Project '100 days of Appalachia' asks residents to respond to first 100 days of Trump presidency

Trump in Charleston, W.Va.

A project being launched this week, 100 Days in Appalachia, "will narrate the first 100 days of the Trump administration through the eyes" of people who live in Appalachia, Melody Kramer reports for the Poynter Institute. The project is a a joint collaboration between West Virginia Public Broadcasting, the Daily Yonder and WVY’s Reed College of Media.

The project team—West Virginia Public Broadcasting’s Dave Mistich and WVU Reed College of Media professors Dana Coester and Nancy Andrews—are "asking contributors to submit photos, words and multimedia that can respond to questions like, 'Does it surprise the reader about Appalachia specifically and rural America in general in any way?' and 'Does it challenge or shed new light on stereotypes embedded in identity politics?'"

Mistich told Kramer, "One of the things I think that we’re going to have to address is the stereotype that Appalachia is Trump nation and just a lot of low-income uneducated people, but that’s not the entire story—there are parts of West Virginia and Appalachia as a whole that have different cultures and different education levels and different socioeconomic statuses—how can tell those stories without exaggerating?"

Coester told Kramer, "If we're successful in building an audience—and if we're successful in delivering some meaningful content that bursts a few cultural bubbles—we'd love to carry this through midterms and beyond, as a potential source for understanding issues in America that aren't going away anytime soon."

USDA releases final rule intended to end soring in show horses

An award winning high-stepper

The U.S. Department of Agriculture's Animal and Plant Health Inspection Service (APHIS) on Friday announced a final rule intended to ban soring, the use of chemicals and physical abuse to induce high steps in show horses. As part of the rule APHIS "will license, train, and oversee independent, third party inspectors, known as Horse Protection Inspectors (HPIs), and establish the licensing eligibility requirements to reduce conflicts of interest," states the agency.

The rule states: "Beginning 30 days after the publication of the final rule, all action devices, except for certain boots, are prohibited on any Tennessee Walking Horse or racking horse at any horse show, exhibition, sale, or auction. All pads and wedges are prohibited on any Tennessee Walking Horse or racking horse at any horse show, exhibition, sale, or auction on or after Jan. 1, 2018, unless such horse has been prescribed and is receiving therapeutic, veterinary treatment using pads or wedges. This delayed implementation allows ample time to both gradually reduce the size of pads to minimize any potential physiological stress to the horses and prepare horses to compete in other classes." 

"Beginning Jan. 1, 2018, management of HPA-covered events must, among other things, submit certain information records to APHIS, provide HPIs with access, space, and facilities to conduct inspections, and have a farrier physically present to assist HPIs at horse shows, exhibitions, sales, and auctions that allow Tennessee Walking Horses or racking horses to participate in therapeutic pads and wedges if more than 150 horses are entered, and have a farrier on call if 150 or fewer horses are entered," the rule states.

Animal rights groups pushed for the Obama administration to finalize a rule before Donald Trump took office, saying there was "no guarantee he would be committed to ending the controversial practice," Michael Collins reports for USA Today. Wayne Pacelle, president of the Humane Society of the United States, wrote in a blog post after Trump was elected: “None of us can predict how President Trump will address animal welfare in the first 100 days of his administration or beyond. But momentum is clearly behind this much needed rule, and it’s been delayed for years. There’s no excuse for further dilly-dallying. It’s time to close the loop on an appalling abuse and deal with people who are abusing horses in the name of entertainment and profit.”

Amtrak plan to speed up travel between N.Y. and Boston causing concern in rural towns

A $120 million federal plan to speed up Amtrak travel between New York and Boston isn't going over well in rural towns in Connecticut and Rhode Island that could be negatively affected by the increased traffic and new tracks, Joseph De Avila reports for The Wall Street Journal. (Journal graphic: Proposed new segment of Amtrak travel between New York and Boston)

Cutting the three-hour and 30 minute trip by 45 minutes would require bringing "four new track lines and as many as 110 trains a day under its historic downtown in a tunnel" in Old Lyme, Conn., a town of 7,600 southwest of Boston, De Avila writes. Lawmakers in Connecticut and Rhode Island said the plan also would "cut through farmland, wetlands and private property along a 35-mile stretch where the new trains could zoom through at speeds of as much as 220 miles an hour. Current speeds are limited to 50 miles an hour in some spots."

