U.S. life expectancy fell by a year during first half of 2020

"Life expectancy in the United States fell by a full year during the first half of 2020, a staggering decline that reflects the toll of the Covid-19 pandemic as well as a rise in deaths from drug overdoses, heart attacks and diseases that accompanied the outbreak, according to government data released Thursday," Lenny Bernstein reports for The Washington Post. The provisional data was released by the Centers for Disease Control and Prevention's National Center for Health Statistics.

Though white Americans overall fared better than Black or Hispanic Americans, rural areas (which have a higher share of white residents) tended to have a higher death rate. "Overall, the NCHS data shows, life expectancy at birth for the entire U.S. population in the first half of 2020 was 77.8 years," Bernstein reports. "For Black Americans, it was 72, for Latinos 79.9, and for whites 78. As has long been the case, women could expect to live longer — 80.5 years, compared with 75.1 for men. The NCHS did not include figures for Asian Americans or other racial groups."

While the data wasn't unexpected, the size of the reduction in life expectancy was more than expected. Elizabeth Arias, lead author of the paper, told the Post that the drop was a "big departure. We haven’t seen anything this large since the first half of the 20th century, when infectious disease was much more common." Since the data comes from the first six months of 2020, when the virus was hitting urban areas harder, Arias said data from the rest of 2020 will likely show a greater proportion of white deaths.

Health-care workers promote positive messaging about vaccines through social-media campaign

A new social-media campaign aims to fight misinformation and promote positive messaging about the coronavirus vaccine through a network of more than 25,000 health-care workers nationwide. Founded by Atul Nakhasi, a 33-year-old doctor in Los Angeles, #ThisIsOurShot hopes to influence the public conversation through "collective impact," Allyson Chiu reports for The Washington Post.

Like many other health-care workers, Nakhasi spends a considerable amount of time on social media fighting misinformation. "You wrap up your day, and you’re hoping the fight ends," Nakhasi told Chiu. "You’re fighting for lives that whole day … keeping people here to the next morning. And then you get home and you feel like the fight never stopped. It just changed turf. The landscape just changed."

Jennifer Bacani McKenney, a county health officer and family medicine doctor in Fredonia, Kansas (pop. 2,500), "responds to a daily flood of pandemic-related texts and social media messages while running her clinic and taking emergency room shifts," Chiu reports.

McKenney told Chiu that the misinformation is "one of our worst enemies" and said it was "almost worse than the virus itself . . . We have strategies to deal with the virus. There’s not a great strategy to deal with the random memes, or the stuff that’s presented as data that’s not actual data, or the bogus YouTube videos or whatever that look like they’re scientific and there’s no basis. It’s amazing the people that believe it and share it, and there’s not a strategy against that."

Haaland poised to become first Native American cabinet official, at Interior; Vilsack USDA nomination also proceeding

Rep. Deb Haaland, D-N.M., during today's hearing.
(Photo by Jim Watson, The Associated Press)

U.S. Rep. Debra Haaland, D-N.M, is poised to become the first Native American secretary in a presidential cabinet with the Senate Committee on Energy and Natural Resources hearing her nomination as interior secretary today.

Meanwhile, former Iowa governor Tom Vilsack is expected to be easily confirmed for his second stint as agriculture secretary today too, the Des Moines Register reports.

"The Interior Department manages one-fifth of the land in the U.S., including national parks, wildlife refuges and tribal lands held in trust," Nathan Rott notes for NPR. "Those lands generate billions of dollars of revenue not only in energy production but from recreation. They are also the source of roughly one-quarter of the country's total greenhouse-gas emissions."  

Haaland is a controversial pick, with many conservatives concerned about her views on energy development. During the hearing, "numerous Republican Senators focused their questioning on Biden's oil and gas leasing 'ban' on federal lands, citing projected economic and job losses from the executive action," Rott reports. "Haaland repeatedly pointed out that the president has not banned new oil and gas leasing, but paused it while his administration reviews the federal leasing program."

Her nomination is historic on several levels. "Haaland, an enrolled member of the Pueblo of Laguna, was one of the first Native American women elected to Congress, along with U.S. Rep. Sharice Davids of Kansas. And if confirmed, she will be the first Native American to head the agency that administers the nation’s trust responsibility to American Indians and Alaska Natives," Traci Morris writes for The Conversation. Morris, a member of the Chickasaw Nation, is the executive director of Arizona State University's American Indian Policy Institute.

Many Native Americans say they're excited to see Haaland's nomination, and said she has worked hard to represent their interests, The Associated Press reports. The story includes interviews with Native Americans reflecting on how she has helped them or how they believe she will help them.

EPA sides with corn and ethanol producers on small-refinery exemptions to the Renewable Fuel Standard

The Environmental Protection Agency "is changing course on small-refinery exemptions to the Renewable Fuel Standard, announcing Monday it agrees with a Court of Appeals decision last year that the agency had mismanaged the program under the Trump administration," Todd Neeley reports for DTN/The Progressive Farmer. The marked increase in such exemptions over the past four years hurt rural America and the biofuels industry, EPA said. 

"The 10th Circuit Court of Appeals, based in Denver, had ruled in January 2020 that EPA mishandled the exemptions program when it came to three small-refinery exemptions in particular. The Trump administration delayed action on the Renewable Fuel Standard to reflect the court's decision," Neeley reports. The Biden administration said it agrees with the ruling, which said the exemptions were meant to be temporary and that the agency can only extend pre-existing exemptions.

With the appeals court ruling "before the U.S. Supreme Court this spring, the EPA statement Monday means the Biden administration will not be defending the Trump administration's stance on the small-refinery exemptions to the RFS," Neeley reports.

The announcement was welcomed by corn growers and the ethanol industry, as well as the states where they have a large footprint, Neeley reports: "Republican Iowa Gov. Kim Reynolds said although the Biden administration's decision is welcomed, she wants to see the Supreme Court uphold the RFS."

Climate change, and deforestation from surface mining or wildfires, put mountainous areas at risk of expensive floods

Counties ranked in ranges of percentages of property at risk for flood damage
First Street Foundation map; click the image to enlarge it or click here for the interactive version.

Climate change and deforestation are putting hundreds of small communities at risk of expensive flood damage they can ill afford, according to new data from the First Street Foundation, a nonprofit organization that researches flood risk and housing. Climate change has driven rising sea levels and heavier rainstorms. Areas at the highest risk of flooding are on the coasts and in mountainous areas where surface mining or wildfires have removed the trees that can mitigate flooding.

"More than 4 million houses and small apartment buildings across the contiguous U.S. have substantial risk of expensive flood damage," Rebecca Hersher, Huo Jingnan and Sophia Schmidt report for NPR. "The cost of flood damage to homes nationwide will increase by more than 50% in the next 30 years, the First Street Foundation estimates."

The poor, who often have inadequate or no flood insurance, are the most vulnerable to flood damage, "and the federal government is ill-prepared to address the problem through the current federal flood insurance program," NPR reports. Central Appalachia, which shows significant risk of flooding on the First Street map above, has particularly high poverty rates.

