Quick hits: Gardening through a drought; Delta farmworkers claim discrimination; just how rural is your place?

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.

Baby formula is coming back, but it's still harder to find in rural areas than cities. Read more here.

Here are tips for keeping your garden going during a drought. Read more here.

Demand for electric and hybrid-electric vehicles is growing faster in rural America than in metro areas (perhaps because there was more ground to make up). Ford is hoping its fully electric F-150 Lightning, comparably priced with its gasoline-powered cousin, will win over rural audiences. Read more here.

An investigation found that some farms in the Mississippi Delta paid their primarily Black local farmers less per hour than foreign workers with H-2A visas, who were most often white men from South Africa. Some Black farmworkers have filed suit, alleging racial discrimination. Read more here.

Determining just how rural a place is can be complicated, since federal agencies use different, often conflicting, definitions based on various criteria. The Rural Health Information Hub has an interesting interactive widget that allows you to see whether where you live is considered rural and by which federal standards. Read more here.

Farmers' markets have been around for a few millennia, and they continue to play an important role in communities today. Read more here.

Fewer drug companies are participating in federal drug-discount program, posing another threat to rural hospitals

"Hospitals and community and rural health clinics that serve low-income patients say drug manufacturers have threatened their financial stability by dramatically cutting back their participation in a federal drug-discount program that saves those health providers millions of dollars a year," Michael Ollove reports for Stateline. "Without the drug discounts, the hospitals and clinics say, they are getting close to laying off health-care workers, reducing hours or scaling back or scrapping mobile health vans, free cancer screenings, behavioral-health treatment and a host of other services that help patients with low incomes who lack insurance."

The program is known as 340B, for a section of law. Drug companies give a discount (generally 20%-50%) to providers that serve patients regardless of ability to pay. "In exchange, the government promises that Medicare and Medicaid will cover their products," Ollove reports. But in the past two years, 17 drug companies, including Bristol Myers Squibb, Johnson & Johnson, Gilead, Merck and Pfizer, have reduced their participation. Their lobby, "PhRMA, argues that the discounts have been used too broadly and for patients who could afford the drugs’ higher retail prices."

Drug makers also don't like providers letting patients fill prescriptions at their "contract pharmacies," which charge the discounted rates. PhRMA argues that there isn't enough transparency from the contract pharmacies to ensure that providers aren't abusing the program. "But safety-net providers say eliminating those drugstores, many of which are geographically closer to their patients, essentially deprives them of savings and their patients of 340B discounts," Ollove reports. "Only small minority of safety-net providers operate in-house pharmacies."

PhRMA bases its objections on two studies: A 2020 report from the Government Accountability Office that found 1,536 rule violations in 2012-19, and a 2018 study in the New England Journal of Medicine that said there's no clear evidence the program has expanded care or lowered mortality rates of low-income patients. But safety-net providers "assert that violations of the rules represent a tiny fraction of the thousands of prescriptions filled under the 340B program," Ollove reports. "They point out the program is overseen by the U.S. Department of Health and Human Services and insist that they plow all the savings back into the mission of caring for low-income patients. The New England journal’s study, they say is flawed."

The drugmakers' withdrawal from the program has hurt many rural hospitals. Recently surveyed hospitals "reported median annual losses of $2.2 million in discounts, with a tenth of those hospitals expecting losses of $21 million or more," Ollove reports. "Rural hospitals surveyed expected annual losses of $448,000, with a tenth projecting losses of $1.3 million or higher. That comes amid a financial crisis that has seen at least 130 rural hospital closures in the past decade." In another survey, one-third of community health centers said that, without 340B discounts, more than half of their patients would go without vital medications such as insulin or inhalers for children with asthma.

“These are billion-dollar companies. . . . The percent they are taking from us is so small to their bottom line, but it is so significant to us," Dr. Kemi Alli, CEO of the Henry J. Austin Health Center in Trenton, N.J., told Ollove. "It just seems inconceivable why they even put the effort into this to take away from the most vulnerable in our society. It doesn’t make any moral sense."

Rural radio talk-show hosts emphasize info, not ideology

Don Neagle at WRUS-AM/FM in Russellville, Ky.

When most Americans hear the phrase "talk radio," they probably think of right-wingers stirring local outrage about national issues, as Stuart Thompson reports for The New York Times.

But many if not most local radio talk-show hosts, especially those in rural communities, emphasize information over ideology. Amy Cobb of Kentucky Living magazine illustrates that with an excellent series of short profiles of broadcast personalities at local radio stations in the state, most of whom reach rural audiences. She shares punchy anecdotes about how the hosts got into broadcasting, what their shows cover, and what they love about broadcasting. Most feature quotes emphasizing how the broadcasters serve the public.

Greg Dunker at WKYX-FM in Paducah shared with Cobb how the station worked to inform locals about rescue and recovery efforts following the deadly tornadoes in December. Tim Smith of WWKY in Winchester told Cobb, “Local radio is extremely important to local communities. We take what we do very seriously.”

