rural heartland has gradually become under-resourced, overlooked, and often forgotten. . . . Rural church-planting strategies are markedly different from strategies in any other context. RMI was created to provide support, learning, and community for those working in non-urban contexts in North America."

"Graham would most likely have never become the leading spokesman for postwar American evangelicalism had he not passed through Wheaton," which broadened his world view, Steven P. Miller writes in the book Billy Graham and the Rise of the Republican South. The Star Trib says, "He never changed his message, but he often tempered it to his audience. In the Upper Midwest, he talked of salvation but also of grace."

Key rural Virginia legislator voices support for Medicaid expansion; other Republicans, and other states, may follow

Kilgore

Prominent Virginia legislator Terry Kilgore, chairman of the House Commerce and Labor Committee, said last week that he supports Medicaid expansion because it will help the constituents in his struggling district in the state's far southwest corner. The Republican's change of mind could make it easier for other rural conservatives to follow suit,  Laura Vozzella reports for The Washington Post.

Kilgore's announcement comes only months after Democrats, many running on a health-care platform, almost obliterated Republicans' majority in the House. That may have helped convince Republicans to swing on the issue, but with a conservative twist: work requirements for able-bodied Medicaid recipients. Republicans in at least 10 states have supported Medicaid expansion with work requirements, and Kentucky and Indiana already received the greenlight from the White House. The Columbia Missourian reports that a bill in that state's legislature would impose work rules.

Kilgore said he believes that Republicans' failure to repeal the Patient Protection and Affordable Care Act means it's not going away any time soon. "They’ve kept Medicaid expansion in the [federal] budget," he told Vozzella. "So it’s time for Virginia to act. But we’ve got to act in the Virginia way."

Food-and-agriculture news outlet kicks off year-long series on rural America with story about no-till farming

Soybeans sprout in a cover crop of rye. (USDA photo)

Civil Eats is kicking off a year-long series, the Rural Environment and Agriculture Project, about how our nation's food is raised and the rural Americans who do it.

Rural America, Civil Eats says, is undergoing big changes; small farmers are struggling to stay on their land, more people are moving to the city, jobs are hard to come by, and businesses and hospitals are closing: And the cultural divide is growing too. "Our hope is that by reporting on these tensions in modern rural America and showcasing solutions where agriculture can help to revitalize communities, we will expand our readers’ awareness of the interdependence of American agriculture and food systems. Of course, we realize that many of these stories will raise challenges that don’t have immediate solutions. And we welcome you to join us on this journey and share your thoughts and ideas along the way."

The first story in the series is about the longstanding move toward no-till farming, in which farmers plant seeds without breaking up the soil first. "According to the USDA’s latest data, by 2010-11, no-till farming had grown to the point where roughly 40 percent of the corn, soybean, wheat, and cotton grown per year in the U.S. used either no-till or a half-step technique called strip-tilling. That works out to around 89 million acres per year," Twilight Greenaway reports. The technique has been around for more than 50 years, since herbicides and precision planting tools made it feasible. Farmers traditionally embraced it as a way of improving yields or cutting costs, but now some are touting it as a way to improve the soil, retain water and organic matter, and sequester carbon. Some see it as a way to cut down on synthetic herbicides and fertilizers.

At the recent No Till On the Plains conference, a fourth-generation farmer from Arkansas who has been using the no-till method for several years said, "I don’t need seed treatments for my cotton anymore. I’ve taken the insecticide off my soybeans. I’m working toward getting rid of fungicide … I’m hoping that eventually my soil will be healthy enough that I can get rid of all of it all together."

Repeal of ACA's individual mandate means that hospitals could be stuck with more bad debt for treating overdoses

Drug overdoses could take a bigger bite out of hospitals' bottom lines soon, thanks to the repeal of the Patient Protection and Affordable Care Act's individual mandate. Hospitals have been mostly insulated from the cost of treating overdoses because almost everyone had insurance. Now that the mandate has been repealed, patients without insurance will likely need to be treated for overdoses and won't be able to pay their bills.

The rising cost of treating overdoses, and their increasing frequency, will likely exacerbate hospitals' financial woes, especially in rural areas where hospitals can barely afford to stay open. According to a 2017 study, "The average cost to treat overdose patients admitted to hospital intensive care units climbed from $58,517 in 2009 to $92,408 in 2015—a 58 percent hike," Kristen Schorsch reports for Modern Healthcare. And in Illinois alone, the steep rise in ER visits was mostly because of heroin.