The Federal Emergency Management Agency warns that the foundation's analysis is only an estimate and notes that First Street did not conduct their analysis about financial impacts of flooding with input about the agency's new flood insurance pricing plan. "For homeowners who are currently underpaying for flood insurance, FEMA says it plans to raise rates by up to 18 percent each year until the price is accurate, according to a January report by the Congressional Research Service. The agency will begin rolling out the new pricing in October," NPR reports. "As the cost of insurance goes up, many people who need flood insurance will likely be unable to afford it, leaving them to face lasting damage."

What's in the House relief-and-stimulus bill

The House Budget Committee began marking up the $1.9 trillion economic aid bill today at 1 p.m. Markups are expected to be minor, so here's some of what's in the bill as of now:

• $4 billion for the Agriculture Department to buy and distribute agricultural products to those in need, to extend grants and loans to smaller producers, to improve agricultural supply-chain resiliency, and help pay for necessary expenses related to crop losses (including weather-related losses).
• $100 million from the overall USDA funding to reduce the amount of overtime inspection costs borne by small and very small federally inspected meat, poultry or egg processors. 
• $500 million from the overall USDA funding for need-based grants to help rural health-care providers with pandemic-related expenses.
• $1,400 in direct aid for people earning up to $75,000 per year, with declining amounts on a sliding scale to a hard cut-off at $100,000.
• An increase of the child tax credit from the current $2,000 per child to $3,000 for each child 6 to 17 and $3,600 for those under age 6. The credit would have the same income thresholds as the stimulus checks, and it would become fully refundable so more low-income parents could take advantage, Payments would be distributed monthly rather than as a lump sum once a year.
• Continuation of tax credits through Oct. 1 to employers who choose to offer paid family leave and sick leave. The mandatory leave approved in a previous relief package would not be reinstated.
• A 15% increase in Supplemental Nutrition Assistance Program benefits (formerly food stamps) would continue through September, instead of expiring at the end of June.
• $880 million for the Women, Infants and Children nutrition program.
• States would be allowed to continue the Pandemic-EBT program, which provides families whose children's schools are closed with funding to replace free- and reduced-price meals that the kids would have received, through the summer.
• $195.3 billion to state governments, including the District of Columbia. 
• $130.2 billion to local governments, to be divided evenly among cities and counties. 
• $20 billion to tribal governments and $4.5 billion to territorial governments.
• $19.1 billion to state and local governments to help low-income households cover back rent, rent assistance, and utility bills.
• About $10 billion to help struggling homeowners pay their mortgages, utilities and property taxes.
• $5 billion to help state and local governments help the homeless.
• $14 billion for coronavirus vaccine research, development, distribution, and compliance outreach efforts. 
• $46 billion for coronavirus testing, contact tracing and mitigation, including laboratory capacity, community-based testing sites, and mobile testing units, especially in medically underserved areas.
• $7.6 billion to hire 100,000 public-health workers to support the coronavirus response.
• $128.5 billion for K-12 schools to make them safer to reopen by reducing class sizes, modifying classrooms to enhance social distancing, installing ventilation systems, buying personal protective equipment, and hiring more nurses and counselors.
• Nearly $40 billion for colleges and universities to defray pandemic-related expenses and provide emergency aid to students for expenses such as food, housing, and computer equipment. 
• $39 billion to help child-care providers with operating expenses.
• $25 billion for a new program benefiting restaurants and bars hurt by the pandemic. The grants would provide up to $10 million per business with a limit of $5 million per physical location.
• $7.25 billion for the Paycheck Protection Program. The bill would also make more non-profit organizations eligible for PPP funds.
• $175 million for outreach and promotion to help target businesses eligible for PPP funds.
• Expanded federal unemployment benefits would be extended, with an increase from $300 a week to $400 a week through Aug. 29.
• The federal minimum wage would gradually rise to $15 per hour by June 2025, and then be adjusted to increase at the same rate as median hourly wages. This provision may violate the parliamentary rules being used to pass the bill.
• Federal premium subsidies for Affordable Care Act policies would be made more generous, and the maximum income cap would be eliminated for two years. Enrollees would pay no more than 8.5% of their income towards coverage, down from nearly 10% now. And those earning more than the current cap of 400% of the federal poverty level (about $51,000 for an individual and $104,800 for a family of four) would become eligible.
• Federal subsidies for lower-income ACA enrollees would be eliminated completely, as would those for people collect unemployment benefits in 2021.
• Laid-off workers who want to remain on their employer's health-insurance plans would have to pay only 15% of the premium through the end of September.
• Federal matching funds for states that that expand Medicaid to low-income adults would be boosted by 5 percentage points for two years.
• $15 billion for the Emergency Injury Disaster Loan program, which provides long-term, low-interest loans through the Small Business Administration. Severely impacted businesses with fewer than 10 workers will be given priority for some of the money.

Rural Texans face disproportionate struggles during winter weather crisis, but many say they can count on neighbors

Most Texans are struggling after last week's freak winter weather, but many rural residents may be having a harder time overall. "Like other parts of Texas, rural communities were hammered by the winter storm that left families without the basic necessities of heat and running water,"  Melissa Taboada and Sarah Vasquez report for The Texas Tribune. "But temperatures in the country dipped lower than in cities, plummeting to the low single digits. Fewer resources serve that larger geography, and without city services, mobility can be more limited. Many living in the rural areas are ranchers and farmers who also had to worry about and prioritize livestock and crops."

Russell Boening, a dairy farmer and president of the Texas Farm Bureau, told the Tribune he's never seen winter weather like this in South Texas in his nearly 40 years of farming, and said he's hearing horror stories from across the state from the organizations 500,000 members.

Rural schools and food banks are having a hard time coping, and some water utilities say their pipes have frozen, leaving families without clean water. Still, "Rural Texans also told stories of joy amid the hardship," Taboada and Vasquez report. "Neighbors helped neighbors, letting them stay at their homes or shoveling ice and snow from their sidewalks. Volunteers worked overnight to cook for warming centers and keep them staffed. While the icy roads kept [Milam County Judge Steve] Young from reaching his 93-year-old father whose pipes froze at his Rockdale house, leaving him without water, local police officers delivered a case of water bottles Friday morning. A Goodall-Witcher emergency room nurse, who volunteers at a local animal shelter, checked on a patient’s dogs."

Jerry Kenney, who invited neighbors to come to his house to shower, told the Tribune the neighbors paid it back by offering to pick up supplies for them all. "I love living in rural communities and East Texas," Kenney told the Tribune. "There’s a sense of belonging and a resilience that is unique. I have no doubt that I can rely on my neighbor in a time of trouble."

In a separate interview with The Daily Yonder, Kenney continued reflecting on the lessons the emergency has brought: "Life without water and electricity gets simple. For the past few days, I haven’t spent much time pondering the things that divide us. It’s hard to hate your neighbor when he’s sharing water with you. Who can indulge social media debates when it’s so cold you can’t feel your fingers?"

An article from the rural Breckenridge Texan reinforces Kenney's sentiment about rural neighbors pulling together, recounting a reporter's all-night ride-along with the county judge (an adminisytrative office in Texas) as he worked to help his community.