Don Neagle, a Kentucky Journalism Hall of Fame member whose career at WRUS-AM/FM in Russellville spans nearly 70 years, is semi-retired but still brings big issues home to Logan County through a wide-ranging interview show, "Feedback," with guests from all over. "I’ve tried to cover so much, and hopefully the information is good and useful for people to hear," he told Cobb.

Cale Tharp of Hodgenville has also had long a radio career, but dreamed of owning his own station. In 2018 he bought WLCB-AM's license and a year later "the same building on the downtown square that had once been home to the station where Tharp spent time as a kid," Cobb reports. "His 'program' has no name because Tharp says he’s on the air all day long," playing country music and talking.

Kentucky Living is a publication of the Kentucky Association of Electric Cooperatives.

Think-tank VP returns to rural Ohio hometown, finds growing wariness of Trump but continued support of his policies

Darrell West, vice president of the Brookings Institution, a Washington, D.C., think tank, grew up in Eaton, Ohio, a town of 8,400 in Preble County, pop. 42,000, west of Dayton. He returned recently for his 50-year high-school class reunion and reports that he found in this place with "conservative tenor" a growing wariness about Donald Trump, who won 78 percent of the county's vote in 2020.

Darrell West

"Many of the people I encountered had voted for Trump in 2020 but displayed surprising hesitancy about his possible 2024 candidacy," West writes. "On the one hand, nearly all of them liked his policy agenda. They openly scorned what they saw as the Democrats’ turn to the left and Biden’s ineffectiveness in dealing with inflation, Covid, foreign policy, and border security. They wanted someone who would keep government spending in check, slow the speed of the pandemic (without mask mandates or mandatory vaccinations), and stop the flow of immigrants across our southern border.

"Yet on the other hand, they didn’t like Trump’s abrasiveness, wondered what to make of the Jan. 6, 2021 insurrection, and preferred someone who would follow Trump’s line but not antagonize so many people. Their ideal candidate seemed to be someone who supported Trumpism but with a nicer persona. In general, many of them told me they hoped Trump would not run, but that someone with his policy views would become the GOP nominee. This is consistent with data compiled by the Brookings Primaries Project based on an analysis of 2022 congressional primary candidates."

The lesson for Republicans, West writes, is "A nicer version of Trump, at least from a personality and public presentation standpoint, clearly would be the strongest GOP nominee for heartland voters. If Trump is the nominee, some Republican voters fear that campaign could reelect Joe Biden."

Preble County (Wikipedia map)

West says most of his Ohio acquaintances hope Biden doesn't run because he is too old, but he worries what might happen then: "The party could end up with a progressive candidate who would harness the anger unleashed by the court decision, mobilize mass voters, and make 2024 completely unlike 2020. Of course, that would fuel sentiment in the heartland that the Democratic Party has been taken over by extremists and raise the level of conflict and antipathy between the two sides. The only safe prediction in that situation is a high-stakes election, record turnout from both sides, and political adversaries who neither trust nor like the opposition. If you think America is highly polarized now, it actually could get a lot worse and turn violent in ways that would shock both Americans and foreigners."

That relates to the big issue of the day, the Supreme Court's removal of the right to abortion, West writes: "While most of the people I knew in D.C. bemoaned the decision as a betrayal of promises made during Senate confirmation hearings and a tragic rollback of women’s rights, a number of acquaintances in rural Ohio applauded the decision. Some of my hometown folks had spent decades organizing the grassroots, rallying churchgoers, running for local office, and supporting pro-life candidates financially. For them, the court decision represented the culmination of a life’s work and evidence of how their political activities over several decades had paid off. . . . Although Republicans were pleased with the court decision, several recognized the new abortion decision would further divide the country, generate a massive counter-offensive from progressives, and pit state against state in a dangerous manner. They wondered what it would mean for other issues such as same-sex marriage. Despite their general conservatism, they recognized that same-sex marriage had become broadly accepted in many places around the country and that conservatives did not have the same ethical ground on that topic as they did when it came to life and death debates over fetuses."

Report: 33 minors are seriously hurt on farms every day, and one dies from ag-related injuries about every three days

Farming remains the deadliest job for minors in the U.S., according to a newly released fact sheet on childhood farming injuries from the National Children's Center for Rural and Agricultural Health and Safety. Here are some highlights from the report:

• Fatalities among youth working on farms outnumber those from all other industries combined.
• Between 2001 and 2015, 48% of all occupational fatalities to minors were agriculture-related.
• At least 33 minors (those under age 18) are seriously hurt in an agricultural setting every day.
• One minor dies in an ag-related accident about every three days.
• The leading source of such fatalities involve transportation (47%) such as all-terrain vehicles and tractors.
• Another 20% of farming fatalities for youth involve contact with machinery such as skid steers, and 13% involve violent contact with animals and other humans.
• Youth under age 16 are 12 times more likely to sustain an ATV injury (fatal or nonfatal) than adults.

The organization's website has materials on ATV safety, a youth farm safety checklist, and work guidelines for all ages.