The Federal Railroad Administration’s proposal, "the first comprehensive plan to upgrade the northeast corridor rail line since 1978, aims to run more trains, more quickly, but can do that only by drawing a straighter route that would largely run from Old Saybrook, Conn., through Kenyon, R.I., north of the current track," De Avila writes. "The existing track and its stations would continue to operate, but wouldn’t be able to accommodate faster speeds."

Connecticut Gov. Dannel P. Malloy and Sen. Chris Murphy, U.S. Rep. Joe Courtney and U.S. Sen. Richard Blumenthal, all Democrats, have opposed the plan, Don Stacom reports for the Hartford Courant. Blumenthal told reporters, "This plan looks more like fantasy than fact, and we're going to fight it. The feeling in Stamford is similar to southeastern Connecticut: People want safe, reliable and fast trains, but the devil is in the details."

Part of the plan includes smoothing out a curved stretch of railroad in Charleston, R.I. That has residents fearful they could be forced off their property, R.J. Heim reports for WJAR in Providence. "One stretch in particular, between New London and Charlestown, called the 'Preferred Alternative Proposal', would have a major impact on residents, wetlands, and preserves throughout Washington County." (Wikipedia map: Washington County, Rhode Island (Charleston is bright red))

Pa. pilot project to pay rural hospitals set amount each month, instead of reimbursing for services

State officials in Pennsylvania hope a new payment model for rural hospitals will keep more of them from going under, Steve Twedt and Karen Langley report for the Pittsburgh Post-Gazette. The Pennsylvania Rural Health Model, funded by $25 million from the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services, will pay hospitals a set amount each month, instead of reimbursing them for services provided.

As part of the pilot project six rural hospitals—a mix of independent hospitals and hospitals affiliated with larger health systems—will be selected "to participate in an initial pilot project of the payment model, which will launch in 2018," reports the Post-Gazette. "The group will then be expanded to 24 additional hospitals in the next three years." State Department of Health Secretary Karen Murphy said the $25 million "will be used to create a rural health redesign center to provide data analytics and other support."

"Various financial reports and surveys in recent years show how much small, rural hospitals in Western Pennsylvania have struggled," reports the Post-Gazette. "For the July-September 2016 period, regional hospitals with fewer than 100 beds collectively lost $10.4 million in those three months, for a negative 4.84 percent operating margin, according to a new Healthcare Council of Western Pennsylvania survey of its members. That compares with a negative 4.67 percent margin in 2015. Hardest hit have been small, rural hospitals that have fewer than 100 beds but are long-established with their communities and often are the only accessible acute care setting for miles."

Judge rules in favor of BLM on methane emission rules from oil and gas on public and tribal lands

"The Obama administration's plan to cut methane emissions on public lands will take effect as scheduled today after a federal court last night rebuffed industry and state attempts to block the rule," Ellen Gilmer reports for Energywire. "The U.S. District Court for the District of Wyoming denied requests from two industry groups and three states, which had asked for a preliminary injunction halting implementation of the Bureau of Land Management's new rule to slash methane emissions from oil and gas operations on public and tribal lands."

The rule, released in November, "sets gradual caps on how much methane may be flared and requires companies to use technologies to reduce flaring and inspect for leaks of the climate-warming substance, which is the main component of natural gas," Gilmer writes. It was challenged by Wyoming, Montana and North Dakota, the Independent Petroleum Association of America and Western Energy Alliance.

Opponents "say the rule is costly, duplicative and beyond BLM's authority because it is essentially an air quality regulation that falls on U.S. EPA's and states' turf," Gilmer writes. They asked Judge Scott Skavdahl—who froze and ultimately struck down the Obama administration's hydraulic fracturing rule last year—to pause the methane rule while the litigation moves forward. Skavdahl, an Obama appointee, denied the request, finding that the challengers had not met the steep requirements for a preliminary injunction."