Pfizer announces its coronavirus vaccine can be stored in regular freezers, opening up more options to rural areas

Pfizer announced Friday that its coronavirus vaccine can be stored in a regular freezer, not the expensive, ultra-cold freezers they originally indicated were necessary. That could mean more vaccine options for rural providers who were unable to afford the new freezers.

"Pfizer submitted data to the Food and Drug Administration showing the vaccine is stable when stored between minus 13 degrees and 5 degrees Fahrenheit, temperatures commonly found in pharmaceutical freezers and refrigerators,"  Jessie Hellmann reports for The Hill. "The company is asking the FDA to update its authorization of the vaccine to allow for vials to be stored at these temperatures for a total of two weeks as an alternative or complement to colder freezers."

The Pfizer and Moderna vaccines are the most prevalent in the U.S., but the Moderna vaccine has been more attractive to rural areas from the start since manufacturers have always indicated it could be stored in a regular freezer. Many rural hospitals, already struggling financially even before the pandemic, said they couldn't afford the $10,000 to $15,000 for one of the ultra-cold freezers.

Pandemic roundup: Some states not prioritizing farmworkers for vaccine; farmers' feelings of isolation have worsened

Here's a roundup of recent stories about the coronavirus pandemic:

Some states still aren't prioritizing farmworkers for the coronavirus vaccine as the federal government has recommended. Read more here.

Some California fire departments are distributing vaccines to rural areas. Read more here.

West Virginia has one of the highest coronavirus vaccination rates in the world. Read more here.

Thousands of U.S. service members are refusing to get the vaccine, or delaying. Read more here.

The New Yorker does a deep dive into rural Alaskan towns with high vaccine distribution rates. Read more here.

Some rural counties in Missouri are seeing mixed results in efforts to get vaccines to residents. Read more here.

FactCheck.org has some new stories vetting popular social media posts about the pandemic, plus a video explainer about why the Centers for Disease Control and Prevention changed its guidance on wearing face masks. Read more here.

Some health officials in New York state believe that a few rural counties' location is related to why they're so far behind the rest of the state in vaccination rates. Read more here.

A former U.S. surgeon general is urging the Biden administration to prioritize rural America in vaccine outreach efforts. Read more here.

The pandemic has exacerbated farmers' feelings of isolation. Read more here.

Are your school boards representative of the districts' families and children? Probably not, this research shows

"Most Americans would agree that public education should serve the educational needs of students. But to what extent does our current governance model—more than 13,000 school-district boards primarily elected by local voters—actually help us realize this goal?" Vladimir Kohan, Stéphane Lavertu, and Zachary Peskowitz, all three policy or political science professors, report for the Brookings Institution. 

According to their research in four states—California, Illinois, Ohio, and Oklahoma—voters often look very different from local student bodies. For example, most majority-nonwhite student bodies are governed by school boards elected by majority-white electorate. Most people who voted on school board members don't even have children themselves, they found. Though state reform laws might help, local school-board reform might be better, they suggest.

How does your local school board measure up? How might a disparity between the school board's makeup and the local community affect the decision whether to reopen schools during the pandemic? As a recent news story noted, in California (and likely elsewhere) rural schools are more likely to reopen than their suburban and urban counterparts.

Weather hits farmers: 'Mother Nature is a really tough business partner, and she has been pretty unforgiving'

Montana feedlot operator Jake Feddes sent Bloomberg this photo of calves with ears taped to prevent freezing

"Farmers from Kansas to Alabama have never dealt with weather like this," says The Wall Street Journal's headline on a story by Jacob Bunge. It's killing livestock, disrupting transport and shutting processing plants, and is "projected to cost agriculture companies and farmers millions of dollars," he reports. "Farmers and state agriculture officials said it remained too early to tally all the costs."

Oklahoma Agriculture Commissioner Blayne Arthur summed it up for Bunge: “Mother Nature is a really tough business partner, and she has been pretty unforgiving here the past few days.”

For Reuters, Tom Polansek reports from Texas, the state perhaps worst hit by the extreme weather, and the No. 1 cattle state. Newborn calves "are particularly vulnerable to the shock of the cold when they leave their mothers’ warm wombs covered in fluid," he noted. "Struggles to care for surviving livestock are the latest challenges for ranchers who over the past year have dealt with Covid-19 cutting demand for meat at restaurants and shuttering slaughterhouses."

Polansek reports, "Ranchers said they are spending long, cold hours breaking up ice in water tanks and on frozen ponds so animals have something to drink. Icy conditions have turned diesel fuel into a useless gel in tractors. Ranchers said they are using gasoline-powered pickup trucks to transport hay that cattle can eat and use for warm bedding."

Farmers are using pantyhose and duct tape to keep calves' ears from freezing and falling off, Bloomberg reports: "For the flora and fauna -- as well as those who make their living cultivating them -- it’s been equally disastrous, a Darwinian mix of outlandish and gruesome. . .. In Mississippi, four broiler houses were destroyed from collapsed roofs overwhelmed by snow and ice."

U.S. Department of Agriculture map shows major cattle counties in dark green; for a larger version, click on it.

Small water systems may have a hard time beefing up cybersecurity at a time their vulnerability has been revealed

The Feb. 5 hacking attempt on a small Florida water system shines a "highlights dire weaknesses in critical infrastructure and has federal policy-makers paying attention to industrial control systems, such as those also used by electric utilities, which are often managed by local municipalities," Mariam Baksh reports for Route Fifty.

The attack, which cybersecurity experts say was likely carried out by amateurs, was possible because of an outdated operating system, poor password security, and other weaknesses, Baksh reports. Federal authorities have issued recommendations to other water systems to stave off similar attacks, but such strategies may be difficult for rural utilities with little funding or personnel. 

Joseph A. Davis of the Society of Environmental Journalists provides an excellent explainer about public water systems in the U.S., including the security weaknesses many face, what funding is available to protect against cyberattacks, and story ideas and reporting sources.

The Bioterrorism Act of 2002 required water systems above a certain size to conduct vulnerability assessments and submit the results to the Environmental Protection Agency. Those assessments are exempt from the Freedom of Information Act and are meant to be kept secret, but loopholes can allow hackers (or journalists, for that matter) to learn more: "The same water systems were also required to draw up Emergency Response Plans for dealing with a terrorist attack," Davis reports. "In doing so, utilities were to coordinate with other agencies like police or hazmat units. The 2002 law did not require these to be disclosed, but did not explicitly forbid disclosure either. So a resourceful journalist could possibly get a look at the local plan."

Though Congress authorized and appropriated hundreds of millions of dollars in grants in the early 2000s to help local utilities beef up their security, few agencies and utilities seem to have improved their security much, Davis reports. Some funding was specifically earmarked for smaller water systems, according to a federal report. The report also says water systems may also find funding through Department of Homeland Security grants.

However, Davis notes that garden-variety water pollution is likely a greater threat to water systems ill-equipped to deal with it.

A look at the little-known, but critical, work of Depression-era Black workers in the Civilian Conservation Corps

Black CCC workers built a bridge at White River National Wildlife Refuge in Arkansas. (CCC photo)

Just in time for Black History Month, Dan Chapman of the U.S. Fish and Wildlife Service provides a look at the little-known history of Black workers—many of them from rural areas and working in rural areas—in the Depression-era Civilian Conservation Corps.

