Hardly anyone noticed last week when Trump rolled back an Obama regulation on gun control

Trump, almost daily, has been showing off
measures he has signed. (AP photo by Alex Brandon)

While President Trump has held photo-ops for most of the laws and orders he has signed, behind closed doors on Tuesday he "quietly signed a measure that killed a regulation enacted by the Obama administration to tighten gun background checks," James Hohmann reports for The Washington Post. That same day he publicly signed two other resolutions.

"The rule required the Social Security Administration to send over the names of people who receive government checks for being mentally disabled and others who have been deemed unable to handle their own financial affairs to the FBI office that runs the national background check database," Hohmann writes. "This is a universe of about 75,000 people. The National Rifle Association says the rule curtails the Second Amendment rights of these people and persuaded GOP leadership to use the Congressional Review Act to undo it. Under the Constitution, Trump had 10 days to sign off. By waiting until the day before the deadline to do so, when there were so many big stories in the mix, he ensured it got minimal coverage."

Hohmann notes, "In a normal time, with a conventional president, undoing this regulation would have been front-page news. Trump’s move would have sparked a national conversation about the country’s continuing failure to seriously address both gun violence and mental illness. Major publications would have run deeper stories about how flawed the national background check system is five years after the massacre at Sandy Hook, with an emphasis on the gun lobby’s role in keeping it that way."

"But in the current news environment, with the Trump administration running a blitzkrieg offense and the attorney general embattled for concealing secret meetings with the Russian ambassador while under oath before Congress, it’s very hard for anyone to stay on top of everything," he writes. "Not only does the media have limited bandwidth, but cable producers are always reluctant to give much airtime to issues that don’t have obvious visuals."

Appeals court says Wyoming wolves should be stripped of endangered status

U.S. Fish and Wildlife Service photo

A federal appeals court on Friday ruled that "wolves in Wyoming should be stripped of Endangered Species Act protections and management given to the state rather than the U.S. government," Laura Zuckerman reports for Reuters. The decision could open the door for hunting of wolves.

"U.S. wildlife managers in 2012 determined that wolves in Wyoming had rebounded from the threat of extinction and that the state plan to oversee the creatures was adequate to ensure their survival," Zuckerman writes. "But conservation groups sued, contending the U.S. Fish and Wildlife Service had acted in an arbitrary and unlawful fashion in finding Wyoming's plan acceptable. They argued the state would fail to maintain the animals at certain population levels and would subject a portion of them to being shot on sight."

"A U.S. district judge sided with environmentalists in a 2014 decision and the several hundred wolves in Wyoming were once again placed under federal safeguards," Zuckerman writes. "The state, U.S. Fish and Wildlife Agency and others appealed that ruling and, on Friday, the U.S. Court of Appeals in the District of Columbia reversed the lower court, finding that the U.S. Fish and Wildlife Service had indeed 'exercised its judgment in a reasonable way' in concluding that Wyoming's management plan would provide wolves with sufficient protections."

Sunshine Week, which starts next Sunday, has never been more important to observe, promote

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

For a dozen years now, the American Society of News Editors has led the observance of Sunshine Week, celebrating open government and freedom of the news media in the service of democracy. This year's week-long observance, which starts next Sunday, March 12, is the most important ever.

Polls show trust and confidence in the news media to be at all-time low, and President Trump has called leading news organizations enemies of the people. The growing anti-journalism feeling has begun to affect even rural journalists, so it's time for news organizations at all levels to be about explaining what we do and why we do it.

The point of a "week" is to have repeated impact on the audience from various sources, so we hope weekly newspapers will promote Sunshine Week in this week's and next week's editions. ASNE has posted a budget for coverage, and The Associated Press will publish a full package of coverage Monday, March 6. This will be available to non-members on the Sunshine Week site. Columns, cartoons, public-records data, Sunshine Week logos, sample proclamations for adoption by government officials and a page for educators are available in the Sunshine Week toolkit.

Sunshine Week is scheduled each year to include national Freedom of Information Day, March 16. That is the birthday of James Madison, father of the First Amendment. Sunshine Week is made possible by an endowment from the John S. and James L. Knight Foundation and this year by a donation from The Gridiron Club and Foundation of Washington, D.C.

Some small, rural weeklies merge to stay afloat

The latest three papers to merge (Ky. Press Association photo)

For a century or so, consolidation in rural areas has meant the merger of banks and schools. Now, in some places, it means the merger of newspapers.

