For the hundreds of rural U.S. hospitals struggling to stay in business, health policy decisions made in Washington, D.C., this summer could make survival a lot tougher. Since 2010, at least 79 rural hospitals have closed across the country, and nearly 700 more are at risk of closing. These hospitals serve a largely older, poorer and sicker population than most hospitals, making them particularly vulnerable to changes made to Medicaid funding."A lot of hospitals like [ours] could get hurt," says Kerry Noble, CEO of Pemiscot Memorial Health Systems, which runs the public hospital in Pemiscot County, one of the poorest in Missouri. The GOP's American Health Care Act would cut Medicaid — the public insurance program for many low-income families, children and elderly Americans, as well as people with disabilities — by as much as $834 billion. The Congressional Budget Office has said that would result in 23 million more people being uninsured in the next 10 years. Even more could lose coverage under the budget proposed by President Trump, which suggests an additional $610 billion in cuts to the program. That is a problem for small rural hospitals like Pemiscot Memorial, which depend on Medicaid. The hospital serves an agricultural county that ranks worst in Missouri for most health indicators, including premature deaths, quality of life and even adult smoking rates. Closing the county's hospital could make those much worse.And a rural hospital closure goes beyond people losing health care. Jobs, property values and even schools can suffer. Pemiscot County already has the state's highest unemployment rate. Losing the hospital would mean losing the county's largest employer."It would be devastating economically," Noble says. "Our annual payrolls are around $20 million a year." All of that weighs on Noble's mind when he ponders the hospital's future. Pemiscot's story is a lesson in how decisions made by state and federal lawmakers have put these small hospitals on the edge of collapse. Back in 2005, things were very different. The hospital was doing well, and Noble commissioned a $16 million plan to completely overhaul the facility, which was built in 1955."We were going to pay for the first phase of that in cash. We didn't even need to borrow any money for it," Noble says while thumbing through the old blueprints in his office at the hospital. But those renovations never happened. In 2005, the Missouri legislature passed sweeping cuts to Medicaid. More than 100,000 Missourians lost their health coverage, and this had an immediate impact on Pemiscot Memorial's bottom line. About 40 percent of their patients were enrolled in Medicaid at the time, and nearly half of them lost their insurance in the cuts.Those now-uninsured patients still needed care, though, and as a public hospital, Pemiscot Memorial had to take them in."So we're still providing care, but we're no longer being compensated," Noble says.And as the cost of treating the uninsured went up, the hospital's already slim margins shrunk. The hospital went into survival mode.
A judge has ruled that counties can’t sue the State of Oregon for financial damages, potentially undermining a $1.4 billion class action lawsuit over state logging practices.Linn County Circuit Court Judge Daniel Murphy has reversed an earlier ruling in the case, which held that Oregon’s “sovereign immunity” doesn’t bar counties from seeking such damages.In his most recent June 20 decision, Murphy has agreed with Oregon’s attorneys that counties — as subdivisions of the state — cannot sue the state government for money.Murphy said he’s “well aware this interpretation contradicts” his earlier opinion, but he will provide the plaintiff counties with “the opportunity to re-plead their case in such a manner that is supported by the law if they can.”“Like peeling a very large onion this case contains complex layers of legal issues and theory that can take time to unravel,” he said.The judge has left open the possibility for the plaintiffs to seek an “equitable” remedy, such as an injunction or order that requires the state government to take certain actions without paying financial damages.