FWS archaeologist Richard Kanaksi is compiling information about their role in creating national wildlife refuges across the South, hoping to highlight the "major, yet largely hidden role played by African-Americans in rebuilding this country from the depths of the Great Depression," Chapman reports. Read more here.

Applications open for science, health, and/or environmental reporting fellowships; deadline is May 10

Applications are now being accepted for a new fellowship pilot program for early-career journalists who want more training in science, health, and/or environmental reporting.

The Association of Health Care Journalists, the Council for the Advancement of Science Writing, and the Society of Environmental Journalists have collaborated to create the year-long National Science-Health-Environment Reporting Fellowships program, aimed at staff and freelance journalists with between two and 10 years of professional reporting experience. The program is funded by the Howard Hughes Medical Institute's Department of Science Education and the Gordon and Betty Moore Foundation.

The 12 selected fellows can maintain their regular jobs while attending training opportunities across the nation and online, including niche workshops, a reporting boot camp, customized webinars, registration to national conferences, access to unique resources, and individual professional mentors to assist with career development. The curriculum includes basic science, interpreting medical studies, analyzing data, explaining evidence-based decisions, understanding climate science and more.

The application deadline is May 10. Click here for more information or to apply. 

Pandemic roundup: Crippling winter weather complicating vaccine delivery and distribution

Here's a roundup of recent pandemic and coronavirus vaccine-related news stories:

Crippling winter weather is hampering vaccine delivery and distribution. Read more here.

Efforts to distribute the vaccine in rural areas are complicated by staffing shortages, low vaccine allocations, and transportation barriers. Read more here.

A pastor in rural Florida used his clout to get 600 local residents vaccinated. Read more here.

Hospital workers in rural Louisiana discuss their struggle to cope with the pandemic, and what problems have persisted even after the arrival of vaccines. Read more here.

Family caregivers, who are routinely left off vaccine priority lists, worry about what would happen if they got sick and were unable to care for an ailing or disabled loved one. Read more here.

Manufacturers are churning out N95 masks, but many medical workers still don't have enough because of federal failures over the past year to coordinate supply chains and provide hospitals with clear rules about how to manage their medical equipment stockpiles. Read more here.

Texas has launched a multimillion-dollar campaign to combat vaccine hesitancy. Read more here.

Some veterans in rural Montana got their coronavirus vaccines via airplane delivery. Read more here.

Researchers are studying ways to encourage Native Americans on reservations to seek coronavirus testing. Read more here.

A New Yorker story takes a deep dive into how food bank volunteers in Harlan County, Kentucky, have been helping others for decades, but now need help themselves. Read more here.

Undocumented immigrants are a critical part of many meatpacking and agricultural operations, but aggressive immigration enforcement has deterred many from obtaining the coronavirus vaccine, especially in the South. Read more here.

Bipartisan proposed legislation aims to make it easier for rural hospitals to qualify for Paycheck Protection Program loans. Read more here.

An arresting multimedia story from The Washington Post illustrates the pandemic's death toll in January through pull-no-punches statistics, stories and photos from communities across the nation. Read more here.

A health system in upstate New York is one of only a handful of rural locations chosen for clinical trials for Operation Warp Speed, the federal research effort to test treatments for Covid-19. Read more here.

Tribal Nations across the United States are racing to vaccinate elders who are the keepers of culture and tradition. Read more here.

Quick hits: Firefighters face lies, biased studies when trying to uncover truth about carcinogenic chemicals in their gear

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.

Firefighters face lies and biased studies when trying to uncover the truth about carcinogenic chemicals used to make their firefighting gear flameproof. Read more here.

Members of Congress are calling on the Treasury Department and the Small Business Administration to clarify Paycheck Protection Program guidelines to make more farmers and ranchers eligible for forgivable loans, but it may be too late. Read more here.

New York Times contributing author Margaret Renkl will speak at the Rural Assembly Everywhere conference in April. Read more here.

Book review: Robert Gipe's Pop, the latest in a trio of illustrated novels set mostly in Eastern Kentucky, "shows the power of telling our own stories." Read more here.

Here are eight novels with rural settings that you can curl up with while the weather outside is frightful. Read more here.

Some experts say the new crop-insurance supplemental option is worth considering even if it's pricey. Read more here.

An initiative is helping farmers market products from heritage livestock sheep breeds. Read more here.

Rural Texas papers struggling to operate amid winter weather disaster

Many Texas newspapers are having difficulty operating and/or delivering because of the winter weather that has brought the state to a halt.

In Colorado City, (whose mayor resigned after a social media diatribe saying that "only the strong will survive" amid power shortages) The Colorado City Record warned subscribers that the paper will be delayed this week because there is no electricity to run the software for designing the paper.

Mike Hodges, Texas Press Association director, said in an email to The Rural Blog that, though he doesn't have exact numbers on how many papers are being delayed, "suffice it to say that the challenge is widespread." Many papers face staff shortages and electrical outages (which sometimes means no heat, water, and/or internet), and mail delivery has been slow because of road conditions. But, Hodges wrote, papers are persevering: "I am not aware of any publishers failing to produce their product this week. However, my staff and I did field an abundance of phone calls and emails from publishers who were having difficulty in meeting deadlines, getting the paper to the printer, getting to and from the press, etc."

Key roles of Iowa and N.H. in presidential nominating process are more threatened than ever, Politico reports

"The siege of Iowa and New Hampshire has begun," report David Siders and Elena Schneider of Politico. "The two states with privileged places on the presidential primary calendar are finding their roles more threatened than ever before — most recently in the form of a bill introduced in Nevada this week to move that state’s nominating contest to the front of the line in 2024."

The two rural forerunners have faced such challenges before, and political leaders in the two states warned that they would defend their positions, but Politico says they will find that more difficult this time because "the combination of Iowa’s botched 2020 caucus and increasing diversity in the Democratic Party’s ranks has made the whiteness of Iowa and New Hampshire all the more conspicuous, putting the two states on their heels and throwing the 2024 calendar into turmoil."

New Hampshire law requires the state to hold its presidential primary at least seven days before any “similar election” in another state, and "Iowa has a similar law on its books, stating that it must hold its caucuses at least eight days before any other nominating contest," Politico notes.

Nevada Assembly Speaker Jason Frierson, a Democrat, told Politico the bill to set a primary for the second-to-last Tuesday in January was designed to start a “national conversation about what makes sense. It would not be ideal to just have a back-and-forth and just have a leapfrog exercise, so the hope is that we can coordinate with the national party as well as our states, and work something out.”

Politico reports, "Frierson, like many other Democrats outside of Iowa and New Hampshire, suggested that instead of presidential candidates focusing for a year or more on Iowa and New Hampshire — two heavily white states — it would 'behoove' them "to be speaking to a diverse population" more reflective of the electorate at large. Nevada, in addition to fitting that bill with its sizable Hispanic population, also shares an advantage that Iowa and New Hampshire have — being small enough in population that a candidate without massive resources can compete there. So, too, does South Carolina, the fourth state in the 'early carve-out' states before Super Tuesday." It has a large Black population.

