Thursday, September 21, 2017

Charts predict how your state's federal health-care funding would change under last-ditch repeal plan

How would your state fare under Senate Republicans' last-ditch bill to repeal the Patient Protection and Affordable Care Act, which could pass Congress next week? The Kaiser Family Foundation has some figures, and so does The New York Times. Kaiser says in a report issued today that the Graham-Cassidy proposal would:
  • Repeal the Medicaid expansion and subsidies for individual insurance—including premium tax credits, cost-sharing reductions, and the basic health program—in 2020.
  • Put the money into a new block-grant program to states in 2020-26. States could use the funds "to cover the cost of high-risk patients, assist individuals with premiums and cost-sharing, pay directly for health care services, or provide health insurance to a limited extent to people eligible for Medicaid," Kaiser reports.
  • Cap state-by-state federal funding of the traditional Medicaid program for the poor and disabled.
  • Repeal the mandates requiring individuals to have health insurance and employers to offer it, and let states waive required benefits and community rating, which prevents insurers from charging higher premiums to people with pre-existing conditions.
The changes would reward the 15 states, controlled by Republicans, that did not expand Medicaid to people in households with incomes up to 138 percent of the federal poverty threshold. Kaiser explains the complex formula and reduces its effect to a simple chart:
State by state, Kaiser defines the extremes: "Five states would see a reduction in federal funds of 30% or more from 2020 to 2026: New York (-35%), Oregon (-32%), Connecticut (-31%), Vermont (-31%), and Minnesota (-30%). Six states would see at least 40% more in federal funds under the proposal: Tennessee (44%), South Dakota (45%), Georgia (46%), Kansas (61%), Texas (75%), and Mississippi (148%). . . . Because actual state allotments under the block grant may vary based on state-specific factors and the secretary’s authority to further adjust the formula, actual state experiences under the block grant may differ. It is uncertain how additional adjustments would be used to alter states’ allotments up or down."

Kaiser's report has three state-by-state tables, showing the projected differences in federal spending for ACA coverage, the total change in federal spending due to the block-grant program and the limit on Medicaid; and the projected loss of federal funds due to those factors.

The New York Times showed the funding changes per person, in charts that were color-coded: first by states that expanded Medicaid (in green), then by states (in orange) with senators who voted against one of the Obamacare repeal bills in July:

How Wisconsonites (and probably people in other states) commute across the rural-urban spectrum

We're used to thinking about populations as either rural or urban, or, if pressed, suburban and small-town too. But new research from the University of Wisconsin Applied Population Laboratory examines how seven types of communities on the rural-urban continuum are connected by the people who commute from one to the other for work. "Every day, many residents of big cities, small towns and the countryside alike travel between their homes and workplaces, sometimes within their own community, and other times traveling over long distances to places that are far apart. Their commuting patterns can help shed light on the ways these places are alike and distinct in terms of their economies and identities," Malia Jones reports for WisContext, a multimedia news and information project funded by the university. The patterns found in Wisconsin are likely echoed in other states as well.

Deciding whether a community is rural or urban can be complicated, so the Applied Population Lab used the Department of Agriculture's Rural-Urban Commuting Area Codes, which divide populations into seven categories along the rural-urban spectrum, based on census data. The results of the research can be seen on this breathtaking chord diagram (click here to use the interactive version):

Static image of interactive map by Caitlin McKown of WisContext
Click on the image to enlarge it; click here for the interactive version.
Most commuters are heading for cities, which is unsurprising, but is interesting to see quantified. And it has broader implications: "People who live in one place but work in another routinely access goods and services and make social connections across both. For example, commuters from isolated rural places may not have access to a grocery store near their home, but may have better access to one near their place of work. The lack of reliable grocery stores in sparsely settled areas is a type of food desert. This problem arises in part because many grocery stores depend on a large number of customers, which can be hard to attract in rural places where there are fewer people per square mile. For commuters from rural places, shopping at a market near work not only offers improved food options, but also creates an economic bond across places as these businesses depend on far-flung customers for their revenue," Jones reports.