Three weeklies in the two counties at Kentucky's southwestern tip are becoming one. The Hickman Courier and The Fulton Leader in Fulton County, and The Hickman County Gazette in Clinton, published their last editions this week. Next week subscribers will receive The Current, a name that reflects their locations along the Mississippi River. They have the same owner, Magic Valley Publishing of Camden, Tenn. "This regional newspaper hopes to unify the area to aid efforts as civic leaders work to develop and grow commerce and improve community lifestyles," Publisher Dennis Richardson said.

The two counties are heavily agricultural, and have been losing population for decades; the 2010 population was 6,813 in Fulton County and 4,902 in Hickman County. But as recently as 1989, the Fulton paper was a daily. The Current will operate from the Leader's old office and will continue to cover eastern Obion County, Tennessee. Fulton is on the state line and is home to the annual Banana Festival, named for the city's distinction in the 1880s of having the only ice house for new refrigerated railcars carrying bananas north.

UPDATE, Aug. 19: Paxton Media Group, based in Paducah, Ky., has created a joint website, KentuckyBarkleyNews.com, for its three weeklies on and near Lake Barkley in Western Kentucky, the Herald-Ledger of Eddyville, The Cadiz Record and The Tribune-Courier of Benton, seat of Marshall County, which is on Kentucky Lake. 

The merged newspaper's merged nameplate

In northern South Dakota, the Isabel Dakotan and the Timber Lake Topic merged at the start of 2016, and "agree it was a good move," Brian Hunhoff reports in the latest newsletter of the International Society of Weekly Newspaper Editors. The merged paper, circulation 1,600, uses the Topic's nameplate with the line, "continuing the Isabel Dakotan," in the designs familiar to readers.

The towns are about 20 miles apart. The papers began working together in 2013, when Topic co-publisher Jim Nelson became ill and Dakotan owner Robert Slocum helped Kathy Nelson keep the paper going. "When Jim passed away in October of that year, we were already a team," Nelson told Hunhoff. Slocum, asked the most challenging part of the merger, said "It's hard to tell people you are improving the product when it means one more empty building on Main Street." He works out of his home.

"The evolution of the Topic and Dakotan may become a model for small, rural papers struggling to survive," Hunhoff writes, quoting Dave Bordewyk, executive director of the South Dakota Newspaper Association: "I do think it's possible this type of merger would work elsewhere."

It has in the Texas Panhandle since 2013, where The Caprock Courier absorbed four very small weeklies in three counties: the Briscoe County News, the Motley County Tribune, The Cottle-King Times and The Valley Crier. Each printed edition has a few pages headed with each paper's nameplate. To read the online or printed edition, click here.

EPA chief says he wants to save some programs; critics not convinced; state impacts examined

EPA Administrator Scott Pruitt (EPA photo)

Environmental Protection Agency Administrator Scott Pruitt is asking mayors to bring him "success stories" to take to the White House Office of Management and Budget to save proposed cuts to EPA, Emily Holden reports for Climatewire.

The Trump administration this week proposed reducing the EPA's budget by 25 percent, employees by 20 percent and eliminating dozens of programs. Reporters around the country, such as Jim Bruggers at The Courier-Journal in Louisville, are looking at the impact on their states. He writes, "The Trump administration's plan to reduce by 30 percent grants used by states and cities to enforce clean air and clean water rules would also seem to contradict the new EPA administrator Scott Pruitt's pledge to give states more control over environmental programs."

Pruitt, speaking Thursday before the U.S. Conference of Mayors, said "he wants to maintain funding to clean up brownfields and Superfund sites, meet unfulfilled air quality standards and keep paying for local water infrastructure," Holden writes. "An EPA official who asked reporters not to identify him by name said Pruitt made it clear that some of his budget priorities differ from the White House's draft. The official said he wouldn't characterize Pruitt's concerns as 'pushback.' He noted that there are some programs both Pruitt and members of Congress want to keep around."

"While Pruitt is doing damage control and touting his support of some of the money that goes to states, he hasn't addressed funding for other issues reportedly on the chopping block," Holden writes. "These range from climate change and environmental justice to the largely successful Diesel Emissions Reduction Act and Energy Star programs."