Warmer winters leading to rise of moose-killing ticks in Maine, N.H., Vermont

A moose captured for a tick count
(Native Range Inc. photo)

Researchers at the University of New Hampshire say climate change is leading to a rise in deaths among moose from ticks, Brian MacQuarrie reports for The Boston Globe. Winter ticks, which attach themselves to a single moose by the tens of thousands, are being blamed for killing about 70 percent of moose calves in Maine, New Hampshire and Vermont. "Their deadly work is being aided by warming temperatures and shorter winters that allow the parasites to survive longer, scientists believe."

"Adult females can expand to the size of a grape and engorge themselves with up to four milliliters of blood," MacQuarrie writes. Pete Pekins, chairman of the Natural Resources Department at the UNH, which is conducting a study on moose in the three states, told MacQuarrie, "The moose are being literally drained of blood. This is about as disgusting as it gets out there."

As part of the study "researchers are attaching tracking devices to the moose as part of an effort to learn how ticks are affecting them," MacQuarrie writes. "If the reduction continues, researchers said, the range of New England moose is likely to shrink northward. And for many moose that survive, the ravages of winter ticks could render them less healthy and less likely to reproduce."

New Hampshire has about 4,000 moose, down from 7,500 in the early 2000s, MacQuarrie writes. In Vermont the number has dropped from 5,000 in 2006 to 2,200 today. About 76,000 moose roamed Maine in 2012, said Maine state moose biologist Lee Kantar. While Kantar did not have current numbers, some estimates are about 60,000.

Vilsack resigns USDA, putting fresh spotlight on Trump's only remaining Cabinet vacancy

The U.S. Department of Agriculture is without a permanent boss or a designated replacement for the new administration that will begin Friday.

President-elect Donald Trump has picked all his Cabinet secretaries except the one for agriculture, a job that Democrat Tom Vilsack resigned Friday. Vilsack's email to employees "did not say why he was leaving early," The Associated Press reports. "He has said he wants to remain involved with agriculture after leaving government, but has not detailed those plans."

Michael Scuse, undersecretary for farm and foreign agricultural services, is acting secretary, but with no permanent successor named, "Some in farm country are worried that agriculture may be a low priority for the new administration," though "Rural voters were key to delivering him the presidency," AP reports.

Vilsack, noting he was confirmed on Obama's first day in office, said his successor "will be at a tremendous disadvantage, in terms of getting up to speed on all this department does."  White House Press Secretary-designate Sean Spicer told reporters Friday that Trump had given the USDA job the same attention as other Cabinet jobs and would make a decision in the near future.

AP reports, "Trump and his team have interviewed several candidates, including former Georgia Gov. Sonny Perdue and former California Lt. Gov. Abel Maldonado. They have also talked to potential candidates from Texas and Indiana, home state of Vice President-elect Mike Pence. Ted McKinney, director of the Indiana State Department of Agriculture, was at Trump Tower on Thursday."

Rural counties in Ky. overcome opposition to start syringe exchanges to head off disease outbreaks

Small, rural counties are leading the way in establishing syringe exchanges to prevent outbreaks of HIV and hepatitis C among intravenous drug users in Kentucky, according to a top state drug official.

Van Ingram, executive director of the Kentucky Office of Drug Control Policy, spoke with Mary Meehan of Ohio Valley ReSource, a regional journalism collaborative of public broadcasters in Kentucky, Ohio and West Virginia. He cited Powell County, in the Appalachian foothills east of Lexington, as an example of rural counties that are changing the perception of how addiction is perceived in the state, shifting the focus toward treatment and public health initiatives and away from the criminal justice system.

So far, syringe exchanges have been approved in 25 of the state's 120 counties; several others are having debates like the one that went on in Powell County, population 13,000, reports Melissa Patrick of Kentucky Health News.