Rural-urban digital divide is major obstacle to sustaining local news in rural areas, Report for America chief says

The United States is "becoming a nation of local news haves and have nots," and the digital solutions being pursued mainly in urban areas "may be locking in this divide," to the detriment of rural areas, Steven Waldman writes for The Poynter Institute. He is president of Report for America, which funds local reporting positions, and chair of the Rebuild Local News Coalition., which "advocates public policies that will strengthen communities by creating a more robust, more inclusive local news system, without endangering editorial independence."

Steven Waldman

Waldman cites the recent State of Local News 2022 report, which says "The economically struggling, traditionally underserved communities that need local journalism the most are the very places where it is most difficult to sustain either print or digital news organizations." It says the closure of newspapers is happening "more often in poorer and older communities," and "Among those especially hard hit are red-voting rural areas and blue-voting low-income urban areas," Waldman writes.

The report noted hundreds of new digital news sites, but most of them are in affluent areas with first-class internet service. "Wealthier communities always had more news choices. But at least moderate- and low-income communities had a baseline of solid local news providers. Now, increasingly, they don’t," Waldman writes. "That will make those communities sicker — literally and figuratively. We know that poorer communities are more likely to get their information from social media, which is more likely to provide misinformation. They will also become less healthy democracies. Studies have shown that communities with less local news have less competitive elections, more corruption, more pollution, higher taxes and less resident involvement in civic institutions."

Modern immigrants succeed just like those of Ellis Island era; the main key is living in places with lots of opportunity

The U.S. has seen two major immigration waves since the Civil War. "The first came from Europe in the late 1800s and early 1900s: the Ellis Island era. The second, which continues today, started in 1965 with sweeping changes in immigration law that welcomed people from around the globe, particularly Latin America and Asia," Andrew Van Dam reports for The Washington Post. "In American mythology, the (largely White) huddled masses of the Ellis Island era teemed to our shores, tamed the prairies, powered the Industrial Revolution and became the heroes of the American success story. Today’s (largely non-White) immigrants are portrayed somewhat less charitably, often as people who came without marketable skills, looking for a handout."

But that's not true, according to years of research and analysis of detailed census records. "Thousands of genealogists, toiling anonymously, have shattered that myth and upended our perception of American immigrants," Van Dam reports. "No spoilers, but the data shows that the current wave of immigrants is succeeding and assimilating at virtually the same rate as immigrants did a century ago."

In fact, the children of immigrants have been more likely to climb the economic ladder than native-born Americans, both in the Ellis Island era and now, Van Dam reports. Researchers have determined that the biggest factor was geographic mobility. 

"Immigrant kids tended to outperform their peers from similar economic backgrounds because, unencumbered by deep hometown roots, their parents were willing to move to where the jobs were," Van Dam reports. "If you compare immigrants to similar native kids born in the same place, they succeed at similar rates. It’s just that immigrant kids are much more likely to have grown up in one of those high-opportunity places."

Congress keeps some pandemic-era expansions of school-nutrition programs, which could mean more in rural areas

Screenshot of interactive map by The Daily Yonder; for the interactive version, click here.

Congress recently passed, and President Biden signed, the Keep Kids Fed Act to extend some special school-nutrition measures taken during the pandemic. "It could offer a summer lifeline for those in rural areas who rely on school-served meals during the vacation season," Sarah Melotte reports for The Daily Yonder. "The act doesn’t keep the provision of universal free meals to students, but it does expand those eligible for free lunches and increases the reimbursement rate for schools, among other things."

The first pandemic relief bill created child nutrition waivers because "children could not receive meals at school because of lockdowns," Melotte notes. "The waivers increased federal reimbursements for lunch programs and allowed schools to omit eligibility requirements for free and reduced-price meals. A USDA survey found that 90% of schools took advantage of the increased funding and waivers to provide free meals to students regardless of income. The waivers also allowed schools to establish grab-and-go lunches during the summer" in more than just low-income neighborhoods.

"The Keep Kids Fed Act allows schools to continue to deliver meals and provide grab-and-go options," Melotte notes. That's important for rural families, because food insecurity is greater in rural areas. "Rural students may face other challenges such as transportation to and from meal distribution sites during the summer, especially with increasing fuel prices," Melotte writes. "Some families cannot afford to drive to a daily food pick up site to get a free lunch, a challenge exacerbated if they also live in a rural food desert . . . areas without a grocery store for 10 miles."

The act "does not allow all students to eat school meals free of charge in school year 2022-23," said a news release from the Department of Agriculture, which runs school-nutrition programs. "In most school districts, families will need to complete an application through their school to determine if their household is eligible for free or reduced-price school meals, as was done before the pandemic. USDA is also supporting the expansion of direct certification, which uses existing data to certify children for free or reduced-price meals without an additional application. All states are required to directly certify students for free meals if their household receives SNAP benefits, and some states also directly certify for free and reduced-price meals based on participation in Temporary Assistance for Needy Families, the Food Distribution Program on Indian Reservations or Medicaid."