John O'Grady, an EPA union leader, "said Pruitt's support for some programs is doing 'nothing to allay' the fears of agency employees," Holden writes. O'Grady said in an email, "EPA is full of very well educated and dedicated attorneys, biologists, chemists, ecologists, engineers, geologists, toxicologists, and other highly skilled professionals who are able to 'read between the lines.' Mr. Pruitt is here at EPA to deconstruct EPA." (Read more)

Study in Appalachia to examine potential health impacts of living near a surface mine

Scientists from the National Academies of Sciences, Engineering and Medicine will study Eastern Kentucky, West Virginia and the coal regions of Virginia and Tennessee to determine if living near a surface mine increases the risk of health problems, Bill Estep reports for the Lexington Herald-Leader.

"A number of studies have shown that mountaintop mining is associated with higher rates of cancer, heart disease and other health problems in Central Appalachia," Estep writes. "Michael S. Hendryx, a professor who did several of the studies while formerly at West Virginia University, told the Herald-Leader last year that the studies were adjusted to account for factors such as higher rates of smoking and obesity in the region."

"However, the coal industry has fiercely disputed the studies, and a 2012 industry-funded study by a Yale University researcher and others concluded that 'coal mining is not per se the cause of increased mortality in rural Appalachia,'' Estep writes. "The study by the National Academies could identify gaps in existing research and help settle some of the uncertainties about the issue."

The U.S. Office of Surface Mining Reclamation and Enforcement, which commissioned the two-year study, "said the research agency would choose experts to examine a 'growing amount of academic research that relates to possible correlations between increased health risks as a result of living near surface coal mine operations,'" Estep writes. "The study will involve synthesizing existing research, not conducting new field studies." (Read more)

White House says Keystone XL pipeline exempt from requirement to buy American steel

Canadian Press graphic

The White House said on Thursday that the Keystone XL pipeline is exempt from President Trump's executive order "requiring infrastructure projects to be built with American steel," Ben Lefebvre reports for Politico. "Trump signed the order calling for the Commerce Department to develop a plan for U.S. steel to be used in 'all new pipelines, as well as retrofitted, repaired or expanded pipelines' inside the U.S. projects 'to the maximum extent possible'."

"By the White House’s judgment, that description would not include Keystone XL, which developer TransCanada first proposed in 2008," Lefebvre writes. A White House spokesperson said, “The Keystone XL Pipeline is currently in the process of being constructed, so it does not count as a new, retrofitted, repaired or expanded pipeline."

Washington Post fact checkers Glenn Kessler and Michelle Ye Hee Le noted after the speech that "TransCanada said in 2013 that it had already purchased all of the steel pipe it needed for the Keystone XL, with the rest coming from a Russian-owned plant in Canada, Italy and India. Experts say the plant in Arkansas (owned by an Indian company) is the only one in the U.S. that could build the pipe—and it gets its steel from India."

Study links increase in county unemployment rate to rise in opioid deaths

Opioid overdose death rates grow fastest in counties with rising unemployment rates, says a study by researchers at the University of Indiana and the University of Virginia published in The National Bureau of Economic Research. Some of the nation's poorest counties, many in Appalachia, also have some of the highest drug overdose rates. A Centers for Disease Control and Prevention study has state-level data on overdose deaths from 2015.

Researchers used county-level mortality data for the entire U.S. from 1999-2014, finding that when the county unemployment rate increases by one percent, the opioid death rates rises by 0.19 per every 100,000, a 3.6 percent increase. Researchers also looked at county level emergency room data from 2002-2014 from Arizona, Florida, Kentucky, Maryland and New Jersey, finding that when the county unemployment rate increases by one percent, the opioid death rate rises by .95, or seven percent.

"Because of the way the study was designed, it couldn’t measure the overall effect of national changes in the economy, like the Great Recession and the subsequent recovery," Jeff Guo reports for The Washington Post. "Instead, the research tells us that places that weathered the Great Recession more gracefully were better able to resist the opioid epidemic, while places that suffered during the Great Recession were harder hit by opioid deaths."

"This is more surprising than it seems. Alcohol use actually behaves the opposite way," Guo writes. "People tend to buy less alcohol in bad times, and more alcohol in good times. In fact, there’s a well-documented correlation between economic growth and higher death rates. When the economy is booming, people tend to behave in more risky ways, and pollution also increases. When the economy is in recession, both those risk factors abate."