Addicts can be expensive patients for hospitals in other ways too. Opioids can trigger other health problems that require medical attention, such as accidents, or asthma flareups caused by heroin, which can reduce the number of breaths a person takes per minute. And an Illinois hospital reports that nearly 40 percent of the patients admitted for opioid-related conditions were readmitted soon afterward. "That's a problem for hospitals, too, because the federal government financially penalizes them if patients come back too quickly after they're discharged," Schorsch reports.

Some rural hospitals may unintentionally contribute to addiction rates: a doctor may write a patient a prescription for a larger number of painkillers if she knows the patient lives far away and can't come back frequently to refill prescriptions. And rural residents tend to work in factories or on farms, where painful injuries are more likely.

Infant death rates higher in rural U.S., but not for all causes

Infants born in rural America have a higher mortality rate than their urban and suburban counterparts, especially African-Americans, but a new study from the National Center for Health Statistics shows that urban infants are more likely to die from certain causes than rural infants.

Rates for the five leading causes of infant death, by urbanization level
(Natl. Center for Health Statistics chart; click on it for a larger version)

The five leading causes of infant death from 2005 to 2015 are congenital malformations, low birth weight, Sudden Infant Death Syndrome, maternal complications and unintentional injuries. By studying data from the National Vital Statistics System from 2013 to 2015, researchers discovered that infant mortality rates for congenital malformations, SIDS and unintentional injuries were higher in rural areas, but rates for low birth weight and maternal complications were higher in urban areas.

"While the purpose of the report was simply to document the numbers, study authors Danielle Ely and Donna Hoyert theorized that some of the gap 'could be related to differences in conditions during pregnancy.' Past research has shown that poverty, smoking and other maternal health behaviors during pregnancy and less access to care all can impact infant mortality," Ariana Eunjung Cha reports for The Washington Post.

What's your favorite song tied to the news media? Ever heard one about a rural newspaper? Here's one.

UPDATE, Feb. 26: Check out "Journalism Blues" by the Texas Center for Community Journalism.

By Al Cross
Director, Institute for Rural Journalism and Community Issues

Asked to name their favorite song tied to newspapers or broadcasting, subscribers to "Connecting," the daily newsletter for Associated Press retirees and friends, had some good offerings, from the famous (the Beatles' "A Day in the Life") to the little known but neat ("Newspapermen Meet Such Interesting People," which Pete Seeger wrote in the 1940s. Another little-known song is my favorite, and my story about it begins at the Great Wall of China. Or, precisely, on the freeway back to Beijing.

Our driver was playing CDs of American country music, and on came a 2011 song by Charley Pride, "Hickory Hollow Times and County News." I was flabbergasted. After 50 years in newspapers and associated trades, I had finally heard a song about a rural newspaper like those I started on and now serve. And I had to go to the Great Wall to do it. Pride, 78, wrote the song. He is from Quitman County in northwest Mississippi, home of the Quitman County Democrat. The lyrics are below; here's a link to them and the audio; however, be advised that the lyrics on that page contain errors; whoever transcribed them from the recording didn't quite appreciate Charley's accent. I have no problem with that; I grew up playing his records as a young disc jockey on WANY in Albany, Ky.

Charley Pride (from latest album cover)

"Hickory Hollow Times And County News"
I was sitting on the sofa in my Music Row apartment
Opening up a letter from my best friend, Silas Blue.
He included last week's issue of our tiny hometown paper
With a note that said he finally got his picture in the news.
So I started on the front page with the mayor and the fire chief
Driving big old tractors in the Founders Day parade,
And a story about the Jaycees' annual bake sale at the fire home
Raising money for the orphans, selling cookie and lemonade.
Got the farm report, the high school sports
Fishing news and bowling scores
The weather and the ladies' gossip too
Who's left town and who's come home
Who's been born and who's passed on
Who's divorced and who's married who
In the Hickory Hollow Times and County News
It's reported Henry Johnson was seen courting the widow Jackson
Outside in the moonlight on the Moose Lodge patio.
Sue Walker said she saw him holding hands in church on Sunday;
Holding hands in church reminds me of my old sweetheart, Betty Jo.
And right there on the next page, grinning like a possum,
My old buddy, Silas, in his tux and cowboy boots;
And standing close beside him in a bridal gown and diamonds,
Betty Jo, my high school sweetheart, the new Mrs. Blue!
(refrain)
And you know it makes me happy to see 'em happy too
In the Hickory Hollow Times and County News
In the Hickory Hollow Times and County News.