Probe finds postal workers delayed lots of mail, then badly under-reported the delays

Weekly newspaper publishers have noticed that deliveries outside their home counties have slowed. Now an investigation by the Postal Service's Office of Inspector General found that postal workers deliberately slowed the delivery of more than 2 billion mailed items in the year studied. It said workers also manipulated delivery records and inaccurately reported delays.

The eight processing facilities examined "had about 1.8 million late arriving mailpieces during the week of our observations; however, the facilities only included 121,000 of them (or less than 7 percent)" in their mail-condition reports, the OIG said in the report. The centers were chosen "based on changes in their delayed mail reported" from fiscal year 2014 to 2016: Brooklyn, Dallas, Greenville, S.C.; Louisville; Mobile; Omaha; Southern Maryland; and South Suburban, a Chicago center.

Some employees said they delayed mail so workers on a slow shift would have something to do. "Investigators discovered more than 572,000 delayed mail items on land. However, postal officials were only reporting 369,000 delays, essentially hiding 36 percent of the problem," Larry Mayer reports for The Billings Gazette.

The Postal Service has struggled in recent years, with mail volume decreasing as online activity increases. And Congress has required it to set aside $5.5 billion a year to pre-fund health benefits for future employees, resulting in cuts to staffing and service. "USPS is the only government agency expected to pay for benefits decades in advance, and the cost burden has resulted in cuts to staffing and service," Mayer reports. That can mean even slower delivery times for mail, especially in rural areas.

The day the report was released, Sen. John Tester, D-Mont., called for those responsible to be fired. Tester is on the Homeland Security and Government Affairs committees, which handle Postal Service issues. "Any employee who deliberately delayed mail delivery, or who knowingly misreported mail delivery should be terminated for violating the trust of America’s hardworking taxpayers and postal ratepayers," he said.

Wireless or a hybrid with fiber-optic cable may help solve the rural broadband problem

Bringing high-speed internet service to people in far-flung rural areas is an ongoing problem, but a rural Minnesota county may have an interesting solution: a hybrid model that combines fiber-optic cables with wireless. And some wireless internet providers are already helping bridge the rural-urban broadband gap.

The problem is mainly the cost of laying the fiber. Telecommunications companies can lay a main line to a community, but rural counties can't usually afford to lay individual lines to homes that may be miles apart from the nearest neighbors. State and federal grants can help, but only go so far. This "last mile" problem is the kicker.

In Minnesota's Yellow Medicine County, a recent study estimated that laying fiber to 1,862 rural homes would cost $22 million. But Finley Engineering, which conducted the study, said using a wireless and fiber hybrid would cost only $5 million. "The hybrid proposal in Yellow Medicine County calls for laying a 52-mile fiber optic line to serve as a backbone to connect a string of towers to cover the rural areas. That compares to the 955 miles of fiber optic cable needed for a fiber-only option," Tom Cherveny reports for West Central Tribune in Willmar, Minn.

Would wireless internet in Yellow Medicine be as fast as broadband? Maybe, says Dan Richter, president of area provider MVTV Wireless. But he says providers in the region are improving internet speeds as economic conditions allow, Cherveny reports. Richter says MVTV will urge a county-appointed task force to consider the hybrid model as a solution.

Craig Settles reports for The Daily Yonder that more than 3,000 wireless internet service providers use fixed wireless technology, in which transmitters boost and relay data back and forth from homes to a fiber-optic source. "Each one [is] usually run by a handful of people who do everything: engineering design, hanging routers, marketing, customer service, and tech support. Some WISPs are integrating fiber technology into hybrid systems that use both wireless and wired communications technology," Settles reports. And though the speed provided by WISPs isn't as fast as cable broadband, it's probably plenty fast enough for most families, according to Jimmy Carr, CEO of fixed wireless company All Points Broadband.