In nearby and much larger Madison County, the Board of Health supports a syringe exchange, but was met with "mixed feelings" about the program at a county Fiscal Court meeting, with some members concerned that the program condoned IV drug use, Ricki Barker reports for The Richmond Register. The county will host several forums to educate local citizens about the cost and benefits of the program and answer any questions that the public may have about it. Health officials told Barker that the department sees about eight to 10 patients a day with hepatitis C.

In Powell County, physician assistant Troy Brooks initially opposed a syringe exchange. "He said it seemed like a way to let addicts keep using their drug of choice without consequence," Meehan reports. But then local police showed him how bad the problems is by taking him to the playground in Clay City, where they collected 41 dirty needles, and he saw the need to protect children and first responders.

Six of the 25 syringe exchanges approved so far aren't operational yet. Thirteen are in counties deemed most vulnerable counties by the federal Centers for Disease Control, which identified 54 Kentucky counties as among the 220 most vulnerable in the nation to a rapid spread of HIV and hepatitis C infection among IV drug users.

Updated map available at http://chfs.ky.gov/dph/epi/HIVAIDS/prevention.htm

Feb. 1 is deadline to enter editorial writing contest for weekly newspapers; conference trip offered

The International Society of Weekly Newspaper Editors is accepting entries for the 57th annual Golden Quill editorial writing contest. Entries must be postmarked by Feb. 1.

Newspapers published fewer than five days per week are eligible for the contest. Entries must have been published in 2016. Each newspaper is allowed up to four entries; two is the maximum per person. The entry fee is $25 per person; checks should be made payable to ISWNE.

To enter, complete the PDF form at iswne.org (under Contests) and send a tearsheet with the Golden Quill entry clearly marked. Send two copies of each entry to Chad Stebbins, Missouri Southern State University, 3950 E. Newman Road, Joplin MO 64801-1595.

Entries should reflect the purpose of ISWNE: Encouraging the writing of editorials or staff-written opinion pieces that identify local issues that are or should be of concern to the community, offer an opinion, and support a course of action.

The Golden Quill winner will receive a scholarship and travel expenses up to $500 to attend ISWNE's annual conference June 28-July 2 at College Park, Md. Runners-up (called the Golden Dozen) will receive conference scholarships if they have not previously attended an ISWNE conference. Grassroots Editor, ISWNE's quarterly journal, will reprint the Golden Quill and Golden Dozen editorials in the Summer 2017 issue. For questions, email Stebbins.

Ads available for newspapers to defend public notice against attacks from local governments

New Jersey Gov. Chris Christie failed in his attempt to remove public notices from newspapers in the state, but the battle over taxpayer-paid advertising for taxpayers' benefit will go on there and in other states, because local governments keep lobbying state legislators to curtail public-notice laws.

The News Media Alliance, formerly the Newspaper Association of America, has developed three advertisements to make the argument for newspapers, which are estimated to get 8 to 10 percent of their annual revenue from government notices designed to inform the public of government actions.

NMA has given all newspapers permission to use the ads, one of which is shown here. Click on it to view a larger version. For the ads, click here and here.

Rates of leading causes of preventable deaths higher in rural areas, esp. in South, Southwest

Rural/urban death rates for stroke. (CDC graphic)

Mortality rates for the five leading causes of potentially preventable deaths—heart disease, cancer, unintentional injury, chronic lower respiratory disease and stroke—are higher in rural areas, says a study by the federal Centers for Disease Control and Prevention. Rates are particularly high in rural areas in the South and Southwest, led by Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma South Carolina, Tennessee and Texas, Lena Sun reports for The Washington Post.

The top five top causes of death "accounted for 62 percent of the total 1.6 million deaths in the U.S. in 2014," Sun writes. "Among rural Americans, more than 70,000 of the deaths were potentially preventable, the study found, including 25,000 from heart disease and 19,000 from cancer."

The study, which looked at deaths in the five areas from 1999-2014, blamed socio-demographic factors for higher death rates in rural areas. Residents of rural areas "tend to be older, poorer, and sicker than their urban counterparts," states the report. Rural residents also report higher rates of limited physical activity because of chronic conditions.