Some rural ERs still turn away women in labor, despite federal law requiring treatment

Jewish Hospital in Shelbyville, Ky.
was cited for turning away a woman in labor

Over the last five years at least 20 rural hospitals have been found in violation of the federal Emergency Medical Treatment and Labor Act (EMTALA) requiring "every U.S. hospital with an emergency room to treat patients who arrive in labor, caring for them at least until the delivery of the placenta after a baby is born," Julie Lasson reports for Pro Publica. "In several cases, women suffered serious complications after being turned away, or were misdiagnosed at facilities that lacked specialists in obstetrics."

"Some ERs not only denied treatment to women in labor, they also would not help them transfer elsewhere, records show," Lasson writes. "A woman turned away by Monroe County Hospital in Forsyth, Ga., ended up calling 911 from outside the dialysis center across the street. Another woman, told there were no staff gynecologists at a Hartford, Ky. hospital, called an ambulance from a grocery store parking lot."

"EMTALA was passed primarily to ensure that emergency rooms couldn't refuse patients because they couldn't pay for services," Lasson writes. "Prompted by a catastrophic case in which a pregnant woman was turned away from two California hospitals that believed she had no insurance, the provisions outlined in EMTALA specific to labor reflected that a growing number of hospitals, especially in rural areas, had begun eliminating obstetrics departments because of high costs and a lack of doctors."

A study by The Walsh Center for Rural Health Analysis found that the number of non-metro hospitals lacking hospital-based obstetric services was 44 percent in 2002, up from 24 percent in 1985, Lasson writes. "A study by the University of Minnesota Rural Health Research Center found that 7 percent of hospitals in nine states with large rural populations closed their obstetrics units between 2010 and 2014."

While some of the cited hospitals have made changes, not all have, Lasson writes. "Government inspectors cited East Texas Medical Center Carthage in Carthage, Texas, for a July 2012 incident in which a staffer told a woman in labor that the hospital didn’t have obstetric services or an obstetrician, and didn’t know where ambulances were stationed to transfer her elsewhere. She and her husband tried to drive themselves to another hospital, but their car broke down, the inspection report said." The baby died. "As part of their investigation, inspectors turned up an email from one Carthage staff member to another, noting this was not the first time the medical center had turned away an emergency delivery."

Connecting rural Wisconsin to broadband will cost $1 billion, says news investigation

Broadband access in Wisconsin (StateTech map)

Connecting rural Wisconsin to broadband would cost about $1 billion, Matthew Simon reports for WSAW in the north-central part of the state. Federal officials say more than 40 percent of rural Wisconsin does not have broadband.

"The issue is large expenses associated with building rural location’s infrastructure," Simon writes. "Things like laying wires and building wireless point-to-point resources to make internet a reality for rural Wisconsin families who, right now, do not have the options. Increasing broadband access depends on six pots of money to build the internet infrastructure: three federal, two state and, also, private company investments."

An investigation by WSAW found that "if state lawmakers approve all internet spending proposals during the 2017 budget year, combined with already available federal funds, there could potentially be up to $182 million private companies could tap into to help build that infrastructure," Simon writes. By 2020, the year Republican Gov. Scott Walker "said he would to see broadband available to all who want it, the total amount of funding available will have grown to total more than $600 million."

"By the 2026 budget year, nearly $1 billion will have been invested in building rural Wisconsin internet," Simon writes. "However, those are only the public dollars. They do not account for the investments companies will also make, which is privately held information. Because the plan is to spend so much public internet building money in such a short time, combined with the private investments."

EPA head: 'WOTUS' rule rollback first step in regulation relief; study says drinking water at risk

Screen shot of Environmental Working Group map
of counties that get drinking water from streams.
For the interactive version click here

New Environmental Protection Agency head Scott Pruitt said Tuesday at the American Farm Bureau Federation advocacy conference that rolling back the waters of the United States (WOTUS) rule, under the Clean Water Act, "is just the first step toward fixing what's wrong with our government regulations," Marc Heller reports for Greenwire. Pruitt, who didn't elaborate on how the agency may rewrite the Clean Water Act regulation, said, "I'm looking forward to the regulatory rollback to provide certainty to you."

Heller writes, "Pruitt was short on specifics about other regulations affecting agriculture that might face extra scrutiny. He said the agency needs to tackle cleanup of around 1,300 Superfund sites nationally and roll back the Clean Power Plan regulating power plant emissions."

A county-level analysis released Wednesday by the Environmental Working Group says that rolling back the Clean Water Act "puts the drinking water of 117 million Americans at risk," Alex Formuzis reports for the organization. "EWG found that more than one-third of the nation’s people get at least some of their drinking water from small streams and more than 72 million Americans in 1,033 counties rely on small streams for more than half of their water."