Smaller banks near big win on Dodd-Frank rollback

A bipartisan bill to make changes to the 2010 Dodd-Frank regulatory reform law could bring relief to small community banks. The law tightened rules on lending institutions in an effort to prevent another Great Recession.

Supporters of the fix-it bill "argue that smaller financial institutions shouldn't have to face the same set of strict rules as behemoth Wall Street banks that could endanger the whole financial system if they go under. Top bank regulators all agree fixes should be made for community banks," Donna Borak reports for CNNMoney.

"Main Street businesses and lenders tell me that they need some regulatory relief if we want jobs in rural America," Democratic Sen. Jon Tester of Montana said during a hearing on the bill in November. "These folks are not wearing slick suits in downtown New York or Boston. They are farmers, they are small business owners, they are first-time home buyers."

The fix-it bill would raise the definition of a "too big to fail" bank from one that has $50 billion in assets to $250 billion, meaning more than two dozen midsize banks would be exempt from Dodd-Frank regulations. These banks would no longer have to hold as much capital to cover balance-sheet losses, wouldn't have to have plans in place to be safely dismantled if they fail, and would only have to take the Federal Reserve's bank health test once in a while instead of yearly.

The bill was drafted by Republican Sen. Mike Crapo of Idaho, the chairman of the Senate Banking Committee, and is backed by 12 Democrats and 12 Republicans. It's a narrowly focused, moderate compromise that Crapo hammered out after years of bipartisan negotiations. The bill could be heard on the Senate floor as early as next week. The House would like to do more, but is expected to go along because the bill goes about as far as one  can go and get the 60 votes needed for passage in the Senate.

Study: Rural areas more likely to have independent grocery stores, which were hit harder by the Great Recession

Number of independent grocery stores per capita in 2015 (USDA charts; click on either image to enlarge it.)

A new report by the U.S. Department of Agriculture's Economic Research Service says rural areas are more likely to have independent grocery stores than urban areas, and that those rural independent grocers were harder hit by the Great Recession than their urban counterparts. "At the onset of the recession, the number of independent grocery stores stagnated, causing the share of these grocery stores to decline through 2015, the report's abstract says.

"Independent Grocery Stores in the Changing Landscape of the U.S. Food Retail Industry" studied the performance of independent grocers from 2005 to 2015. Independent grocers are defined as those that own and operate four or fewer retail food establishments, so they tend to be smaller in size and sales volume than corporate-owned or chain supermarkets, Bryce Oates reports for The Daily Yonder.

Some findings from the study:

• Rural independent grocers are most prominent in Western, New England, and Great Plains states.
• Independent grocers altogether employ the equivalent of 330,000 full-time workers.
• In rural counties that are not adjacent to a metropolitan county, independent grocers tend outnumber chain stores, but are small; independent-grocer sales only account for 18 percent of all food retail sales in these counties.
• In rural counties adjacent to metropolitan counties, independent grocers account for 16 percent of retail food sales, and only 10 percent in metropolitan counties.
• The counties with the most independent grocers per person tend to be poorer and have more African-American, Hispanic and Latino populations.
• Grocers with a higher percentage of sales from USDA's Supplemental Nutrition Assistance Program (food stamp) redemptions are more likely to be independent, especially in rural areas.
• The Great Recession hurt rural independent grocers more than metropolitan ones, especially in the rural West. Rural independent grocers in Great Plains states were hurt the least.

Wildfires inspire idea: charge rural folks more for electricity

"The cost of preventing power-line wildfires could rise so high that California’s top utility regulator recently suggested a new way to pay for it — charge residents of high-risk areas more money for electricity," David Baker reports for the San Francisco Chronicle. "Michael Picker, president of the California Public Utilities Commission, floated the idea during a Jan. 31 meeting on fire safety for utility companies. With more Californians moving into rural areas prone to fires, he questioned the fairness of forcing all utility customers to pay the costs of preventing rural wildfires sparked by utility lines."