Obesity and smoking rates are often higher in rural areas, while a lack of access to health care and transportation can prevent some rural residents from seeing a doctor, Sun writes. Drug overdoses and vehicular deaths, categorized under unintentional injury, also are often higher in rural areas, while seat-belt is lower. (CDC charts; click on image for larger version)

GOP senators from Medicaid expansion states want to delay ACA repeal until a replacement is enacted

Republican senators who want to delay President-elect Donald Trump's plans to immediately repeal the Patient Protection and Affordable Care Act, until a suitable replacement can be enacted, are mostly from states that expanded Medicaid under the law, Sy Mukherjee reports for Fortune. About 20 million Americans stand to lose coverage if the law is repealed and not replaced.

GOP senators from Alaska, Louisiana, Maine, Ohio and Maine"signed on to an amendment Monday that would essentially delay (although non-bindingly) the repeal process by about a month to give congressional committees more time to craft an alternative," Mukherjee writes, noting that Alaska, Louisiana and Ohio have expanded Medicaid. Other Republican senators from Arizona, Kentucky (expansion states) and Tennessee (where the legislature blocked the governor's expansion plan) "recently warned against a hasty Obamacare repeal sans a replacement."

Mukherjee notes, "A number of red states have ardently refused to go along with the expansion, but Kentucky, Arkansas, Louisiana, Alaska, and other Medicaid expansion states have all seen massive drops in their uninsured rates after adopting it, providing a boon in rural regions where many hospitals regularly see patients who can't afford their care. There's also significant evidence that this newfound coverage has allowed previously uninsured people to access all sorts of basic medical treatments that they never used before, according to the Kaiser Family Foundation." (Kaiser graphic: States that have expanded Medicaid, as of October 2016, are in blue)

No snow? No problem, as ski resorts on federal land add warm-weather attractions under 2011 law

A slide at Vail Resorts in Colorado (Vail Resorts photo)

Western ski towns that operate at least partly on federal lands are adding year-round attractions to make up for a decline in tourism dollars from lack of snow blamed on climate change, Allen Best reports for High Country News. "In the East, where most ski areas operate on private or state lands, the push to create non-snow activities began some years ago. The payoff came last winter: At Christmas, many resorts were barren of snow, but New Hampshire’s Cranmore Mountain Resort drew visitors by reopening its bungee trampoline and ropes course. At Mount Sunapee, people zipped down a canopy tour line."

"But more than a hundred ski areas on Western national forests were governed by a 1986 law that authorized snow-related activities but provided no guidance for other uses," Best writes. "A 2011 bill sponsored by then-U.S. Sen. Mark Udall, a Colorado Democrat, greatly expanded what ski areas are authorized to do, as long as the new activities and facilities 'encourage outdoor recreation and enjoyment of nature' and 'harmonize with the natural environment'."

"As the Ski Area Recreational Opportunity Enhancement Act was being drafted, some environmental groups fretted that ski resorts would be turned into Disneylands, says Doug Young, then an aide to Udall," Best writes. "So the bill prohibits water parks, swimming pools, golf courses, tennis courts and amusement parks, even as it clears the way for mountain bike parks, ziplines and ropes courses." Vail Mountain in Colorado and Heavenly Mountain in Lake Tahoe were the test centers for summer activities.

The U.S. Forest Service, which charges ski areas for summer activities, has projected "about 600,000 summertime visits to ski areas and almost $32 million in additional direct spending in neighboring communities, with a ripple effect of 500 annual, temporary or full-time jobs," Best reports.

Obama creates three national monuments in Ala., S.C. on civil rights movement, Reconstruction

The bus (Photo by Joseph Postiglione via The Anniston Star)

President Obama on Thursday created three new national monuments in the South. "The White House said the president was using his authority to mark the upcoming Martin Luther King Jr. Day on Monday by creating two new sites in Alabama, the Birmingham Civil Rights National Monument and the Freedom Riders National Monument in Anniston," where a bus was attacked and burned, and the Reconstruction Era National Monument in South Carolina, Jennifer Yachnin reports for Greenwire.