"EWG researchers drew on geospatial data compiled by the EPA to identify the counties that are most dependent on small streams for their drinking water. In more than 21 states, at least a million people fit this criteria—more than five million each in New York, Texas and Pennsylvania, and more than three million each in Georgia, Maryland, Ohio, North Carolina, California and Arizona," Formuzis writes.

Vermont's health care experiment could serve as a national model, especially in rural areas

Vermont, one of the nation's most rural states, has launched an ambitious "experiment that could transform the delivery of health care nationwide," Michael Ollove reports for Stateline. The state is replacing the traditional "fee for service" system where doctors and hospitals are paid for each procedure, treatment or test they provide in favor of a "pay-for-performance" system. Studies have shown that pay-for-performance is more successful in rural areas, because fewer competing insurers and hospitals make it easier to coordinate the system.

"Under Vermont’s plan, to be phased in through 2022, health plans would pay doctors and hospitals based on how well they care for their patients and contain costs, rather than on the volume of services they provide," Ollove writes. "Some health care plans, public and private, have been experimenting with 'pay-for-performance' systems for more than a decade. But Vermont’s experiment is the most ambitious, aiming to cover 70 percent of the state’s residents (excluding those who are in out-of-state employer-sponsored plans), whether they are beneficiaries of Medicare, Medicaid or commercial health insurance."

Organizations "that choose to participate in Vermont’s experiment would join one of two 'accountable care organizations,' or ACOs, which are groups of doctors, hospitals and other providers who combine to coordinate the care of their patients," Ollove writes. "At the beginning of each year, Medicare, Medicaid and Blue Cross Blue Shield (Vermont’s dominant private insurer) would pay the ACOs a per capita amount to cover the care of each patient. Participating providers would earn financial rewards for staying under budget, and for meeting standards of high-quality care."

"The ACOs have agreed to limit spending growth to about 3.5 percent a year for the five years of the experiment. (The national growth rate for health spending in 2015, the last year for which data is available, was 5.8 percent.)," Ollove writes. "As a reward for staying under budget, ACOs would receive up to three percent of the amount they were budgeted. If they miss the targets, they would have to pay a penalty of up to three percent." The model doesn’t count spending on prescription drugs.

"Because payments will be based on the health outcomes of patients, the architects of Vermont’s all-payer model think doctors and hospitals will provide services they forgo under a fee-for-service system because they are not paid for them. Some of those services will not only benefit patients, but save money in the long run," Ollove writes.

Another key is that all "providers in the ACOs will use the same electronic health record system, allowing for seamless communication between hospitals, practices, home health agencies and nursing homes. The single system will make it easier for providers to share what works best for each patient." (Read more)

White House proposes cutting EPA budget by 25%, employees by 20% and eliminating 38 programs

The Trump administration has proposed reducing the Environmental Protection Agency's budget by 25 percent, employees by 20 percent and eliminating dozens of programs, Juliet Eilperin and Brady Dennis report for The Washington Post. EPA in fiscal year 2016 had 15,376 employees and a budget of more than $8.1 billion, according to EPA data. The federal budget for 2016 was $3.54 trillion, reports InsideGov.

A White House plan obtained by the Post calls for reducing EPA's' budget to $6.1 billion and cutting staff to 12,000, reports the Post. Because much of the funding "already goes to states and localities in the form of grants, such cuts could have an even more significant effect on the EPA’s core functions. Grants to states, as well as its air and water programs, would be cut by 30 percent. The massive Chesapeake Bay cleanup project would receive only $5 million in the next fiscal year, down from its current $73 million."

"In addition, 38 separate programs would be eliminated entirely. Grants to clean up brownfields, or abandoned industrial sites, would be gone," reports the Post. "Also zeroed out: the radon program, climate change initiatives and funding for Alaskan native villages. The agency’s Office of Research and Development could lose up to 42 percent of its budget, according to an individual apprised of the administration’s plans. And the document eliminates funding altogether for the office’s “contribution to the U.S. Global Change Research Program,” a climate initiative that President George H.W. Bush launched in 1989."

The main reason for the cuts is that Trump is seeking a $54 billion increase in military spending, reports the Post. The White House doscument said: “The administration’s 2018 budget blueprint will prioritize rebuilding the military and making critical investments in the nation’s security. It will also identify the savings and efficiencies needed to keep the nation on a responsible fiscal path.”