With caucuses that some say are anachronistic and bad for minorities, Iowa's system could be in more jeopardy. Iowa's Dave Nagle, a former congressman and state Democratic chair, defended "Iowa’s place as a voice for rural voters and voters in the Midwest," Politico reports, and 'suggested that at a minimum, the Nevada legislation was straining relationships between states. For years, he said, the four early nominating states had resolved to 'stand together, not get in a contest against each other.' The legislation, he said, 'has a tendency to break down the alliance.'"

Three years later, project to bridge political divide between residents in rural Massachusetts and Eastern Ky. still going

Thanks to modern technology, the pandemic hasn't stopped a cross-cultural effort meant to bridge the political divide between two rural communities, one liberal and one conservative.

Three years ago, a handful of rural residents from communities in Kentucky and Massachusetts began meeting to see if they could find common ground. Hands Across the Hills was established just after the 2016 election when liberal residents of Leverett, Mass., reached out to residents of Whitesburg, Ky., because they wanted to better understand not just why people voted for Trump, but Appalachian culture overall. 

The initiative started out with in-person visits with home stays, local field trips, and lots of sharing and listening, and has continued via Zoom meetings and phone calls throughout the pandemic, according to CBS News, which has a video update of the project (above).

Paula Green, a Leverett resident who has led similar cross-cultural efforts for decades in war-torn areas like Bosnia and Rwanda, leads the project along with her Whitesburg counterpart Gwen Johnson. In a recent column, Green cautioned that initiatives like Hands Across the Hills are illuminating but not a large-scale solution: "Dialogue groups help but are too small to balance out the political rewards of those who stoke hatred for their own gain. When I consider where we are as a country today, it seems clear that my conservative correspondent, our friends in Kentucky, and millions of others are telling us that our country needs an overhaul. Too many people are hurting, and the solution is not just interpersonal, as important as that is. What is needed is a new vision for our economic, political, and social policies, all of which are on life support. Until we get these structures right, blaming and demonizing each other provides too easy a reach, an outlet for our frustration."

Rural heartland banker survey shows highest economic outlook since 2011, but hiring and retail sales are still down

Creighton University chart compares current month to last month and year ago; click here to download the full report.

A February Creighton University survey of rural bankers in 10 Midwest states that rely on farming and energy showed sunny economic predictions for six months from now, with the highest confidence index since 2011. Still, hiring and retail sales remain weak, and low loan volume is still a concern. The index is a survey of bankers in about 200 rural communities with an average population of 1,300 in Colorado, Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota and Wyoming.

Though current economic activity is still below pre-pandemic levels, "sharp gains in grain prices, federal farm support, and the Federal Reserve’s record-low interest rates have underpinned the Rural Mainstreet Economy. Only 8 percent of bank CEOs indicated economic conditions worsened from the previous month," Creighton economist Ernie Goss writes.

Farmland prices, farm equipment sales, home sales and checking deposits were all up a little from last month and a lot from last February. The land price index is the highest since May 2013, has recorded five straight months above growth-neutral in that category for the first time since 2013, Goss reports. Equipment sales, likewise, have been above growth-neutral for the past three months after 86 consecutive months below growth-neutral. Half the bankers said they expect equipment dealers to see a 1-4% increase in sales over the next 12 months, and 23% said they expect to see a 5-10% increase. 

Pandemic and fentanyl have driven drug record overdose deaths in the U.S.

Percentage change in all fatal drug overdoses from the 12 months ending in June 2019 to the 12 months ending in May 2020. CDC map; click the image to enlarge it.

The coronavirus pandemic and an influx of fentanyl have driven record drug overdose deaths in the U.S. between June 2019 and June 2020, according according to a report from the Centers for Disease Control and Prevention released in December 2020. "

"The Ohio Valley, an early epicenter of the opioid crisis, saw overdose fatalities soar, and in parts of the region the rate of increase surpassed the national average," Corinne Boyer reports for Ohio Valley ReSource.

Overdose deaths spiked in 10 Western states as well, driven mainly by fentanyl. "The increases are particularly troubling for rural counties in those states, some of which have the highest rates of opioid overdose deaths in the country," Liz Carey reports for The Daily Yonder. 

Overdose deaths related to synthetic opioids such as fentanyl increased more than 98%, according to the report. Out of 38 jurisdictions, 37 saw increases in such deaths from the 12-month period ending in June 2019 to the 12-month period ending in May 2020, Carey reports.

The geographic shift is noteworthy, the report says: "Historically, deaths involving illicitly manufactured fentanyl have been concentrated in the 28 states east of the Mississippi River…In contrast, the largest increases in synthetic opioid deaths from the 12-months ending in June 2019 to the 12-months ending in May 2020 occurred in 10 western states (98.0% increase)."

People in Western states who use opioids recreationally tend to use a heroin variety that reacts poorly with fentanyl, so fentanyl hasn't been as deadly there. But starting in 2018 fentanyl deaths began rising in Western states because fentanyl was contaminating other drugs or disguised to look like it. So someone might believe they were taking a Xanax but were actually taking fentanyl, Carey reports.

Some public officials say the coronavirus pandemic has also contributed to the increase in overdose deaths, Carey reports. Tom Jeanne of the Oregon Health Authority said in a recent statement: "Food insecurity and disruptions in access to safe housing and mental health services have compounded stress from job losses, school and social isolation, and other problems brought on by the pandemic." Jeanne noted that the pandemic had also made it more difficult for people with substance use disorder to attend 12-step programs or access addiction clinics.

Many addiction treatment programs moved to a virtual setting after pandemic shutdowns, but that's not practical for people with limited or no internet access, Boyer reports. One clinic in Lexington, Ky., provided wi-fi access so people could participate in group therapy sessions from their cars. For those without a phone or internet, the clinic created an isolated space in the clinic with computers for telehealth visits.

Surge in opioid deaths sparks renewed calls to deregulate key addiction treatment drug, buprenorphine

Drug overdose deaths have soared to record highs during the pandemic. That has sparked a debate over the ease of prescribing the addiction treatment medication buprenorphine, a synthetic opioid that can be prescribed for a month at a time. The issue is especially pressing since patient access to buprenorphine and other medication-assisted treatment (MAT) is limited in many areas, especially rural. Only 18% of the 1.6 million Americans who struggle with opioid addiction are receiving any kind of MAT, Christine Vestal reports for Stateline.

Doctors, nurse practitioners and physician assistants must take an eight-hour online course and submit to Drug Enforcement Administration oversight to be allowed to prescribe buprenorphine. A growing number of medical experts say it's unnecessary red tape, "but opioid addiction treatment providers and a major patient group argue that, in fact, more training is needed to protect patients. Some also worry that looser rules will result in the pills being resold illegally," Vestal reports. "The Biden administration and Congress are set to decide whether revoking provisions in the two-decade-old federal narcotics law that require the training is worth the potential harm of pills becoming more readily available."

One reason for controlling buprenorphine prescriptions is the fear that the drug might make it onto the streets. Dr. Shawn Ryan, an addiction specialist on the board of the American Society of Addiction Medicine, told Vestal he supports eliminating the training requirement because buprenorphine diversion to illegal markets hasn't been a serious public health problem.