Register by 5 p.m. CT Thurs. for Rural Health Journalism Workshop in Chattanooga on July 14; registration $50 tops

There's still time to register for the Rural Health Journalism Workshop 2022, which will be held July 14 in Chattanooga, Tenn. The one-day conference is free for members of the Association of Health Care Journalists. Registration will close at 5 p.m. CT Thursday, July 7. Membership is usually $60 a year, but AHCJ will knock $10 off if you use the code RURAL22 when you register.

From the workshop website: "This workshop will bring journalists together with health care and policy experts who focus on the medical challenges of rural areas. Leave with a better understanding of what’s happening – or will be happening – in rural regions, and return to work with dozens of story ideas you can pursue. You don't have to live in a rural area to write great stories about what's happening just beyond the city limits. And think about how much policy is set based on the non-urban population of your state. This special one-day, no-fee workshop will help you find and cover health stories in rural America."

Sessions will cover data resources for reporters, rural health-care resource inequality during the pandemic, the promise and limitations of rural telemedicine, mobile clinics and other creative approaches to bridging rural health-care gaps, how to ask the right questions about opioid settlement money, and how to boost the number of rural doctors and nurses by establishing health-care pipelines in schools. Click here for more information about each session as well as a full list of panelists.

The conference is hosted by the University of Tennessee's Health Science Center, Cempa Community Care and Erlanger Health System, and is sponsored by The Leona M. and Harry B. Helmsley Charitable Trust, the Robert Wood Johnson Foundation, and The Commonwealth Fund.

Midwestern fish farms face marketing, processing obstacles

Food costs are going up, and so is fish and seafood consumption in the U.S. That sounds like a good omen for Midwestern aquaculture farms, but "Many fish producers say they face challenges getting their produce to consumers in the region," reports Casey Smith  of The Associated Press.

Experts say the Midwest could be an aquaculture powerhouse, but the number of fish farms in the region fell from 336 to 271 over the past decade. "This could be because the region has historically relied on wild-caught seafood, said Amy Shambach, an aquaculture marketing outreach associate with the Illinois-Indiana Sea Grant. Seafood produced in the Midwest also must compete with cheaper, imported seafood," Smith reports. Higher production costs might also be to blame. 

"Stagnant fish farming in the Midwest aquaculture industry has national implications, Shambach said. With global seafood consumption expected to increase by 100-170 billion pounds by 2030, the growing seafood trade deficit means more fish will need to be farm-raised, opening the door for Midwestern farmers to meet demand," Smith reports. There is plenty of local demand, restauranteurs say, but the lack of local fish processors is a problem, Smith reports.

A portrait of a rural weekly and its sole employee: the owner, 77, who needs a buyer and wants to keep local coverage

Shirley Dunham (Photo by Nina Baker)

The Daily Yonder has a portrait of an independent rural weekly newspaper in Montezuma, Iowa, kept alive by its last remaining employee: a 77-year-old owner who says she plans to keep going for another decade.

The Montezuma Record has been a fixture in the town of 1,500 since 1924, but declining revenue and readership have slowly whittled it away. Shirley Dunham became the last employee when the previous executive editor, her husband Charles, died in 2018, Nina Baker reports.

The paper was losing money when Dunham took over, and she has only been able to keep it operating because no one who works for it—including her—takes a paycheck. In 2020 the paper confounded the pandemic phenomenon and began making a profit because businesses bought advertising in search of new customers, Baker reports.

The paper, with a circulation 600, alos gets a lot of support from local nonprofits. Montezuma Lions Club member Roger Allen told Baker that they take out ads in the Record because "We think it's important that our community still has a newspaper ... We try to support it just on that principle." That's not the only local support the Record enjoys, Baker reports:. "Dunham’s subscriber base expanded as well. She said she thinks that with more residents staying at home, some began to gravitate towards the Record to stay up-to-date with local news, but she can’t be certain."

Montezuma in Poweshiek County
(Wikipedia map)

Dunham said she won't retire for at least another decade, and when the time comes, she'll likely sell to a chain since no one local is interested. Gannett Co. bought the other Montezuma newspaper, The Montezuma Republican, and its neighbor, The Brooklyn Chronicle, in 2000, Baker reports: "Gannett merged both papers in 2009 due to declining circulation. The new paper, called The Poweshiek County Chronicle-Republican, does not circulate widely in Montezuma."

Dunham acknowledges that any new owner will probably combine the Record with another paper, a common move these days, but she has one condition for would-be buyers: "If the newspaper is merged, at least one full page must always be allocated to coverage of Montezuma." But buyers may be scarce. Many small papers owned by families or individuals have closed because they can't find buyers.

Struggling rural hospitals can go emergency-only, starting next year; new Medicare agency rule lays out the process

"The Biden administration released a proposed rule that grants more regulatory flexibility for small, rural hospitals in a bid to curb a worrying trend of facility closures," Robert King reports for Fierce Healthcare. "The Centers for Medicare and Medicaid Services’ proposed rule released Thursday outlines the conditions of participation for a facility to become a Rural Emergency Hospital, which enables a facility to offer emergency care, observation and other outpatient services."