Webinar next Tuesday will showcase new toolkit for rural tobacco control and prevention

Tune in for a free webinar from 2-3 p.m. ET on Sept. 26 to discuss the new Rural Tobacco Control and Prevention Toolkit, just released by the Federal Office of Rural Health Policy. The toolkit provides "evidence-based examples, promising models, best practices, and resources" that rural organizations can use to implement smoking cessation and prevention program. Such programs are important because rural Americans are more likely to get--and die from--cancers related to tobacco use.

The webinar is presented by the Rural Health Information Hub and a research organization at the University of Chicago, which developed the toolkit for the government. A recording will be available on the website afterward. Click here to learn more or register.

EPA's general inspector says agency isn't doing enough to curb farm pollution

Arthur Elkins, the Environmental Protection Agency's auditor general, just released a report slamming the agency for not keeping tabs on emissions from large-scale animal feedlots, as it promised to do eleven years ago. The EPA was supposed to publish reliable methods of estimating pollutants from these feedlots. Because individual feedlots don't have that yardstick, they can't provide meaningful data on their output of ammonia and other hazardous pollutants. Because the EPA doesn't have that data, it can't decide whether or not to put pollution controls in place or report the feedlots to emergency responders if the pollution is an immediate threat. "And until EPA officials finish work on the estimating methods, they are refusing to act on citizen petitions to regulate emissions from animal feeding operations, often known as AFOs, on the grounds that the methods "are needed to inform the agency's decision-making," the report said," Sean Reilly reports for Environment & Energy News. In the meantime, feedlots may be producing more pollutants than the surrounding environment and population can stand.

Large feedlots can create air pollution from sources such as decaying manure and animal feed, but figuring out a straightforward way to measure that pollution can be tricky. In 2003, the National Academy of Sciences first said that pollution estimates were needed. After more than two years of research, the EPA said in 2005 that it would use data from an industry-funded study to develop methods to estimate emissions. The agency was hoping to publish the methods in 2009 at that point, but the timetable was "wildly optimistic," Reilly writes. "The industry monitoring study took two years longer than originally expected; EPA had also not accounted for the time needed to get approval from an in-house board for agreements to protect individual producers from lawsuits or other enforcement actions for alleged violations until the new system was in place. Yet another hang-up emerged when EPA's Science Advisory Board, a body of independent experts, found in 2013 that a draft version of the estimating methods for some pollutants and sources wouldn't provide an accurate gauge of overall emissions. The board urged more work.
Since then, the entire enterprise has essentially been dead in the water, the inspector general's report suggested."

Lack of inertia and the retirement of key members of the project means the effort has also suffered from lack of expertise in "agricultural emissions, air quality and statistical analysis," the report said. Acting EPA air chief Sarah Dunham said she agreed with the report and said the agency plans to announce in the spring a schedule for issuing the new estimating methods.

Wednesday, September 20, 2017

First dataset from all states shows veterans' suicides are highest in the West and rural areas

Chart based on partial report issued in 2012
(Click on the image to view a larger version)
Military veterans living in the Western U.S. and rural America are much more likely to die by suicide, possibly because of contributing factors like social isolation, gun ownership, opioid addiction and access to health care, according to the first 50-state Department of Veterans Affairs data on suicide, Hope Yen reports for ABC News: "It shows Montana, Utah, Nevada and New Mexico had the highest rates of veteran suicide as of 2014, the most current VA data available. Veterans in big chunks of those states must drive 70 miles or more to reach the nearest VA medical center." West Virginia, Oklahoma and Kentucky have high suicide rates as well as higher rates of opioid prescriptions.

The study also breaks down gender and age disparities: female veterans are two and a half times more likely to die by suicide than their civilian counterparts. Male veterans are 19 percent more likely. Veterans 50 or older account for about 65 percent of veteran suicides.