The political divide between rural and urban America is more cultural than it is economic, rooted in rural residents’ deep misgivings about the nation’s rapidly changing demographics, their sense that Christianity is under siege and their perception that the federal government caters most to the needs of people in big cities, according to a wide-ranging poll that examines cultural attitudes across the United States. The Washington Post-Kaiser Family Foundation survey of nearly 1,700 Americans — including more than 1,000 adults living in rural areas and small towns — finds deep-seated kinship in rural America, coupled with a stark sense of estrangement from people who live in urban areas. Nearly 7 in 10 rural residents say their values differ from those of people who live in big cities, including about 4 in 10 who say their values are “very different.” That divide is felt more extensively in rural America than in cities: About half of urban residents say their values differ from rural people, with less than 20 percent of urbanites saying rural values are “very different.” Alongside a strong rural social identity, the survey shows that disagreements between rural and urban America ultimately center on fairness: Who wins and loses in the new American economy, who deserves the most help in society and whether the federal government shows preferential treatment to certain types of people. President Trump’s contentious, anti-immigrant rhetoric, for example, touched on many of the frustrations felt most acutely by rural Americans.The Post-Kaiser survey focused on rural and small-town areas that are home to nearly one-quarter of the U.S. population. These range from counties that fall outside metropolitan areas such as Brunswick, Va. (population 16,243) to counties near population centers with up to 250,000 residents such as Augusta, Va. (population 74,997), close to Charlottesville and the University of Virginia. Urban residents live in counties that are part of major cities with populations of at least 1 million, while suburban counties include all those in between.The results highlight the growing political divisions between rural and urban Americans. While urban counties favored Hillary Clinton by 32 percentage points in the 2016 election, rural and small-town voters backed Trump by a 26-point margin, significantly wider than GOP nominee Mitt Romney’s 16 points four years earlier.But popular explanations of the rural-urban divide appear to overstate the influence of declining economic outcomes in driving rural America’s support for Trump. The survey responses, along with follow-up interviews and focus groups in rural Ohio, bring into view a portrait of a split that is tied more to social identity than to economic experience.“Being from a rural area, everyone looks out for each other,” said Ryan Lawson, who grew up in northern Wisconsin. “People, in my experience, in cities are not as compassionate toward their neighbor as people in rural parts.”
A public-private agreement has managed to preserve the habitat of a threatened species while accommodating hunting, fishing, ranching, and energy development. Interior Secretary Zinke says he's revisiting the agreement. That could lead to the sage grouse qualifying as "endangered," which would mean a far less flexible approach to conservation. “The sage grouse initiative, the collaboration, up to now it’s been working,” said O’Toole, owner of Ladder Ranch along the Wyoming and Colorado border.“It’s the collaboration that’s the key. Everybody involved has been trying to prevent the whole sage grouse effort from the conflict and litigation that could from a listing” of the bird as an endangered species.The sage grouse team involves ranchers along with the Bureau of Land Management, U. S. Forest Service, U. S. Department of Agriculture, state agencies and non-governmental partners. The success of the collaboration, including its public-private partnership, led to the 2015 decision to invest in this approach rather than list the sage grouse as endangered under the Endangered Species Act (ESA). Listing the grouse as endangered would trigger a more stringent set of regulations that limit landowner and public agency choices and could trigger litigation.
Now a harsh ruling by the Washington State Supreme Court in Hirst v. Whatcom County, blocks access to water for rural families — making that life unaffordable and simply impossible for the average Washington citizen. Declaring that counties can no longer rely on the Washington State Department of Ecology to determine if there is enough water for permit-exempt wells, the court brought the state’s Growth Management Act into conflict with 80 years of water law. Supporters of Hirst argue the court’s strict new interpretation helps salmon. However, that is just a political disguise for the underlying motivation of impeding development and stopping families from being able to live in rural areas.Permit-exempt wells were designed to decrease bureaucratic red tape for a de minimums (minimal) amount of water, in the form of 5,000 gallons per day. Supporters of the Hirst ruling say families should not be given access to this water without getting a special, and expensive, permit.The result is an effective ban, even though permit-exempt wells use far less than the permitted 5,000 gallons a day. In fact, all the rural wells in a large area have less of an effect on the natural water supply than one concentrated city-run water system.The cumulative effect of all permit-exempt wells on the total water supply amounts to less than 1 percent. Supporters of the water ban want to block access to a paltry 0.9 percent of total water consumption, and make all citizens in Washington bear the cost.What is the cost all of Washington must bear? Existing homeowners reap a windfall, since they already have wells without a permit. For people without water, however, their land has become nearly worthless. Few families can spend up to $100,000 or more for the hydrogeological studies needed to get a permit-exempt well or pay for expensive water transfers. The result is slowed rural development, decreased property tax revenues for rural communities, and lower employment rates in rural areas.
Virginia has long been coal country, but the solar power industry has been increasing its foothold in the Commonwealth over the last few years. Virginia now has more jobs in the solar industry than the coal industry. Numbers from the Virginia Department of Mines, Minerals and Energy show a 40% drop in the number of people working in the coal industry over the last five years. Henry Childress with the Virginia Coal and Energy Alliance says coal produces more energy with fewer employees.For now, though, the solar industry has more employees in Virginia than the coal industry. That’s a dramatic shift for a state that has a long history with coal. Alexander Winn at the Solar Foundation says he’s hopeful some of those jobs might move from coal to solar.“There are efforts to retrain some coal workers, and hopefully those will continue to grow as solar becomes an increasingly large employment sector in the Virginia energy industry.”Most solar energy jobs are in installation, construction and manufacturing. Numbers from the Solar Foundation show that the industry grew by about 65% over the last year alone.