In December 2020 Congress created the rural emergency hospital as a new type of Medicare provider. The model, which takes effect in 2023, aims to mitigate the loss of emergency services in rural areas where hospitals have closed. Some small rural hospitals or critical-access hospitals can convert to REHs, facilities that provide 24-hour emergency services but no inpatient care. The new classification matters because rural hospitals rely on Medicare reimbursements, but in order to receive it they must maintain expensive inpatient beds so they can still be classified as hospitals. (This webinar had a good overview.)

"CMS’ goal for the new designation is to enable small facilities in rural areas and critical access hospitals to “right-size their service footprint and avoid potential closure,” according to a fact sheet on the rule," King reports. "Overall, the conditions of participation closely align with current conditions for critical access hospitals. However, CMS is seeking comments on specific standards for the rural facilities, such as whether the agency should require a facility to also provide outpatient surgery services if surgical labor is necessary. "

Judge rejects claim by W.Va. community that nation's three largest opioid distributors should pay for public nuisance

A federal judge has rejected claims by Cabell County, West Virginia and the county seat of Huntington that the nation's three opioid distributors caused a public nuisance by sending millions of pain pills into the community and should pay for the damage they caused.

U.S. District Judge David Faber said "The opioid crisis has taken a considerable toll" on the county, and "While there is a natural tendency to assign blame in such cases, they must be decided not based on sympathy, but on the facts and the law."

Faber tried the case 11 months ago after the three companies, AmerisourceBergen, Cardinal Health and McKesson Corp., waived their right to a jury trial, Courtney Hessler reports for The Herald-Dispatch in Huntington. 

Cabell County (Wikipedia map)

"Following the trial, the three distributors finalized a $21 billion national deal with a vast majority of states, counties and cities to resolve most of the lawsuits against them. Communities in West Virginia were not part of that deal," Meryl Kornfield, Scott Higham and Sari Horwitz report for The Washington Post. "Lawyers for the plaintiffs said they are considering an appeal."

Hessler reports, "Faber said the city and county failed to prove the defendants did not maintain effective controls against diversion of the opioids into the illicit market," or that they lacked due diligence in stopping suspicious orders. "It was good-faith prescribing that drove the increased volume of prescription opioids, he ruled."

"Finally, he ruled that the plaintiffs failed to devise a detailed abatement plan outlining how the communities would spend any money they received if they did prevail at trial," the Post reports. "In the end, Faber ruled that public nuisance statutes had been wrongly applied in the case."

The plaintiffs showed that company officials "made light of the public health crisis in emails. They questioned AmerisourceBergen executive Chris Zimmerman about a parody song about “pillbillies” addicted to OxyContin when he testified in May. Public outrage over the news of the email spurred death threats, according to the company’s lawyers," the Post reports. Zimmerman testified that he shouldn't have sent the email, "but he added that the exchange was cherry-picked and that the corporate culture at AmerisourceBergen was the 'highest caliber'."

Mountain State Spotlight reports, "Another trial, with dozens of West Virginia cities, towns and counties suing the same three big drug distributors, is scheduled to begin Tuesday in Charleston. Although this trial is in state court and being handled by Mercer Circuit Judge Derek Swope, many of the other participants, including the lawyers, are the same."

UPDATE, July 12: MSS's Ian Karbal explains how the drug distributors prevailed at the trial.

Appalachian commission's annual update of county economic status shows 15 more lower-status counties

The Appalachian Regional Commission has issued its annual categorization of the economic status of the 423 counties Congress has told it to serve. The new list and map have more lower-status counties, which the federal agency blamed on the Covid-19 pandemic.

The categories and their numbers are distressed (82 counties), at risk (109), transitional (218), competitive (10) and attainment (4). The number of distresses counties increased by one, and 14 counties moved from transitional to at-risk. ARC says it uses the designations to help it determine "match rates for projects and target investments to distressed areas." Its website adds that census tracts within distressed counties can be labeled distressed if they have have a median family income two-thirds or less of the U.S. average and a poverty rate at least half again as much as the U.S. average.

EPA is putting new restrictions on prestcides malathion, diazinon and chlorpryifos to protect endangered species

The Environmental Protection Agency is putting new restrictions on three widely used pesticides, citing the need to protect threatened and endangered species in critical habitats. The new label changes to malathion, chlorpyrifos and diazinon follow a final opinion issued last week from the National Marine Fisheries Service as part of an Endangered Species Act review, Todd Neeley reports for DTN/The Progressive Farmer. Few of the restrictions will apply to users in the Corn Belt; the new rules are mostly for those on the coasts and in the Northeast.

"Though the agency already has banned ag uses of chlorpyrifos, the EPA announcement could be emblematic of the future of ag chemicals as ESA reviews continue," Neeley reports. "EPA now has 60 days to request from registrants of the insecticides to submit amended labels to the EPA. According to a news release from EPA, the registrants will then have 60 days to submit new labels."