Over 300 native North American bee species at increasing risk of extinction, says study

Hundreds of bee species in North America are declining says a study by the Center for Biological Diversity. The study, which said sufficient data exists for 1,437 native bee species—out of more than 4,000—in North America, found that 749 are declining. Researchers also found that 347 native bee species are "imperiled and at increasing risk of extinction." Study author Kelsey Kopec said "declines are caused primarily by habitat loss, heavy pesticide use, climate change and urbanization." (Center for Biological Diversity graphic)

"Experts from the center reviewed the status of 316 bee species and then conducted reviews of all available information to determine the status of a further 1,121 species," Gina Cherelus reports for Reuters. "The center said the species which lacked sufficient data were also presumed to be at risk of extinction Gina Cherelus reports for Reuters. Among the native species that are severely threatened are the Gulf Coast solitary bee, the macropis cuckoo bee and the sunflower leafcutting bee, which is now rarely seen."

Bees are responsible for more than $15 billion in increased U.S. crop value each year. Honeybees lost 28 percent of colonies during the 2015-16 winter, up from 22 percent the year before.

Risk of man-made earthquakes down in Texas, Okla. with decrease of oil field wastewater disposal

USGS says the risk of damaging quakes triggered
by oil field wastewater disposal is lower
this year but still significant.

Scientists at the U.S. Geological Survey say a decline in oil field wastewater disposal has led to a decrease in risk from man-made earthquakes in Oklahoma and Texas, Mike Soraghan reports for Energywire. But they warn "that there's still a significant chance for oil field activity to trigger a damaging quake in the next year."

USGS's second annual hazard map forecasting the danger of damaging quakes caused by man-made activity was published this week in the journal Seismological Research Letters, Soraghan writes. "The forecast showed a slight decrease in Oklahoma, although some portions are still considered to have a 10 to 12 percent risk of a damaging quake. But the Dallas area was removed from the map. That meant the number of people considered to be at elevated risk from man-made quakes dropped from 7 million to about 3.5 million."

"The likelihood of damaging ground shaking in central Oklahoma remains similar to that of natural earthquakes in high-hazard areas of California, according to the USGS assessment," Soraghan writes. "And USGS officials noted the level of hazard remains higher than what current building codes take into account. The forecast maps released yesterday indicate that the Raton Basin area along the Colorado-New Mexico border also remains at elevated risk. An area in West Texas, where companies have increased production from the Permian Basin, was added as being at a slightly elevated risk of damage from quakes."

Medicaid expansion kept hundreds of rural hospitals afloat; ACA repeal could put them at risk

Medicaid expansion brought a windfall to many rural hospitals, as millions of Americans gained coverage and were able to pay for care, but the looming threat of repealing the Patient Protection and Affordable Care Act puts "670 rural hospitals across the country at risk of shutting their doors," Jeff Lagasse reports for Healthcare Finance, citing findings from iVantage Health Analytics.

According to iVantage, which "examined rural hospital performance across a variety of measures," the expansion of Medicaid benefited rural hospitals the most, Lagasse writes. "Rural hospitals in expansion states, running on extremely tight margins, saw a significant improvement to their bottom lines, and provided a benefit to the estimated 62 million Americans living in rural areas, many of whom received health coverage under the ACA for the first time."

How does pulling the plug on ACA threaten rural hospitals? For starters, Lagasse notes, "many are not part of larger health systems, which gives them decreased leverage when dealing with insurance companies; they also don't have as much capital to invest in amenities such as facilities and electronic health records."

"There's a statistically significant impact on the rural median operating margins in states that expanded Medicaid," Michael Topchik, national leader of the Chartis Center for Rural Health and member of the iVantage leadership team, told Lagasse. Topchik implicitly touched on the politics of repealing and replacing the ACA: Many states President Trump carried, "like West Virginia, Iowa, Kentucky, Louisiana . . . saw a lot of people gain coverage either directly through Medicaid expansion or secondarily through the exchanges" for tax-subsidized insurance policies.

iVantage "estimated that that loss of Medicaid expansion would contribute to 137,000 fewer jobs in the broader community, with 99,000 of those jobs lost in the health-care sector," Lagasse writes. "The ACA used only federal funds from 2014 through 2016 to pay for the expanded benefits, and while that reduces to 90 percent by 2020, it's more than the 50- to 75-percent match that existed before ACA implementation" for traditional Medicaid. "Preliminary replacement plans from the GOP-led House would eliminate Medicaid expansion by 2020."