The Birmingham Civil Rights National Monument will
save the A.G. Gaston Motel where Martin Luther King Jr.
had a "war room" before the motel was bombed in 1963.
The hotel, vacant for 20 years, will be restored.

Obama said in a statement: "Today, I am designating new national monuments that preserve critical chapters of our country's history, from the Civil War to the civil rights movement. These monuments preserve the vibrant history of the Reconstruction Era and its role in redefining freedom. These stories are part of our shared history. ... I have sought to build a more inclusive national park system and ensure that our national parks, monuments and public lands are fully reflective of our nation's diverse history and culture."

The Anniston monument will encompass two sites, the bus station where an interracial group of civil-rights activists "rolled into town challenging segregation on interstate buses" and were attacked by a mob, and "the site on Alabama 202 west of town where [the] bus broke down and was firebombed by a white mob," Eddie Burkhalter reports for The Anniston Star. Obama said in his proclamation, "Media coverage of the Freedom Rides inspired many people to take action and join the effort to end racial inequality."

"The Reconstruction monument includes several sites near Beaufort, S.C., which fell under control of the Union Army in November 1861, and became one of the first places where emancipated slaves voted, bought property and created churches, schools and businesses," reports Jennifer Scheussler of The New York Times. "For some historians, the creation of the Reconstruction monument, by the nation’s first African-American president, represents a particularly sweet symbolic victory" of a 15-year effort that was opposed by "the Sons of Confederate Veterans and others, and died in Congress. It was renewed in spring 2015." Stephen Fastenau of the Beaufort Gazette reports, "A National Park Service study concluded Beaufort County was the most logical place for a monument to the period during and after the Civil War because of the saturation of important sites."

Read more here: http://www.thestate.com/news/state/south-carolina/article126235164.html#storylink=cpy

Obama also expanded two national monuments. The California Coastal Monument, created by President Clinton in 2000 and expanded by Obama in 2014, will be expanded again by 6,230 acres. The Cascade-Siskiyou National Monument will add 42,000 acres of public land in Oregon and 5,000 acres in California.

Coal baron elected W.Va. governor facing conflict-of-interest issues surrounding business holdings

Jim Justice at The Greenbrier
 (USA Today photo by H. Darr Beiser)

The same conflicts of interest playing out nationally with President-elect Donald Trump are occurring on a smaller scale in West Virginia, Jonathan Mattise and Michael Virtanen report for The Associated Press.

Jim Justice, the billionaire operator of Southern Coal Corp. and owner of The Greenbrier resort, was elected governor of West Virginia, and like Trump, "has refused to shed his holdings, giving assurances he can be trusted to act honorably," reports AP. "Like Trump, he has put his business empire in the hands of family members, though he said as recently as last month that he would put his holdings in a blind trust." Justice, who has around 100 businesses in his name, has real estate, farm and resort holdings. That has raised "questions about how state agencies that answer to him will regulate the safety of his coal mines, consider the tourism tax breaks at his resort, or pursue millions of dollars in past-due state taxes owed by some of his entities."

AP continues, "One difference in West Virginia, though, is that Justice, like some other governors around the country, is subject to more stringent conflict-of-interest rules than even the president of the U.S., who is exempt from the provisions that apply to Cabinet members and other government employees," reports AP. "West Virginia ethics law prohibits public officials, the governor included, from knowingly using their offices for their own private gain or that of someone else. State regulations also bar public officials from profiting from state contracts over which they may have control."

Justice told reporters, "I'm going to try to remove myself completely. In fact, I'm going to remove myself completely from the daily decisions, the decisions that they make. But I want you to realize just this: What is the alternative? I mean, is it best to just close the businesses that I have? They generate tens and tens and tens of millions of dollars to our state. It would be frivolous to do that. It'd be absolutely the stupidest thing in the world to do. I don't want a thing—and absolutely I want to underline that—you can't bring me anything to my business that's going to be beneficial to me in any way."