Though state investigators haven't figured out what caused last year's fires, power lines tossed about in harsh winds are a likely culprit. Such fires have repeatedly ravaged California, but it's expensive to preventing them with measures like tree trimming or burying lines underground. Picker said it's unfair to charge everyone for upgrading and protecting the grid in areas that only a few residents would benefit from. Read more here.

Ky. attorney pledges $25,000 for school metal detectors, inspires others; schools in state and others get threats

Shane Romines

In the wake of school shootings in Parkland, Fla., and Benton, Ky., an attorney from southeastern Kentucky is inspiring Kentuckians to donate money to put metal detectors and other protective equipment in the state's schools.

"Shane Romines initially offered — via a Friday Facebook post — $25,000 from his Copeland & Romines Law Office in Corbin to buy metal detectors and other equipment for each of the five schools in the Corbin Independent Schools district. He encouraged others to donate in that district or others," Valarie Honeycutt Spears reports for the Lexington Herald-Leader in Kentucky. "As of Monday, about $75,000 had been pledged so far for metal detectors; other equipment, such as Tasers or guns for resource officers or school staff; and training in several districts — if school leaders agree, Romines said. Knox County was the first to accept donations for detectors it plans to install."

Romines, who has two children attending Corbin Independent Schools, said he's willing to fund firearms for school staff to carry firearms if schools are interested. Under current state and federal law in Kentucky, school board members can contract with a teacher or other school staff member to allow them to carry a firearm on school grounds.

Some school districts haven't decided whether they'll take the metal detectors. The superintendent of Corbin Independent Schools said the school board is weight whether to accept the donations. "At least one district and school board — for the 2nd largest district in the state — balked at adding detectors," Honeycutt Spears reports. "Fayette County Public Schools officials studied the possibility of installing metal detectors after weapons were found at schools. But they said in October that it wasn’t feasible or desirable to have hundreds of students each day passing through metal detectors."

The question of metal detectors is particularly salient after a rash of copycat threats made to schools in the aftermath of the recent shootings, in Kentucky and other states such as Indiana, Wisconsin, Florida, and New York.

Read more here: http://www.kentucky.com/news/local/education/article200893064.html#emlnl=Afternoon_Newsletter#storylink=cpy

Read more here: http://www.kentucky.com/news/local/education/article200893064.html#emlnl=Afternoon_Newsletter#storylink=cpy

Monsanto loses bid to stop Arkansas dicamba ban

"An Arkansas judge on Friday dismissed a Monsanto Co. lawsuit aiming to stop Arkansas from blocking the use of a controversial farm chemical the company makes, dealing a blow to its attempts to increase sales of genetically engineered seeds," Tom Polansek reports for Reuters.

University of Missouri map; click on the image to enlarge it.

After receiving nearly 1,000 complaints about dicamba damage to crops, on July 7 the Arkansas Legislative Council approved the state Plant Board's proposal to ban applications of dicamba from April 16 through Oct. 31. Dicamba tends to vaporize after being sprayed on crops and drifts into other fields; the herbicide damaged more than 3.6 million acres of soybeans in the U.S. in 2017.

Monsanto's suit alleges that the ban hurt the company's ability to sell dicamba-tolerant seed in Arkansas and caused "irreparable harm" to the company, since the ban did not extend to products by other companies such as DuPont Inc. or BASF. But Pulaski County Circuit Judge Chris Piazza ruled against Monsanto, citing a recent state Supreme Court decision that the state cannot be made a defendant in court.

Meanwhile, Monsanto is on the defensive from several dicamba-related lawsuits: one alleging that the company essentially forced farmers to buy its dicamba-resistant seeds, and several that allege crop damage because of the chamical.

Congressional stalemate over guns and immigration, showing rural-urban divide, isn't going away soon

Gun laws and immigration reform are contentious issues in Congress, and they're not going away any time soon. "Both issues illuminate the central divide between the parties as their political coalitions have sorted and separated along lines of race, generation, education, and geography," Ron Brownstein writes for The Atlantic. "On both matters, Republicans are championing primarily non-urban and predominantly white constituencies that want fewer immigrants and more access to guns. Democrats reflect a mirror-image consensus: Their voters coming from diverse urban areas usually support more immigrants and fewer guns."