House health-care draft suggests a plan that could leave rural areas short of coverage

Photo from The Atlantic

A 100-page draft of a House Republican plan to repeal the Patient Protection and Affordable Care Act suggests that "millions of people in rural areas where it’s already hardest to find doctors might no longer be able to afford health insurance in a few years," Van R. Newkirk II writes for The Atlantic.

"The basics of that plan, which was unveiled by House Speaker Paul Ryan two weeks ago, and the rough shape of which has the support of new health secretary Tom Price and the Trump administration, are known," Newkirk reports. "The plan removes the individual and employer mandates to purchase and provide insurance, respectively, and it would also repeal most of the taxes that fund Obamacare. It would roll back funding for the Affordable Care Act’s Medicaid expansion and dramatically restructure the Medicaid program’s funding. Further, the plan would replace the Affordable Care Act’s cost-sharing subsidies and premium tax credits with an age-rated tax credit, all while keeping Obamacare’s popular pre-existing conditions ban."

The draft was leaked to Politico last week. It "specifies that Obamacare’s Medicaid expansion for low-income able-bodied adults won’t be completely eliminated, but the eligibility and funding will be rolled back after 2020. The draft also contains a provision changing federal funding for Medicaid in 2020 onward from an open-ended obligation to a system where the per-person spending every year is capped based on spending levels in 2019 and increased annually to correspond with medical inflation," Newkirk says.

The draft plan repeals the tax-based individual mandate and replaces it with an incentive to maintain continuous health-insurance coverage. "For people not covered by employers or public insurance who have to purchase insurance on individual, small group, or exchange markets, this proposal would allow insurers to charge up to 30 percent more in premiums to people who go without coverage at any point for more than two months, and also for young adults who don’t enroll in coverage as soon as they age out of their parents’ plans, a surcharge that would not be remitted as taxes to sustain the system, but would be paid as profits to insurers. The effects of this potential measure on individuals’ pockets are potentially limited by a reduction of federal oversight over what can be considered health-insurance coverage, which would allow people to avoid penalties by purchasing barebones coverage," Newkirk explains. (Read more)

Fact-checking Trump speech: economy, pipelines, health care, immigration, coal, manufacturing jobs

Washington Post photo by Jonathan Newton

President Trump's address to Congress Tuesday night contained plenty of factual errors. We only have room here for a few fact checks. If you want to re-publish them, we encourage you to look at reports from The Washington Post, The New York Times, NBC News, PolitiFact.com and FactCheck.org.

NBC's Chuck Todd, Mark Murray and Carrie Dann write on First Read that Trump's biggest whopper of the night concerned the economy when he said: "Ninety-four million Americans are out of the labor force. Over 43 million people are now living in poverty, and over 43 million Americans are on food stamps. More than 1 in 5 people in their prime working years are not working. We have the worst financial recovery in 65 years." NBC says while some figures are true "others are highly misleading."

For example, 93 percent of people not in the labor force say they don't want a job. David Freedlander of The Daily Beast noted on Twitter that of the 94 million not working, 44 million are retired, 15.3 million are disabled. 13.3 million are taking care of a family member and 13.2 million are in school.

The Times and Post both say Trump "cherry-picked" data on the economy "to reinforce his argument that he’s walking into the White House with the economy in a near-shambles, as Philip Bump of the Post writes. Trump's description of “the worst financial recovery in 65 years” is true, Bump writes,m but "we also had the worst economic situation since the Great Depression." NBC noted that Trump failed to mention that he inherited a country with a low unemployment rate of 4.8 percent and rising household income.

Pipelines: Trump said the Keystone and Dakota Access pipelines will create "tens of thousands of jobs." Times reporter Coral Davenport noted that most of the jobs will be temporary: "A 2014 State Department environmental review estimated that Keystone would support 42,000 temporary jobs over its two-year construction period — about 3,900 of them in construction, the rest in indirect support jobs, such as food service. It estimated that Keystone would create about 35 permanent jobs."

Trump also said, "I’ve issued a new directive that new American pipelines be made with American steel.” Post fact-checkers Glenn Kessler and Michelle Ye Hee Le write, "Workers in Arkansas have already built about half of the high-strength line pipe needed for the project, some 333,000 tons. TransCanada said in 2013 that it had already purchased all of the steel pipe it needed for the Keystone XL, with the rest coming from a Russian-owned plant in Canada, Italy and India. Experts say the plant in Arkansas (owned by an Indian company) is the only one in the U.S. that could build the pipe—and it gets its steel from India."