"But addiction treatment providers who are not physicians argue that the training requirement is needed to ensure quality treatment," Vestal reports. That includes Mark Parrino, president of the American Association for the Treatment of Opioid Dependence. "Instead of removing the guardrails designed to protect patients, Parrino argued, the federal government should consider policies that would increase Medicaid and private insurance reimbursement rates for treatment with buprenorphine and remove time-consuming pre-authorization rules that impede access to the medication."

Buprenorphine was approved for opioid addiction treatment in 2000, but medical experts have long argued over whether it should remain regulated. "heated up last month when the Trump administration proposed eliminating the training rule without congressional action. In a Jan. 14 announcement, the Department of Health and Human Services said it would publish 'practice guidelines' exempting physicians from the requirement," Vestal reports. The Biden administration put that initiative on hold and promised to examine the issue and find ways to increase access to buprenorphine. On Feb. 8 a small bipartisan group of lawmakers from the House and Senate asked Biden to work with Congress to quickly eliminate the training requirement, citing a bill filed by Sens. Maggie Hassan, D-N.H. and Lisa Murkowski, R-Alaska. 

"According to the bipartisan group, the training requirement 'reflects a longstanding stigma around substance use treatment and sends a message to the medical community that they lack the knowledge or ability to effectively treat individuals with substance use disorder,'" Vestal reports. "It’s unclear how quickly Congress might move on the buprenorphine proposal, but a recent warning from the federal Centers for Disease Control and Prevention about a surge in drug overdose deaths adds urgency to the issue. According to provisional CDC death data, more than 83,000 people died of drug overdoses, primarily related to opioids, in the 12 months ending June 2020—a more than 21% increase over the previous 12 months."

Rural public transit agencies struggling in pandemic; advocate says drivers should be prioritized for vaccine

"In communities where the nearest hospital or supermarket may be an hour’s drive away, rural public transportation meets residents’ most basic needs. But at the start of the pandemic, ridership of public buses and vans—commonly ridden to crucial destinations like work, dialysis appointments, and the grocery store—declined by 90 percent in some rural areas," Olivia Weeks reports for The Daily Yonder. "According to a January survey of more than 100 rural and small-urban transit agencies by the Community Transportation Association of America, rural transit operations reported a 52.2% decrease in ridership since this time last year."

Loss of customers means a loss of revenue, which can make it difficult for transit agencies to stay open since they still must run routes and pay maintenance costs and salaries. "Maintaining staff is crucial even when ridership is low—a typical 16-passenger rural transit bus can safely fit only four people with proper social-distancing. Often it takes two buses to transport eight people when, prior to Covid-19, one bus could fit 16," Weeks reports. "The problems with restoring that ridership are plentiful: rural transit vehicles are small and social-distancing is difficult, drivers and riders are often high-risk for Covid-19, and vaccine availability varies widely from state to state."

CTAA director Barbara Cline said rural transit drivers must be prioritized as frontline workers and that rural America needs more access to vaccines, Weeks reports. The Federal Transit Administration has suggested that public transit providers facing low ridership should partner with local governments to provide essential community services during the pandemic such as meal delivery and vaccine distribution. CARES Act funding can assume the costs.

Two-part series examines how Biden administration can address cybersecurity threats, bridge broadband gap

During the Trump administration, the Federal Communications Commission did little to address cybersecurity efforts and rolled back such initiatives from the Obama administration. A two-part series the Brookings Institution examines how the Biden administration can "build back better" to address cybersecurity threats and bridge the rural-urban broadband gap.

Though the Biden administration faces many challenges, cybersecurity and broadband expansion should be high priorities, writes Tom Wheeler, a visiting fellow in governance studies at Brookings' Center for Technology Innovation.

In the first part of his package, Wheeler outlines how Trump's FCC "unbuilt" the agency's cybersecurity responsibilities and underlines why enhanced cybersecurity protections are critical. In the second part, Wheeler discusses broadband as a critical utility and what can be done to bring it to more rural Americans.

Frozen wind turbines not to blame for Texas power outages; natural-gas issues, isolated power grid responsible instead

Millions of Texans have lost power after the state's electrical grid was unable to cope with extreme winter weather. Some conservative pundits and state lawmakers have cited reports of frozen wind turbines as evidence that the state must be relying too much on renewable energy, but that's not true, Erin Douglas and Ross Ramsey report for The Texas Tribune.

"An official with the Electric Reliability Council Of Texas said Tuesday afternoon that 16 gigawatts of renewable energy generation, mostly wind generation, were offline. Nearly double that, 30 gigawatts, had been lost from thermal sources, which includes gas, coal and nuclear energy," Douglas and Ramsey report. "It’s estimated that of the grid’s total winter capacity, about 80% of it, or 67 gigawatts, could be generated by natural gas, coal and some nuclear power. Only 7% of ERCOT’s forecasted winter capacity, or 6 gigawatts, was expected to come from various wind power sources across the state."

Natural gas seems to be the energy source least able to cope with the spike in demand, with gas freezing in pipelines without winter insulation. Michael Webber, an energy-resources professor at the University of Texas, told the Tribune that the gas industry is producing much less power than usual. Dan Woodfin, a senior director at ERCOT, which manages the electric grid in Texas, said on a Tuesday call with reporters, "It appears that a lot of the generation that has gone offline today has been primarily due to issues on the natural-gas system."

Winter weather problems with natural gas are not new, Jason Whitely reports for the Dallas Business Journal. After a winter weather disaster in 1989, the Public Utility Commission of Texas recommended that natural-gas generators and producers winterize their operations, but didn't make it mandatory as other states have. Another such disaster in 2011 prompted the Federal Energy Regulatory Commission and the nonprofit North American Electric Reliability Corp. to issue a report saying the same thing, but it was largely ignored.

Both wind turbines and natural-gas pipelines can be winterized, but many Texas power generators haven't made the investment because the state doesn't often get such cold weather. Compounding the problem, Texas has its own electrical grid, meaning the state can't easily import electricity, Matt Egan reports for CNN Business.

UPDATE, Feb. 18: "Texas counts on wind to meet only 10% of its winter capacity, according to the state’s grid manager," The Wall Street Journal reports. "Natural gas and coal make up the lion’s share, comprising 82%. Sure, some wind turbines glitched under cold weather conditions, but so did natural gas- and coal-fired power."

Rural coronavirus infections fell 30% last week; deaths up

New coronavirus infection rates, Feb. 7-13
Daily Yonder map; click the image to enlarge it or click here for the interactive version.

"The number of new Covid-19 infections in rural counties fell by nearly 30 percent last week to the lowest level since October. But Covid-related deaths in rural America grew slightly, showing the lingering impact of the winter surge that peaked more than a month ago," Tim Murphy and Tim Marema report for The Daily Yonder.

Rural counties saw 81,952 new coronavirus infections during the week of Feb. 7-13, a nearly 30 percent drop compared from 115,359 cases the week before. "Meanwhile, the number of Covid-related deaths in rural counties plateaued for the past month. Last week’s rural death count was 3,599, up by 17 deaths from two weeks ago. The rural death toll has lingered between 3,500 and 3,600 since mid-January," Murphy and Marema report.