Despite the differences in party platforms, most Americans seem to have found common ground: a Pew Research Center poll from last summer found that 84 percent of adults support background checks for all gun purchases, and 68 percent said they support a ban on assault weapons. And depending on the poll, up to 85 percent of Americans say they support legal status for the so-called Dreamers, who were brought to the country illegally as children. Three-fifths of Americans in an ABC/Washington Post poll last fall said they opposed building a border wall with Mexico, but two-thirds said they would accept a legislative deal that coupled protection for Dreamers with increased border security spending.

The key to this disconnect between popular opinion and party action lies in the "intertwined cultural, demographic, and economic divide now separating urban and non-urban America—and how closely the nation’s partisan split follows the contours of that larger separation," Brownstein reports. Republicans represent what he calls "'a coalition of restoration' centered on the older, blue-collar, evangelical, and non-urban whites most uneasy about the tectonic cultural and economic forces reshaping American life. That means that compared with the nation overall, most Republicans are representing areas with more guns and fewer immigrants."

Democrats represent a nearly opposite constituency Brownstein calls a "'coalition of transformation': minorities, Millennials, and college-educated and secular white voters, especially women" with only one-fifth who say they own guns. Brownstein advises readers to get used to the feuding between the two parties, because the socio-political distance between them seems likely to grow only wider.

Twice-weekly newspaper tackles homelessness in northwestern North Carolina with three-part series

Here's a worthy read: a three-part series by Kayla Lasure of the twice-weekly Watauga Democrat in the northwest corner of North Carolina, delving homelessness in a seven-county region that has the second-highest rate of homelessness in the state: Alleghany, Ashe, Avery, Mitchell, Watauga, Wilkes and Yancey counties. A 2017 count documented 466 homeless in the region, about 70 percent of them unsheltered. Another 69 who were placed in permanent and rapid rehousing weren't part of the homeless count, Lasure reports in her first story.

Several community members told Laysure they want to erase the stigma of being homeless; Todd Carter, the director of the area's homeless shelter, the Hospitality House, told her that many of the residents are judged for listing the shelter as their address. But many don't realize that 63 percent of shelter residents "recently went through some form of trauma. This wasn’t counting any trauma the person had experienced in the past or in childhood," Lasure reports.

Hospitality House Executive Director Tina Krause told her: "We're not just a homeless shelter; we're a trauma center providing critical care." Krause said that most weeks, at least one client acts on a suicidal thought, and that there were six suicide attempts on site in one week last winter, and one client died off site.

The McKinneys with their newborn son Liam.
(Watauga Democrat photo by Kayla Lasure)

In her second story, Lasure illustrates the lack of resources for the homeless by profiling Justin and
Amanda McKinney, who are rebuilding their lives after years of homelessness, jail and drug abuse. After Amanda  was released, she had a hard time affording a place to live because no one would hire her with her criminal history. After living at the Hospitality House for three months and sending out 42 job applications, she finally landed a job, but didn't tell her employer where she lived until she had proved her work ethic.

Justin's story began similarly: While deployed in the Air Force, he broke his back in an explosion and needed surgery. He became addicted to the opioids he was prescribed, and said the withdrawal was so painful that he began using methamphetamines to cope. He also had difficulty finding work or housing after his release, which led to Hospitality House.

The couple told Lasure they had little in the way of support from family or friends because of their addictions. "When you’re in an addiction, you push a lot of people away, and people distance themselves from you," Justin told Lasure. "You do a lot of things during an addiction you wouldn’t normally do. You crush your own support system."

In her third story of the series, Lasure profiles a Watauga County sheriff's sergeant's efforts to change the way other law-enforcement officials view the homeless community. "Sgt. Casey Miller is a member of the Sheriff’s Office Problem-Oriented Policing Squad . . . a call-based group that can concentrate on community issues that regular patrol deputies wouldn’t have the time to focus on. These issues consist of places with common reports of speeding or drug activity," Lasure reports.

Sheriff Len Hagaman told Miller that neighbors of Hospitality House were complaining that shelter residents were trespassing on their property, loitering, dealing drugs, and leaving trash. Miller met with area leaders and listened to their concerns, then investigated. It turned out that Hospitality House residents weren't the culprits: about 15 people who lived in the community were preying on the residents, trying to sell them drugs, get money from them or steal their belongings. The 15 were ordered to stay away; three were later caught and charged with trespassing.