Facebook launching year-long project to fight fake news and educate users on sources to trust

Edgar Welch is arrested in Washington, D.C.,
last month after taking a gun into a pizza
restaurant he thought hid a child sex ring
involving Hillary Clinton. That was a
fake news story he read on the internet.  

Facebook is joining the fight against fake news, Sarah Frier reports for Bloomberg Technology. The popular social media site, which has 1.79 billion users, is launching its Journalism Project, which "includes stronger partnerships with media companies, greater support for local news and better efforts to educate users to avoid hoaxes."

The project will follow "a year of debate over Facebook’s role in the media—inside the company and externally—during which it faced questions over whether the social network is biased in the way it presents news to users and whether it propagates false information," Frier writes. "Members of the media will be updated on the efforts, which include training for journalists and ways to promote news literacy among users, on a new Facebook Journalism Project page."

Facebook officials said they want to educate users "on what news sources to trust—a potentially thorny issue after a controversy last year over its trending topics section, which prioritized news from certain mainstream organizations, but not some popular conservative sites," Frier writes. "The company will work with outside organizations like the News Literacy Project and run public service ads and is open to making financial grants where necessary, Facebook said."

Repealing health reform could kill struggling rural hospitals, many in areas Trump carried

If Congress repeals the health-reform law, struggling rural hospitals, many in regions that strongly supported Donald Trump, could be in danger of shuttering, Shefali Luthra reports for Kaiser Health News. The Patient Protection and Affordable Care Act "threw a number of life-savers to these vital but financially troubled centers. And its full repeal, without a comparable and viable replacement, could signal their death knell."

Best Places map

Luthra's example is Highlands Hospital in Connellsville, a poor rural town in Southwest Pennsylvania, which has struggled with the loss of coal mining and manufacturing jobs. Trump won Fayette County with 64 percent of the vote. Without Obamacare's expansion of Medicaid, the 64-bed hospital, the town's second largest single employer, could close, costing the town hundreds of local jobs.

"In Pennsylvania, 625,000 people enrolled in the expanded Medicaid program," Luthra writes. "Close to 300,000 came from rural areas, said Andy Carter, president of the Hospital and Health System Association of Pennsylvania. As of October, about 42,700 of Fayette’s residents had Medicaid, according to state data, an increase of about 8 percent from 39,460 in June 2015. (Pennsylvania‘s Medicaid expansion took effect in January of that year.) That’s close to one-third of the county’s population."

"Rural hospitals have long operated on the edge," Luthra writes. "In the past six years, more than 70 such facilities have closed, citing financial duress. Almost 700 more have been deemed at risk of following the same path. Meanwhile, the need for reliable health care remains pressing. Conditions such as heart and lung disease are widespread in rural areas. Addiction to the prescription painkillers known as opioids is acute. Nationally, the Medicaid expansion offered a bit of stability for some rural hospitals at risk of closure. Researchers say it disproportionately benefited such facilities—particularly here and other states with large rural populations, such as Illinois, Kentucky and Michigan."

Penalties for patient-safety shortcomings hit 769 hospitals; could be nixed by Obamacare repeal

This is the third year federal government will apply penalties to hospitals that fall short of patient safety standards, leading one Consumers Union leader to wonder why hospitals aren't working harder to eliminate the infections and complications that are causing them to loose money, Trudy Liberman writes in her column for the Rural Health News Service.

“What I am most frustrated about is the lack of urgency in the country and at the agencies for eliminating these infections," Lisa McGiffert, head of the Consumers Union Safe Patient Project, told Liberman. "They are aware of them, but there’s not a sense of urgency to stop them."

"The penalties, along with the entire program to eliminate hospital-acquired conditions, were authorized under the Affordable Care Act," Liberman writes. "They could be in jeopardy if the law is repealed. Some hospitals probably would be happy if they disappeared."