The new infection rate fell in metropolitan counties too, but deaths rose about 10%. Click here for more data and analysis from the Yonder, including charts, regional data and analysis, and an interactive map with the latest county-level data.

Affordable Care Act health-insurance marketplace has been reopened for three months; here's what you need to know

Because so many have lost their health insurance after being laid off or are finding it difficult to afford their current plan, President Biden has reopened the federal health insurance marketplace for three months to allow people to buy or change their plan. 

"The Biden administration is promising to spend $50 million on outreach and education to get the word out about the new special enrollment period," Michelle Andrews reports for Kaiser Health News. "That’s critical, experts said. Although the number of people signing up for Affordable Care Act plans has generally remained robust, the number of new consumers enrolling in the federal marketplace has dropped every year since 2016, according to KFF, corresponding to funding cuts in marketing and outreach."

KHN has a detailed explainer with info about the new open enrollment period, which opened Monday. Click here to read it.

Op-ed: Biden plan to revitalize coal communities 'welcome news,' may bring much-needed funding and policy support

Peter Hille

President Biden, in late January, signed an executive order aimed at help revitalize the economies of coal-impacted communities. The order came after economic-development groups in coal states, and labor leaders and environmental organizations all over the country, signed an open letter calling for the move.

The Interagency Working Group on Coal and Power Plan Communities, created by the order, brings together Cabinet-level leadership from different departments and will issue a report within 60 days on the initial steps of the initiative. 

The order is welcome news, writes Peter Hille in a recent op-ed. Hille is president of the Mountain Association, an Eastern Kentucky economic development nonprofit and one of the organizations that co-signed the call for a working group. 

"Community leaders from Appalachia to Wyoming to the Navajo Nation, where people once relied on the coal industry, have been developing and implementing promising solutions to create inclusive, equitable and sustainable economic growth for years. But these leaders have largely lacked supportive public policy and investment at the necessary scale to accelerate this work," Hille writes. "The Mountain Association joined with partners across the nation to develop a National Economic Transition platform, reflecting the interests of labor, environmental organizations, grass roots groups, economic developers and Native American communities. The NET platform identifies seven pillars, key elements to guide policy makers and leaders in building new and more resilient economies in these places, and ensuring that the new economy works for everyone." Click here to read more about the NET platform.

USDA to hold free virtual Agricultural Outlook Forum Thursday and Friday

The Agriculture Department will hold its 97th annual Agricultural Outlook Forum as a virtual conference Feb. 18-19, with a short pre-conference session Feb. 17. Registration is free but required.

The program will begin with a presentation by USDA’s new chief economist, Seth Meyer, on predictions for U.S. commodity markets and trade for 2021 and the U.S. farm income situation. A keynote address by Agriculture Secretary-designate Tom Vilsack, presentations by congressional leaders, and a session on genetic literacy are also scheduled for the morning of Feb. 18.

The program will cover five key areas: supply chain resilience, commodity market outlooks; food price and farm income outlooks; U.S. trade and the global market place; risk management and sustainability; and innovation, technology and productivity. Click here for more information or to register.

Grain Bin Safety Week and National FFA Week Feb. 21-27

Two national observances with rural resonance are coming up next week, so here's a heads up for planning your coverage.

Feb. 20-27 marks the 73rd annual National Future Farmers of America Week. The FFA website has an informational page and toolkit with more information, graphics, and coverage ideas. Read more here.

Grain Bin Safety Week is also next week (Feb. 21-27). Deaths from grain-bin entrapments increased in recent years because of the record wet weather. And, with on-farm grain bins growing ever larger, the risk of injury or death is real. But farmers can take several steps to avoid the risk, Russ Quinn reports for DTN/The Progressive Farmer. Click here for more information about the observance on the Grain Bin Safety Week website.

Click here for more information about a contest to award rural fire departments and emergency response teams with grain rescue tubes and special hands-on training for grain-bin entrapment. Since the contest began eight years ago, four lives have been saved thanks to the program. Nominations are due April 30.

Natural-gas utilities are advised there may be a shortage due to frozen pipelines; electric blackouts also possible

Several news sources are reporting that natural gas could be in short supply in their areas due to frozen pipelines. "Energy markets in the U.S heartland struggle to keep up with high demand for heating and electricity prompted by severe winter weather stretching from Texas to New England," the Springfield (Mo.) News Leader reports.

"As Texas utilities began rolling blackouts overnight due to extreme cold weather that's blocking natural gas pipelines with frozen water, the Springfield Area Chamber of Commerce issued an alert on behalf of City Utilities asking "everyone in the community to rally together to help all of us get through this dire situation."

The newspaper also reported the possibility of rolling electricity blackouts due to the extreme cold. "At 10:08 a.m. Monday, the Southwest Power Pool, a multistate energy market that includes Springfield's City Utilities, issued an "Energy Emergency Alert Level 3." . . . Level 3 means that rolling blackouts are a possibility."

City officials in Fulton, Mo., "said frozen natural gas wells in Oklahoma and Texas are causing a shortage of available natural gas, leading to an increase of as much as 100 times the typical purchase price," KRCG-TV reports.

Detailed census data needed for redistricting won't be ready until late Sept., causing 'chain reaction in the political world'

The Bureau of the Census said Friday that due to the pandemic, it won't provide data needed for redistricting until late September, causing "headaches for state lawmakers and redistricting commissions facing deadlines to redraw districts this year," writes Mike Schneider of The Associated Press.

The bureau "had previously said the redistricting data would be available no earlier than the end of July because of delays caused by the virus," Schneider notes. "Before the pandemic, the deadline for finishing the redistricting data had been March 31." Departing from past practice, the bureau will issue all the data at once, rather than releasing it state by state.

"The delayed release creates a chain reaction in the political world," Schneider writes. "Several states will not get the data until after their legal deadlines for drawing new districts, requiring them to either rewrite laws or ask courts to allow them a free pass due to the delay. Candidates may not know yet whether they will live in the district they want to run in by the filing deadline. In some cases, if fights over new maps drag into the New Year, primaries may have to be delayed. . . . The biggest impact will be to compress the window during which lawyers can challenge bad maps in court."

Eric Holder, who was attorney general in the Obama administration and chairs the National Democratic Redistricting Committee, said the delay shouldn’t be “a pretext to hold 2022 elections on old maps” for political advantage, "or to draw maps without significant public input, using the compressed timetable as an excuse," Schneider reports.

Research center says 40% of rural hospitals are at risk of closing; database, analysis help you see if yours might be

Maps from "Rural Hospitals at Risk of Closing" report

Forty percent of America's rural hospitals are struggling to stay open. Is yours one of them?

You can get a pretty good idea from an analysis and a database published by the Center for Healthcare Quality and Payment Reform, a research center chartered by Congress.

The center's report doesn't name the at-risk hospitals, but it does offer a wealth of financial information about most of the short-term, acute-care hospitals in rural America.

Harold Miller, president and CEO of the center, told Melissa Patrick of Kentucky Health News that the report doesn't name the hospitals the center considers at risk because it's hard to say exactly what is going on in each of them without digging a bit deeper into their individual stories, and he doesn't want to imply that the only hospitals struggling are the ones he puts on a list.