The problem is nationwide. Rajeev Ramchard, an epidemiologist who studies suicide for the RAND Corp, told Yen that veterans in every state are at least one and a half times more likely to die by suicide than the general population. He pointed out that 70 percent of veterans who take their lives had not been connected to VA health care. "These findings are deeply concerning, which is why I made suicide prevention my top clinical priority," VA Secretary David Shulkin told ABC. "This is a national public health issue."

"Shulkin, who has worked to provide same-day mental health care at VA medical centers, recently expanded emergency mental care to veterans with other than honorable discharges," Yen reports. "The department is also boosting its suicide hotline and expanding telehealth options." Expanding private-sector care and stemming veterans' suicide are priorities of President Trump. In a statement this week as part of Suicide Prevention Month, he said the U.S. 'must do more' to help mentally troubled veterans.

Mississippi journalists accept reporting awards

Discussing the work that won them the Bill Minor Prize with moderator Rick Cleveland (from left) are Jerry Mitchell of The (Jackson) Clarion-Ledger, Ray Mosby and Natalie Perkins of the Deer Creek Pilot, Jamie Patterson of The Yazoo Herald and Tim Kalich of The Greenwood Commonwealth. (Photo by Layne Bruce, Mississippi Press Association)
Five Mississippi journalists accepted awards for their reporting and reflected on it and the state of journalism at an event in Jackson Friday. Ray Mosby and Natalie Perkins of the Deer Creek Pilot in Rolling Fork and Jerry Mitchell of The Clarion-Ledger in Jackson won the Bill Minor Prize for Investigative Journalism, and Jamie Patterson of The Yazoo Herald and Tim Kalich of The Greenwood Commonwealth won the Minor Prize for General News Reporting. Bill Minor, who died in March at 94, was a longtime Mississippi statehouse correspondent for The Times-Picayune in New Orleans and later a syndicated political columnist.

"Mosby and Perkins’ investigative coverage uncovered the dire need for renovations and repairs to the jointly owned Sharkey-Issaquena Community Hospital," Layne Bruce reports for the Mississippi Press Association. Mitchell, who has made a career of investigating unsolved murders of the civil-rights era, did a story in 2012 that led to the 2016 conviction of a man for killing his wife in 1962. “It was the oldest conviction of a suspected serial killer in U.S. history,” Mitchell said. “It took over 50 years. . . . When the trial was over, the [district attorney] told me ‘If you know any other guilty sons-of-bitches, let me know.’”

"Kalich was honored for a 2016 jailhouse interview with Edgar Ray Killen, convicted in the murders of civil-rights workers James Chaney, Andrew Goodman, and Michael Schwerner during the Freedom Summer of 1964," Bruce reports. "Kalich said the interview took place at the behest of Killen, who previously has had a not surprisingly combative relationship with the press.

“He wrote me a letter and said he liked our newspaper,” Kalich said. “I don’t know what that says about our newspaper.” His four-hour interview "was complicated by the rambling nature of Killen’s responses and the fact the state penitentiary at Parchman, where the interview was conducted does not allow any outside materials to be brought inside," not even paper.

"Patterson’s award-winning entry saw its genesis in two residents who turned to the local newspaper for help" because they had bought properties that the city had deemed a nuisance. “They later found out unpaid bills for cleanup, of $17,000 for one and $30,000 for the other, had been attached the land.” It was a complete surprise, Patterson said, adding that her investigation found “chaos” in the city’s recordkeeping.

The panel's moderator, syndicated columnist Rick Cleveland, "opened the program by discussing the challenges facing community journalists," Bruce reports, quoting him: “The best way to combat the perception that the media is the enemy is to put our heads down and do our jobs.”