Penalties are levied against hospitals that have a high number of patients with avoidable infections and complications, including blood clots, urinary-tract and surgical-site infections, bed sores and falls. And this year, infections related to antibiotic-resistant infections, like methicillin-resistant Staphylococcus aureus (MRSA) and C. difficile, have been added to the list.

Medicare will impose a 1 percent cut in payment to 769 U.S. hospitals who fell short of these patient safety standards in the fiscal year that ended Sept. 30. Since the inception of the penalty program, Lieberman reports, 241 hospitals have been punished in all three years, but 347 that were penalized last year are not on the "bad-guy list."

Critical-access hospitals (by definition, rural) and specialized hospitals that treat psychiatric patients, veterans and children are exempt from the penalties.

Despite recent controversies, support for Trump among rural Iowans who shifted red remains high

2016 county presidential election
results in Iowa (Wikipedia maps)

Recent controversies surrounding President-elect Donald Trump have done little to quell his popularity in rural eastern Iowa, "the epicenter of the political quake that made Trump president," Trip Gabriel reports for The New York Times. Gabriel, who spent a year living in Iowa leading up to the caucuses in early 2016, recently returned to see if public opinion about Trump had changed in a state that President Obama won in 2012, but that Trump won handily in 2016. More than 30 Iowa counties swung from Obama to Trump.

2012 presidential election results

"Al Ameling, 58, a technical analyst who lives in Marble Rock, near the Minnesota border, is representative of the profound demographic shift among white rural voters in the northern Midwest that helped produce Trump’s stunning upset," Gabriel writes. "Ameling voted for Obama in 2008, sat out in 2012 and enthusiastically backed Trump. Nothing he has heard since Election Day has shaken his support, including reports this week that American intelligence agencies are investigating unverified accounts of meetings between Trump aides and Russian officials, as well as salacious activity by Trump in Moscow. On Wednesday, Trump called the allegations completely false."

Ameling told Gabriel, "The way it is nowadays, unless I see positive proof, it’s all a lie. I don’t know if it was classified, but if it was, whoever leaked it needs to go to jail. We need law and order back in this country.”

Gabriel writes, "The Iowans I interviewed largely went about their lives outside the political hothouse social media. They did not follow hour-by-hour developments of the presidential transition. Indeed, on Wednesday, several were unfamiliar with the reports that Russia was holding compromising information on the president-elect, which Trump addressed in a news conference. Many were hazy on specific policy details about how, say, House Republicans were seeking to replace Medicare with a voucher system. These voters feared an outbreak of European-style terrorist attacks by Muslims in the U.S., maybe in their own communities. And overwhelmingly, Trump supporters did not want their hard-earned money redistributed to people they regarded as undeserving."

Mike Staudt, a retired farmer from Marble Rock who voted for Obama in 2012 but supported Trump in 2016, called the Affordable Care Act a form of socialism, Gabriel writes. Staudt told him, “I know these guys are really rich. They may have pulled off a few plays that weren’t exactly on the up-and-up, but they all had to be pretty smart to be billionaires. If they replace their own concerns with the concerns of the country, they can make things really move forward. That’s what I’m excited about.” (Read more)

Farmers come to rescue of town covered in snow

Farmers clear snow in Harrah, Wash.
(Yakima Herald photo by Jake Parrish)

Leave it to farmers to save local residents from being snowed under. Snow has piled up so high in the town of Harrah, Wash., on the Yakima reservation, that the snow budget of $500—usually spent entirely on sand—isn't enough, Phil Ferolito reports for the Yakima Herald. So farmers on Wednesday "brought out tractors, front-end loaders and a backhoe to clear snow from roads and parking spaces in the center of town."

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Harrah, which hasn't seen this much snow—17 inches has fallen this winter—in at least 20 years, has a one-man Public Works Department for a population of 650, and relies on local volunteers for snow removal, Ferolito writes. Farmers were more than ready to help. "Two front-end loaders at opposite ends of town scooped snow from large piles in parking lots, around stop signs and in front of the fire station and then dumped it into irrigation ditches just outside town." (Read more)