"This was more intended to say to the state, 'Guess what, you have a bunch of hospitals that are not doing well and you shouldn't ignore that problem'," he said.

An earlier report rom the Chartis Group, a rural-health consultancy, says 135 rural hospitals have closed since 2010, and 453 more are vulnerable to closure.

 
The new "Rural Hospitals at Risk of Closing" report says hospitals with an immediate risk of closing have had persistent financial losses, meaning "the hospitals had a cumulative negative total margin over the most recent three-year period for which financial data were available" and had a low or non-existent financial reserve, meaning the hospitals either "had total liabilities exceeding all assets other than buildings or equipment or had assets greater than liabilities, but only by enough to sustain continued losses for at most two years."

If the hospital is losing money and its net assets are so small that it would exhaust them in just a couple of years, Miller said, they were classified as being at immediate risk. 

The report says the primary cause of rural hospital closures is that payments from government and private health-insurance plans is less than the cost of delivering care to patients in rural communities; that these payments are not enough to sustain their essential services.

Rural hospitals' financial troubles are often blamed on low reimbursement from Medicare and Medicaid, but Miller said some small rural hospitals have more trouble with private health plans, which pay them less than big hospitals for the same care, and less than the cost of delivering that care.

"It's not as if there is just one thing that explains why they're losing money," Miller said. "In some cases, it's more Medicaid patients, in some cases, it's bad payments by commercial payers. In some cases, and it's hard to tell that from these data, it's sometimes the mix of services that hospital offers."

The report shows the payer mix of hospitals and what they make or lose on patient services in addition to their total margins. It reviews many of the problems faced by rural hospitals and analyzes many of the proposed solutions, and offers a new approach.

It proposes a two-part payment model that would require an up-front payment from both public and private insurers based on the number of plan members who live in the community, regardless of the number of services provided, along with a service-based fee much lower than current payment models.

This "patient-centered payment system" would ensure "that the hospital has adequate revenues to support the minimum standby costs of essential services, such as the emergency department, inpatient unit and laboratory," and the service fee "would ensure that if patients need more services, the hospital would receive sufficient additional revenue to cover the added costs of delivering those services, rather than being forced to delay or ration care," the report says.

"We need to do something different," Miller told Kentucky Health News. "All the stuff we've tried so far hasn't worked."

Post and Courier reports on, and partners with other S.C. newspapers to help fill, gaps in accountability journalism

Newspapers in Holly Hill and Santee, S.C., have been among
those that have closed in rural areas of the Palmetto State.
(Photo by Andrew J. Whitaker, The Post and Courier)

"Corruption is flourishing in the rural corners of South Carolina as newspapers fold or shrink coverage amid a financially crippling pandemic," Glenn Smith and Tony Bartelme report for The Post and Courier of Charleston, which is trying to do something about it by partnering with rural papers.

"Seven of our state’s newspapers closed their doors in the past year, joining more than 60 that shuttered across the nation as the coronavirus strangled an industry already battered by shrinking revenue and draining job cuts," Smith and Bartelme report. "The losses hit hardest in the vast rural stretches of the Palmetto State."

The reporters' story accompanies a special project they started with Joseph Cranney and Avery Wilks, "Uncovered," which calls it "a project to cast new light on questionable government conduct, especially in smaller towns. We’ll work with community newspapers, leveraging The Post and Courier’s investigative resources with reporters who know their towns inside and out. We'll publish our findings simultaneously." The story carries the headline, "News deserts and weak ethics laws allow corruption to run rampant in SC."

Allendale County (Wikipedia map)

Their first example: Allendale County, which lost its only newspaper in 2015. Since then, "The state took over the county’s problem-plagued school district for the second time while three of Allendale’s public officials went to jail on embezzlement charges."

Rural papers aren't known for investigations. They still discourage corruption, said experts such as Chief Mark Keel of the State Law Enforcement Division told the Post and Courier, which reports:

"Often, the corruption comes to light when local suspicions or complaints end up in the community newspaper, prompting someone in power to reach out to SLED for help, Keel said. Kristine Artello, a corruption expert and professor at Virginia Commonwealth University, interviewed former federal prosecutors and investigators for a study into what triggers corruption cases and the tools investigators need for these cases to succeed. One surprising finding: Newspapers and law enforcement often had a synergistic effect. Old-school investigators told her 'they would come into the office in the morning and the first thing they did was read the newspaper and make circles in the articles, saying, "This smells funny. I want to investigate that." And that’s what they started with.' But as communities lose newspapers, they lose the kinds of clues law enforcement needs to make cases, Artello said."

The Post and Courier's stories offer many examples from South Carolina but one takes a broader look, quoting Al Cross, director of the Institute for Rural Journalism and Community Issues, publisher of The Rural Blog: “We’re in a crisis in local journalism in this country, and it was a crisis before the pandemic came along.” He says just covering government meetings isn't enough: “Covering a meeting is like sitting in a train station and watching trains pick up and let off passengers,” Cross said. “You might have some idea what is going on, but you don’t really know unless you get on that train, ride it and ask questions.”

USDA part of relief bill has loan payoffs for farmers of color; Republicans complain that Democrats shut their ideas out

"Democrats forced a $16.1 billion agriculture stimulus plan through the House Agriculture Committee on Wednesday, brushing aside Republican assertions that a provision providing debt relief for minority farmers was far too broad and could face legal challenges," Agri-Pulse reports.

The committee approved the measure, which will be part of Democrats' overall relief-and-stimulus bill, on a party-line vote. "Democrats defeated almost every GOP attempt to alter the measure," Philip Brasher reports, "including two amendments that would have scaled back provisions that will pay off USDA farm loans held by minority producers."

Republicans complained that new committee Chair David Scott didn't let them help write the bill, "and said it omitted assistance for key rural needs such as broadband expansion," Brasher reports. They were most critical of debt relief, a "result of discussions that started with the Biden transition team."

Under the plan, a farmer who meets the 1990 Farm Bill's definition of "socially disadvantaged" could be paid 120% of the amount owed on a USDA loan (the extra to cover taxes on the money) without having to prove discrimination. "Democratic members of the committee initially struggled to explain whether white women would qualify for the payments," Brasher reports. "but a committee staffer said it would be limited to Blacks, Hispanics, Native Americans and Asian Americans."

Scott, the first Black Democrat on the committee, said “There has been no one who has been discriminated in the whole agriculture industry like African Americans, who deserve some compassion and understanding. . . . African Americans were the pioneers in agriculture … We had to do it for no compensation as slaves in this country, and ever since then we’ve been trying to bring justice to that.”

Among the failed amendments was one from ranking Republican Rep. Glenn “GT” Thompson of Pennsylvania, to redirect money to "rural broadband, distance learning, rural hospitals and other needs," Brasher reports. "Rep. Michelle Fischbach, R-Minn., inadvertently highlighted deficiencies in rural broadband while trying to defend Thompson’s amendment. 'The digital divide is something that is very, very real in my district,' she said. Moments later she lost her connection to the hearing."

A Scott press release said the bill includes $500 million "to help rural hospitals and local communities broaden access to Covid-19 vaccines and food assistance" and $3.6 billion for USDA "to help the food and ag sector supply chains."