EPA may allow farmers to use the controversial herbicide dicamba, with restrictions

The Environmental Protection Agency may allow farmers to use the controversial herbicide dicamba in 2018, but with more rules aimed at making it safer to use, Tom Polansek reports for Reuters. After dicamba is sprayed on crops, it sometimes dries into a fine powder that is picked up and spread by the wind. In 2017 alone, that has damaged about 3 million acres of soybeans and other crops that aren't dicamba-tolerant.

Reuben Baris, acting chief of EPA's herbicide branch, said he wasn't sure what steps the agency would take to mitigate damage associated with dicamba use. Officials had considered banning it, as several states have already done temporarily. Now the focus has shifted to discussions with state regulators on how to prevent crop damage in the future while allowing dicamba to be used in some way. EPA has also been in talks with Monsanto and BASF, which sell dicamba, to encourage changes in how they are used.

State officials had told Reuters that EPA "was considering establishing a set date after which the spraying of dicamba weed killers on growing crops would not be allowed," Polansek reports. Arkansas is considering a statewide spray deadline of April 15, 2018. "Monsanto has said the date would amount to a ban in Arkansas because the chemical was designed to be sprayed over the genetically engineered crops during the summer growing season," Polansek reports.

Rural Idaho schools hire more unlicensed teachers to deal with teacher shortage

School districts in south-central Idaho, struggling to attract qualified teachers, are hiring an increasing number who are either unlicensed or following a nontraditional university teaching program. The Twin Falls school district, for example, issued "alternate authorizations" for 34 such teachers for this school year, Julie Wootton reports for the Twin Falls Times-News. Some new hires are licensed, but need an alternate authorization because they aren't certified to teach the age groups they're being hired for, and some are student teachers who haven't yet graduated. But an increasing number of them don't come from an education background at all.

"Some education officials say it’s not necessarily a bad thing to hire someone who has experience working in a different career, but gaining a teaching license is important," Wootton reports. "Unlicensed teachers have three years to work toward a state certificate. Plus, they receive training and mentoring to help them adapt to working in a school and managing a classroom."

Many unlicensed teachers in Idaho work toward a state certificate by taking self-paced online classes through the American Board for Certification of Teacher Excellence, a non-profit program that helps professionals switch careers. Because so many instructors are going through the ABCTE, the Twin Falls district is now providing them with specialized training in topics like classroom management and navigating teacher-student relationships -- skills they would normally learn during student teaching if they were going through a traditional program.

Rural Idaho isn't short of teachers because the state is graduating fewer of them; the number of certified teachers graduating in Idaho has held steady for the past few years. But Debbie Critchfield, vice president of the Idaho State Board of Education, said many graduates are looking for jobs in urban areas of the state. "It’s almost more of a distribution problem," Critchfield said. "We’re not getting our certified teachers into our more rural areas around the state."

Republican Governors Association has a partisan website masquerading as news, AP reports

A partial screen shot of The Free Telegraph shows an attack
 on the Democratic nominee for governor of New Jersey.
The growing field of partisan media has a new entry that tries to disguise its partisanship. “The Republican Governors Association has quietly launched an online publication that looks like a media outlet and is branded as such on social media,” Bill Barrow reports for The Associated Press. “The Free Telegraph blares headlines about the virtues of GOP governors, while framing Democrats negatively. It asks readers to sign up for breaking news alerts. It launched in the summer bearing no acknowledgement that it was a product of an official party committee whose sole purpose is to get more Republicans elected. Only after The Associated Press inquired about the site last week was a disclosure added to The Free Telegraph’s pages identifying the publication’s partisan source.”

Barrow reports that the site was registered through “a company that allows the originators of a website to shield their identities. An AP search did not find any corporate, Federal Election Commission or IRS filings establishing The Free Telegraph as an independent entity. As of early Monday afternoon, The Free Telegraph’s Twitter account and Facebook page still had no obvious identifiers tying the site to RGA. The site described itself on Twitter as 'bringing you the political news that matters outside of Washington'. The Facebook account labeled The Free Telegraph a 'Media/News Company'.”