Immigration: Trump said, “By finally enforcing our immigration laws we will raise wages, help the unemployed, save billions and billions of dollars and make our communities safer for everyone.” Kessler and Lee write, "Trump exaggerates the impact of illegal immigration on crime, taxpayer money and jobs. Extensive research shows noncitizens are not more prone to criminality than U.S.-born citizens. The vast majority of unauthorized immigrants are not criminal aliens or aggravated felons." Several studies have shown that immigrants are less likely to commit crimes than people born in the U.S., Richard Perez-Pena reported in January for the Times.

Health care: Trump said, "Obamacare premiums nationwide have increased by double and triple digits." Times reporter Robert Pear notes that double-digit increases in premiums have been common for many years. "President Trump cited Arizona's 116 percent increase; it is the only state that experienced a triple-digit hike. Premiums for a popular group of health plans sold on HealthCare.gov rose this year by an average of 25 percent, according to the Obama administration. While subsidies are available to people with low and moderate incomes, people who do not qualify for financial assistance must bear the full cost."

Jobs and trade: Trump said, "We've lost more than one-fourth of our manufacturing jobs since Nafta was approved." Times reporter Binyamin Appelbaum writes, "The U.S. has lost a lot of factory jobs since 2000, but the biggest reason is technological progress, not foreign competition. America's manufacturing output is at the highest level in history—it just doesn't take as many workers to make stuff anymore. Some jobs have been lost to foreign competition, but studies assign a modest role to NAFTA."

Coal: Trump said he ended a regulation that threatened "the future and livelihoods of our great coal miners." Davenport writes, "There is no evidence that the rule threatened a significant number of coal mining jobs, or that rolling it back will create new ones. No credible studies have shown that rolling back major regulations on coal pollution will contribute to a major increase in coal-mining jobs."

Senate confirms Ryan Zinke to head Interior Dept.

Ryan Zinke

The Senate today confirmed Ryan Zinke to lead the U.S. Department of the Interior, Darryl Fears reports for The Washington Post. "Zinke will take over a department that manages a fifth of the land in the U.S., about 500 million surface acres, a total that doesn’t include millions of more acres and natural resources underground. Interior has an enormous environmental footprint, with agencies that decide how resources such as coal are managed and which animals are eligible for listing under the Endangered Species Act."

"Republicans called the former Montana congressman and Navy SEAL a strong choice for Interior, as an avid hunter with western roots who understands how federal regulations on the cultivation of coal, natural gas and minerals on public lands can hurt corporate revenue and reduce jobs," Fears writes. "Democrats were wary of Zinke despite his declaration that he believes humans contributed to climate change." Some fear he will "rescind the Obama administration designation of 1.3 million acres in Utah as the Bears Ears National Monument, a status long pursued by Native tribes and conservationists."

Map shows percentage of people in each county who believe climate change is happening

Do people in your neck of the woods believe climate change is happening? The Yale Climate Opinion Maps, created by Yale University's Yale Program on Climate Change Communication and George Mason University's Center for Climate Change Communication, include county-level data (updated this week) on the percentage of people who believe climate change is occurring.

Seventeen survey questions were asked, such as: Do you think that global warming is happening?; How much do you trust or distrust climate scientists as a source of information about global warming?; and a question that asks if participants think global warming is caused by human activities, natural changes to the environment, other causes, or if they believe global warming is not happening. (Yale map: Screenshot of how many people in Logan County, West Virginia believe climate change is happening. For the interactive map click here)

"Across the country, 70 percent of Americans think global warming is happening and that it will harm future generations," Erika Bolstad reports for Climatewire. "An estimated 82 percent of adults think there should be support for research into renewable sources of energy. An estimated 69 percent think there should be strict limits on CO2 emissions from coal-fired power plants."

Data also includes "information from other survey questions, including how much people trust climate scientists, whether they think global warming will harm plants and animals, and how often people discuss global warming with their friends and family," Bolstad writes. "It even asks how often they hear about global warming in the media."

The data include the number of people surveyed in each county, from which a margin of error can be calculated: Divide 0.25 by the sample size, take the square root, then multiply the root by 1.96 (for a confidence level of 95 percent, meaning that 19 of 20 times the result of the poll would be the same, within the error margin, of a survey of the county's entire population).