Marc Heller reports for the Energy & Environment Network: "Among the new limits, diazinon can no longer be applied from the air, and chlorpyrifos can’t be applied over wide areas for the control of ants, for instance. Other conservation measures are aimed at keeping pesticides out of water, and reducing the overall load of the chemicals at any time." Neeley has a more detailed run-down of restrictions on each of the three pesticides.

July 4 reflections: If our national divisions run along rural-urban lines, rural news media should pay attention to that

By Al Cross, director and professor
Institute for Rural Journalism and Community Issues, University of Kentucky

Economist and liberal New York Times columnist Paul Krugman, in his effort to figure out what made the Republican Party "so extreme" (and he notes that mainstream analysts called it an "outlier" 10 years ago), writes that he looked for "cases in which right-wing extremism rose even in the face of peace and prosperity, and I think I’ve found one: the rise of the Ku Klux Klan in the 1920s."

July 4 in Boone, N.C. (High Country Press photo)

That Klan was actually a revised iteration of the first Klan, the terrorist group in the Reconstruction South. The reprise was "a white nationalist movement, to be sure, but far more widely accepted and less of a pure terrorist organization [at least in the North]. And it reached the height of its power — it effectively controlled several states — amid peace and an economic boom," Krugman writes. He cites Linda Gordon’s The Second Coming of the K.K.K.: The Ku Klux Klan of the 1920s and the American Political Tradition, which he says "portrays a 'politics of resentment' driven by the backlash of white, rural and small-town Americans against a changing nation. The K.K.K. hated immigrants and 'urban elites'; it was characterized by 'suspicion of science' and 'a larger anti-intellectualism.' Sound familiar? OK, the modern G.O.P. isn’t as bad as the second K.K.K. But Republican extremism clearly draws much of its energy from the same sources. And because G.O.P. extremism is fed by resentment against the very things that, as I see it, truly make America great — our diversity, our tolerance for difference — it cannot be appeased or compromised with. It can only be defeated."

Historical analogies can be useful, as George Santanaya reminded us by saying "Those who cannot remember the past are condemned to repeat it." Immigration is again a big issue, but the last century has seen many changes. Skeptics of science are driven not so much by religion (we are approaching the 100th anniversary of the John Scopes trial) as by political motive, a sad legacy of the Covid-19 pandemic. Rural America is now a very small piece of the U.S. population, though it still enjoys over-representation in the Senate and to a lesser degree in the Electoral College. But the biggest change in politics has been that the sharpest lines drawn not by economic concerns but by issues of personal belief and conscience, such as abortion and gender identity, on which there is little room for compromise. The 1973 Supreme Court's Roe v. Wade compromise lasted almost 50 years, but has been abolished by today's court, which a key expert says is the most conservative since 1931.

More broadly, changes in the media landscape have poisoned our politics. The advent of television brought us the widespread use of political money and the cheapening of political debate. The rise of cable TV brought us audience-hungry news channels that are more likely to give viewers what they want to hear rather than what they need to hear. Such misinformation grew exponentially with social media, which have delivered a wave of nationally oriented news and opinion and reduced the time and attention that Americans give to local issues. Those platforms and the internet have destroyed the advertising-based business model for newspapers, the main finders of fact in our society. And as local politics has become nationalized, small-town newspapers have grown even more wary of alienating readers and advertisers by weighing in on national issues.

But if the deepest fault line in our politics runs along the rural-urban divide, such reluctance by small-town newspapers is a disservice to their communities, their states and the nation. Publishers and news staffers who are fully engaged with their communities, and provide reliable news coverage, have the level of trust and respect to cover and comment on divisive issues. And such coverage and commentary can create bridges that make the issues less divisive. In small places where we know each other and want to get along may lie the beginnings of bigger bridges that could heal the nation.

World using more coal, but that doesn't mean a U.S. boom

"An energy-starved world is turning to coal as natural-gas and oil shortages exacerbated by Russia’s war against Ukraine lead countries back to the dirtiest fossil fuel," report Jenny Strasburg and Phred Dvorak of The Wall Street Journal. "From the U.S. to Europe to China, many of the world’s largest economies are increasing short-term coal purchases to ensure sufficient supplies of electricity, despite prior pledges by many countries to reduce their coal consumption to combat climate change. The global competition for coal—also now in short supply after years of declining investment in new mines and resources—has driven benchmark prices to new records this year."

But that doesn't necessarily mean restoration of coal jobs lost in the U.S. Other nations aren't signing long-term contracts with coal producers, unlike those who supply natural gas, which is increasingly being shipped overseas in liquid form, the Journal reports: "The kind of coal production most easily scaled up is lower-quality coal, generally mined close to the surface, that is less efficient and can satisfy only a fraction of Europe’s coal-import needs, said Natalie Biggs, head of thermal-coal market analysis at energy consulting firm Wood Mackenzie."

U.S. coal production "can only increase so much without pouring significantly more money into" mines to expand them, said Chris Walker of  Peabody Energy Corp., "who until last year led the company’s international marketing and trading operation." However, "Parts of the U.S. are boosting use of coal power, as high demand for electricity amid unusually hot temperatures pushes regional power grids to the brink of blackouts this summer."