Democrats and liberal media critics told Barrow that material from the site is likely to appear digital and television ads, masquerading as news. A leading academic in the field of political advertising, Kathleen Hall Jamieson of the University of Pennsylvania, “said The Free Telegraph commits a form of 'identity theft' by 'appropriating the integrity of news' because 'the form of news carries credibility' that blatantly partisan sites do not.”

New book illuminates challenges of family farming by following a Nebraska family for a year

The survival of traditional family farms – those large enough to financially support a family but small enough to be worked and managed almost entirely by family members – has been under pressure for several decades in the U.S.

A new book, This Blessed Earth: A Year in the Life of an American Family Farm, by journalist and poet Ted Genoways, looks at the day-to-day challenges and financial realities of farming that exists on a scale somewhere between huge corporate agriculture and smaller, specialized ventures.

Genoways wanted to explore the world of farmers who are trying to pass on their land and way of life to the next generation while dealing with a range of political and market factors that affect their ability to make a living. Recognizing changes in consumer habits, he asked, "Is all of this really helping family farmers? How do they feel about a food movement that lionizes ideologically-driven operations like Joel Salatin's Polyface Farms, the pastoral curmudgeon made famous in Omnivore's Dilemma, and vilifies generations-old operations in the middle of the country, where many farmers have no choice but to raise commodity grains - principally corn and soybeans - just to keep their families afloat?"

The book follows Nebraska farmers Rick and Heidi Hammond and their daughter, Meghan, who raise corn, soybeans and cattle. The family began farming in Nebraska in the 1860s. "I saw firsthand conversations about what to do at a particular moment on a soybean farm in rural Nebraska that was directly influenced by what was happening at that moment in China," Genoways describes.

Lorraine Boissoneault writes for Smithsonian magazine, "Genoways says farmers follow everything from trade agreements like the Trans-Pacific Partnership to the debate over NAFTA and immigration from Mexico - to which the Mexican government has suggested it might stop imports of American corn."

In the face of these geopolitical issues and more traditional farm challenges, such as harsh weather, field pests and plant diseases, the Hammonds are trying like many other farm families to make a living and preserve their most precious resource: their land.

"He's not your typical 2017 farm hero, but, as Genoways artfully illustrates, [Rick] Hammond is working hard to pass his farm on to the next generation against the odds," Twilight Greenaway writes for Civil Eats. "And the myriad challenges family farms like his face – from unstable prices to a diminishing water supply and increasingly erratic weather – are worth our attention."

Genoways is also the author of the 2014 book, The Chain: Farm, Factory and the Fate of Our Food.

Tuesday, September 19, 2017

FERC overrules state regulatory department that tried to halt construction of a pipeline

Pipelines may have a smoother path to approval now that a newly reconstituted Federal Energy Regulatory Commission has established a new legal precedent for its powers.

"Leaders of blue states such as New York and California have positioned themselves as bulwarks against Trump administration efforts to roll back environmental regulations. Where the federal government steps away, these governors say, states will step in," Dino Grandoni reports for The Washington Post. But FERC, which approves permits for gas and oil pipelines, has asserted federal authority over states' rights in one such case, possibly setting a precedent for expanded authority.

The New York State Department of Conservation had denied a permit needed by the Millennium Pipeline Company to begin construction on the Valley Lateral Project. But last week, FERC ruled that the state of New York could not halt construction on the pipeline, saying that New York had taken too long to issue the permit and thereby waived its authority under the Clean Water Act.

The act was the first decision under FERC's new chairman, Neil Chatterjee, and may provide a hint of how FERC will rule in future cases now that it is fully staffed. Three seats on the commission had remained unfilled since President Trump's election, meaning FERC did not have the quorum it needed to approve new projects. Chatterjee is a longtime energy adviser to Senate Majority Leader Mitch McConnell. UPDATE: The Senate Agriculture and Natural Resources Committee approved Trump's appointments to the two remaining seats, Kevin McIntyre and Rich Glick, on Tuesday.