Miller told Lasure that the issue caused him to think differently about the homeless, especially when he learned that 96 percent of Hospitality House's clients reported at least one instance of trauma in the past year. He says he now checks up on residents and tries to get to know them. "What people don’t understand they tend to try to avoid," Miller told Lasure. Officers "don’t think bad of homeless people; they can’t wrap their head around why they can’t just go out and get a job and a house. It’s not always that simple."

Community Newspaper Holdings Inc., with many rural papers, kicks off 3-year project to take 'Pulse of the Voters'

Big news outlets were largely blindsided by the 2016 presidential election, partly because their mostly urban journalists sought commentary from the same pundits we've all heard from for years and didn't spend enough time in rural America. They missed the rising disenchantment of small-town and rural voters that helped propel Donald Trump into the Oval Office. That's why Community Newspaper Holdings Inc. is launching a three-year project called "The Pulse of the Voters." Most CNHI papers are in smaller cities, many outside metropolitan areas, which puts them in a good posture to find out what non-metro voters think about the issues. 

Starting in March, about 100 participating papers will sit down with voters every few months and find out what they think "to a level that can't be covered in a poll or survey," reports CHNI's Herald-Banner, a daily newspaper in Greenville, Texas.

Some questions they'll ask include: "What are the issues that concern you the most? Jobs . . . education . . . health care . . . affordable housing . . . national security . . . immigration . . . race relations. How has life changed for you – or not – since President Trump entered the White House? We want to listen to your voice on whether you approve or disprove of Trump’s job performance, of Congress and the national political divide between Republicans and Democrats. Why do you feel this way?" reports The Morehead News, a CNHI thrice-weekly in Kentucky. 

"No matter your political ideology, gender, race, religion or economic status, no matter whether you live in the city or in the country, we would like to listen to your concerns and help amplify your voice as candidates ask for your trust to shape policies locally," Dave Bohrer writes for The Meridian Star, a CNHI daily in Mississippi.

CNHI papers will share notes with each other and produce regional and national stories. The project is scheduled to run through 2020. CHNI was recently acquired by Raycom Media, a broadcaster.

Anthem makes exceptions, including distance to care, of policy denying claims for ER visits it deems non-emergency

Responding to complaints from legislators and health-care providers, insurer Anthem has added several exceptions to its recently established policy of not paying for emergency-room visits if it determines there was no emergency. The policy first took effect in Kentucky, Missouri and Georgia; "Ohio, Indiana and New Hampshire were added to the program in January, after the new exceptions were already in place," Leslie Small reports for FierceHealthcare.

The exceptions include patients who:

• are sent to the ER by another provider, including an ambulance
• visit an ER between 8 p.m. Saturday and 8 a.m. Monday, or on a major holiday
• are younger than 15
• live more than 15 miles from an urgent care center
• are traveling out of state
• receive any kind of surgery
• get intravenous fluids or IV medications, or an MRI or CT scan
• have an ER visit associated with an outpatient or inpatient admission

"Anthem said the changes went into effect Jan. 1," Shelby Livingston reports for Modern Healthcare. "It will apply the exceptions to any previously denied claims."

The company said in a prepared statement, “Anthem stands by our belief that emergency rooms are an expensive place to receive routine care. The costs of treating non-emergency ailments in the ER has an impact on the cost of healthcare for consumers, employers and the health care system as a whole.”

The changes did not satisfy the American College of Emergency Physicians. "This is still a fundamentally flawed policy,” Laura Wooster, the group's associate executive director of public affairs for the American College of Emergency Physicians, told Small. “Making fixes around the edges doesn’t end this dangerous policy that’s really going to scare patients away from going to the ER or even considering going to the ER.”

Small reports, "Anthem’s program was meant to deter members from using the emergency room for illnesses or injuries that aren’t life-threatening. But critics say patients shouldn’t be forced to self-diagnose, warning that the new policies will encourage people to avoid seeking care for serious medical conditions out of fear that their claim will be denied."

Shannon Muchmore reports for HealthcareDive, "Anthem has said its program denies a small percentage of claims, but the change in policy signals the payer may be worried about the backlash, including from patients who have gone public with denied claims."