Gannett sells Indianola newspaper; Paxton buys O'Bannon papers; another family-owned Texas weekly needs a buyer

Amy Duncan and Mark Davitt

Add Indianola, Iowa, to the list of places where Gannett Co. is selling a newspaper. Two former executives of The Indianola Record-Herald and the Indianola Tribune are buying the operation and plan to publish a weekly print edition along with the Independent Advocate, a website they started in January 2019. (Here's Gannett's story on it.)

Paxton Media Group, one of the few chains buying newspapers, has purchased The Corydon Democrat and the Clarion News from the O'Bannon family, which had owned the Democrat since 1907 and included the late Frank O'Bannon, Indiana governor in 1997-2003. Paxton, based in Paducah, Ky., owns several other papers in southern Indiana and about half of those in western Kentucky (and about a third of those in the state as a whole).

Last week's State of Local News 2022 report from Northwestern University showed that Texas has lost more newspaper journalists, relative to population, than any state except two that are more urbanized, reports Sewell Chan, editor of The Texas Tribune: "Over the past 17 years, the Lone Star State lost about eight newspaper journalists per 10,000 residents, while California and New Jersey each lost around 10 at that same rate. . . . Over that period, Texas lost about one-third of its newspapers — 211 closed, leaving 423. . . More than one-tenth of Texas counties — 27 of 254 — no longer have a local newspaper, daily or weekly."

One more may be soon be added to that list. Chan reports that O.D. and Carolyn W. Anderson published the last edition of the Rocksprings Record and Texas Mohair Weekly June 30 and are still looking for a buyer. “My husband and I are 78 and 84, we have some health issues,” Carolyn Anderson told Chan last week. “We have two daughters, but they have their very separate lives. . . . We have a little bit of interest, but not enough right now.” Edwards County, in southwest Texas, has 2,000 people.

Here's a report from Gateway Journalism Review on the Western Iowa Journalism Foundation, which "works to target specific counties in Western Iowa to help raise money for publications to fund projects – both big and small." Its part-time executive director, Becky Vonnahme, told Olivia Cohen, “In rural areas especially, our mission right now is that you just need to have a valid news source; so many parts of the country in rural areas have lost their newspaper and we really feel, at the foundation that it is leading to the misinformation and the disinformation, peoples reliance on social media … because there isn’t a valid news source.”

Emily Weaver

Emily Weaver had to close the weekly Mount Olive Tribune, but "Losing this one has encouraged me to work even harder to propel The Daily Record forward in Dunn," she tells a former North Carolina colleague. "I have new goals and plans to reach them." In a farewell note, she told readers, "Every community needs that check and balance, that watchdog who tells people when their taxes are going up and when their hard-earned tax dollars are misspent. They need someone to let them know what happened next door when all of the police cars were there or where to find that special bargain or how to contact their legislator who represents them. Newspapers and media outlets do that every day. And they provide it all in one forum. People might learn snippets of what's going on around them on social media, but random posters, who hide behind screen names and avatars, aren't fact-checking the way a journalist is required to do. If you don't know the source, how can you trust it?" The Tribune's closure prompted one of its former reporters, Jacqueline Hough of the Herald-Advocate in Bennettsville, S.C., to write an editorial about the importance of community newspapers; it included separate references that may have been related: "In the last eight months, I have done more as a news editor/reporter than in my 21 years in journalism. . . . the Herald-Advocate was purchased by Champion Media on Sept. 30, 2021."

When newspapers fold, polarization rises, CNET reports; here's what you can do about it.

Political newcomer in mostly rural congressional district in Maryland is running as a reasonable-regulations Democrat

Dave Harden (New York Times photo by Matt Roth)

Social and cultural issues have been cited as the main reasons rural voters have shifted Republican, but in some places government regulations on business play a role, too. One of those places is eastern Maryland, where former Foreign Service officer Dave Harden is running for Congress as a reasonable-regulations Democrat.

“The regulations in rural economies are ridiculous,” Harden told Farah Stockman of The New York Times editorial board, who writes: "Democrats have to find a way to reconnect with rural America, Mr. Harden told me. Frank talk about regulations is a good place to start. . . . Nitpicky government rules remain a potent and underappreciated source of populist anger against Democrats, especially in rural areas."

Stockman says voters ask Harden, "Why are wineries in Maryland limited to serving only 13 kinds of food? Why does a woman who sells her grandmother’s cobbler have to cough up tens of thousands of dollars to build a commercial kitchen? Why does a federal inspector have to be on hand to watch wild catfish get gutted — but not other kinds of seafood? The short answer is that restaurant associations tend to wield more political clout than wineries, and catfish farmers in Mississippi are more powerful than seafood harvesters in Maryland. Big businesses can afford to hire lawyers to help them cut through red tape and lobbyists to bend government rules to their will. Small businesses, especially in rural places, get slammed."