It has been remarkable how quickly the “buzz” about rural voters and their electoral impact has faded. Many Main Street advocates, myself included, predicted the super-majority of rural voters who carried Donald Trump to victory would prompt a policy spotlight that would shine brightly on small towns and rural spaces. After all, without rural voters there would be no President Donald Trump.Then, the incoming administration waited until the day before the inauguration to announce an Agriculture secretary-nominee. Earlier, a biofuels skeptic was nominated to run the EPA, which oversees the Renewable Fuel Standard.Now, to add insult to injury, Trump has proposed $29 billion in cuts to crop insurance that create a yuge (huge) hole in the producer safety net! This will leave farmers without options in bad crop years caused by changing weather. All the while, eliminating locally led conservation efforts on farms and ranches and limiting programs that provide hunting and fishing opportunities on private lands.Trump Republican cuts to agriculture and rural economic development programs will eliminate rural business programs that have supported more than 800,000 jobs in the last eight years. He proposes ending rural energy programs that help small businesses on Main Street save on energy costs — and that’s before the proposed cuts to Medicaid under Trumpcare-AHCA.
Oregon's Legislature took a step closer Tuesday to strengthening its unique sanctuary-state status, with the House passing a bill that would bar state and local agencies from asking about a person's immigration status and from disclosing information to federal officials, except in certain circumstances. The bill, introduced at the request of Gov. Kate Brown and Attorney General Ellen Rosenblum, both Democrats, has sharply divided lawmakers along party lines in the Democrat-controlled Legislature.Oregon became America's first, and so far only, sanctuary state in 1987 with a law preventing law enforcement from detaining people who are in the United States illegally but have not broken other laws. In February, Brown ordered all state agencies to follow it. Massachusetts lawmakers are considering a bill that would create another sanctuary state.A federal judge has blocked, at least temporarily, an executive order issued by Trump to cut funding to sanctuary cities that refuse to cooperate with federal immigration agents.
Migrant workers arrive here every spring to work in the “muck,” which is what everybody calls the fertile soil that makes this part of Ohio the perfect place to grow radishes, peppers, cucumbers and leafy greens. The temporary workers can be seen planting, weeding and, later in the season, harvesting crops that will be sold at national supermarket chains. But there’s trouble in the muck this growing season. “Without the Hispanic labor force, we wouldn’t be able to grow crops,” said Ben Wiers, a great-grandson of the pioneer Henry Wiers, who bought five acres here in 1896, noting that he considers many workers at Wiers Farms, which cultivates more than 1,000 acres of produce under the Dutch Maid label, to be friends.But beefed-up border enforcement has slowed the flow of workers who enter the country illegally. Last year, a shortage forced Mr. Wiers and the other growers to leave millions of dollars’ worth of produce in the fields. This year could be worse. The Trump administration has encouraged local law enforcement across the country to help identify deportable individuals for the federal authorities, making long-distance travel risky for those already in the country without legal status.“It’s not a hospitable climate,” lamented Mr. Wiers, who joined other farmers in discussing their concerns recently with Representative Jim Jordan, Republican of Ohio.
The state’s emerging opioid crisis may be partly to blame for the workforce shortages stymieing local efforts to attract new jobs. This was one of the revelations from the second meeting of the state’s new House Rural Development Council, which met recently in Toccoa. The group of legislators is tasked with identifying potential policy fixes for the economic challenges facing the rural Georgia. “We have a drug problem in Stephens County, and it’s a big one and it does impact the labor force,” Barry Roberts, director of operations for ASI Southeast, told legislators Friday during a meeting that was livestreamed. ASI Southeast employs more than 400 people, making it the largest private employer in the county that sits on the South Carolina border. The company, which makes steel and polymer products used in commercial restrooms, has invested $50 million in Georgia in the last decade, Roberts said. “We want to stay here. We want to thrive here,” Roberts said. “But we do feel like there are some obstacles in the way right now.” The substance-abuse problem, which manifests itself at ASI Southeast as failed drug tests, is one issue that “needs to be on your radar,” he told state lawmakers. It’s not a problem unique to the northeast Georgia community, though. Chris Clark, president and CEO of the Georgia Chamber of Commerce, said the chamber is monitoring the growing statewide impact of the opioid crisis.