Stockman cites polls showing that Democrats and Republicans had similar views on government regulation of business in 2006, "but the percentage of Republicans who felt [regulation was too heavy] climbed steadily under President Barack Obama, who enacted more economically significant rules than his predecessors. By the end of his first term, 84 percent of Republicans thought that government meddled too much in business, while only 22 percent of Democrats agreed, according to Gallup. Democrats were more likely to say that the government doesn’t regulate businesses enough. With business owners more likely to be Republicans and government workers more likely to be Democrats, you have the makings of a yawning partisan divide."

Wikipedia map, adapted by The Rural Blog

Joshua Sewell of Taxpayers for Common Sense "said misleading rumors that the Environmental Protection Agency planned to regulate farm dust or that President Biden’s Build Back Better plan would have taxed belching cows played right into the stereotype of Democrats as city folk who were infuriatingly eager to regulate almost anything in rural America."

Enter Harden, who "He hopes to replace Andy Harris, the sole Republican in Maryland’s congressional delegation" and is in a July 19 primary with "Heather Mizeur, a progressive herb farmer who once represented Montgomery County, a much more urban area, in the state legislature," Stickman reports. "Mizeur has more money and name recognition than Mr. Harden, but he believes he has a chance because she seems out of step with the conservative district, which is considered a safe Republican seat. . . . Harden is trying to walk a difficult line, appealing to voters who are angry about government overreach without turning off the Democratic base."

New report offers short- and long-term solutions to help rural hospitals survive as they move out of the pandemic

Federal pandemic money shored up rural hospitals as they worked to care for increased volumes of critically ill patients, but many of them were at risk of closure before Covid-19 hit, and the financial challenges creating that risk have not gone away, so "Rural hospitals that were struggling before the pandemic will once again be at risk of closure unless additional action is taken to shore up these facilities," says a new report from the Bipartisan Policy Center.

The report, The Impact of COVID-19 on the Rural Health Care Landscape, examines the ongoing financial and workforce-related challenges facing rural hospitals through the lens of eight states: Iowa, Minnesota, Montana, Nebraska, Nevada, North Dakota, South Dakota and Wyoming. It lays out short- and long-term policy recommendations to strengthen rural care, as well as ones to serve as a bridge as health-care systems exit the pandemic.

The pace of rural hospital closures slowed during the pandemic, due in large part to the federal relief provided to hospitals nationwide. "In 2021, only two hospitals closed, down from 19 in 2020, marking a significant reduction from the 138 closures between 2010 and 2020," the report says. 

George Pink, deputy director of North Carolina Rural Health Research Program at the University of North Carolina Chapel Hill, said in a June 29 webinar, "This funding really allowed many hospitals to survive during the pandemic, and probably prevented many rural hospitals from closing," reports Melissa Patrick of Kentucky Health News.

Pink ticked off a list of challenges rural hospitals face. First, they serve small populations that are typically older, sicker, under-insured or uninsured. Also, they have low patient numbers that don't create enough revenue to cover the fixed cost of a 24-hour emergency department; high percentages of patients on Medicare, programs that often don't cover the cost of care; and struggles with recruiting health-care providers.

With the last pandemic funds soon to be distributed, Pink said he expects rural hospitals to fall to pre-pandemic levels of profitability. "In fact, profitability can decline even faster because of what hospitals are now having to pay for labor, particularly nursing," he said.

Bipartisan Policy Center graphic; for a larger version, click on it. 

Of the eight states the Bipartisan Policy Center reviewed for this report, the percentage of hospitals experiencing at least three consecutive years of negative total operating margins ranged from 6% in Nevada to a high of 38% in Wyoming. 

The BPC also assessed the financial vulnerability of 2,176 rural hospitals between 2017 and 2020. It found that 909 had two or more concurrent financial risk factors that put them at risk of service reduction or closure; 441 of them faced three or more risk factors; and 173 of them had four or more. The factors included negative operating margins (total and on patient services alone), negative current net assets, and negative total net assets.

Asked if their hospitals would survive without the federal relief money, Joan Hall, president of Nevada Rural Hospital Partners, a consortium of Nevada's 13 critical-access hospitals, said the hope is that there will be more money coming, but they are not sure there will be, Patrick reports.

"I think that is a something we're very worried about," said Hall. "We're seeing still sicker patients, patients with different kinds of of needs that typically we've not had to provide care for in rural areas." 

Joe Schindler, vice-president of finance policy and analytics at the Minnesota Hospital Association, added that it would be "disastrous" for hospitals that have depended on money from programs like the Medicare Dependent Hospital Program, which assists smaller hospitals that are heavily dependent on Medicare patients and is set to expire on Sept. 30, to lose this funding.

"This is the worst time probably to pull the rug out on programs that have helped support rural access for many of those hospitals that need those supports," he said.

The report offers several short-term proposals to help shore up rural health systems, largely measures to stabilize payment models and delaying until two years after the federal public health emergency for Covid-19 ends Medicare's scheduled payment reductions of 2%, Patrick reports.

The report also offers what it calls "evidence-based, viable solutions to the health care crisis in rural America" that seek to "stabilize rural health-care systems, strengthen the newly created Rural Emergency Hospital model, ensure an adequate workforce, and broaden access to virtual care in rural America."