Attorneys general put insurers on notice for possible role in opioid epidemic; a lawsuit, maybe?

A patient takes hydrocodone.
(NYT photo by Kevin Liles)
Drug companies and doctors have been accused of playing a part in the opioid crisis ravaging America, but insurers may be partly responsible too. Health-insurance plans are more likely to cover opioids that are relatively cheap, while limiting access to more expensive painkillers that carry a lower risk of addiction. That's a problem, because a study by researchers at the University of Arkansas for Medical Sciences found that 20 percent of patients who get a 10-day first-time prescription for opioids will still be using opioids after a year.

"ProPublica and The New York Times analyzed Medicare prescription drug plans covering 35.7 million people in the second quarter of this year. Only one-third of the people covered, for example, had any access to Butrans, a painkilling skin patch that contains a less-risky opioid, buprenorphine. And every drug plan that covered lidocaine patches, which are not addictive but cost more than other generic pain drugs, required that patients get prior approval for them," Katie Thomas of the Times and Charles Ornstein of ProPublica report. "In contrast, almost every plan covered common opioids and very few required any prior approval. The insurers have also erected more hurdles to approving addiction treatments than for the addictive substances themselves, the analysis found."

Officials are taking notice. The Department of Health and Human Services is studying whether insurance companies make opioids more accessible than non-opioid painkillers or non-drug therapies (early analyses say yes). And attorneys general from 35 states, the District of Columbia, and Puerto Rico co-signed a letter sent to industry trade and lobbying group America's Health Insurance Plans this week, pressuring insurance companies to take action. "The chief state legal officers are pushing for insurers to review, and potentially revise, payment and coverage policies to encourage health care providers to prioritize non-opioid pain management over opioid drugs for the treatment of chronic pain not caused by cancer," Bill Lucia reports for Route Fifty.

Kentucky's attorney general, Andy Beshear, and his West Virginia counterpart, Patrick Morrisey, held a joint press conference Sept. 18 in Huntington, W.Va., to call attention to the letter. Beth Warren reports for The Courier-Journal that Beshear didn't say what would happen if insurers don't take action, but he referred to lawsuits attorneys general brought against cigarette manufacturers for selling addictive, potentially deadly products; the companies are paying billions in settlements. "Ask the tobacco companies how that works out," Beshear said.

Cathryn Donaldson, a spokeperson for AHIP, told Lucia in an email that insurers are committed to helping solve the problem. "Many health plans have instituted new programs that are helping to dramatically reduce how much—and how often—opioids are prescribed," she said. But the data analysis by the Times and ProPublica found that there are still significant barriers in place for the prescription of less addictive painkillers and addiction treatment drugs such as Suboxone, especially in some state Medicaid programs.

Appeals court rejects theory that it doesn't matter where coal mined when it comes to carbon dioxide

Coal mining in the Powder River Basin. (Bureau of Land Management photo)
A federal appeals court ruled last week that the Bureau of Land Management did not adequately consider the environmental impact of greenlighting four large coal mines in Wyoming's Powder River Basin, and thus violated the National Environmental Policy Act. "The BLM concluded in 2010 that if companies were not allowed to mine the coal on federal land in Wyoming, the demand for coal would still be so high that it would be mined somewhere else, so the carbon-dioxide emissions would be the same whether the federal leases were approved or not. The Court of Appeals for the 10th Circuit ruled Friday that the BLM’s conclusion did not withstand scrutiny," Timothy Cama reports for The Hill.

BLM's decisions for leasing coal often hinge on the "perfect substitution" theory, which assumes that coal will be mined elsewhere if not at the tract under consideration, and that the prices the coal brings will be the same anywhere. But the court noted that Powder River Basin coal is generally cheaper than coal from other mines, Ellen Gilmer reports for Environment & Energy News.

Judge Mary Beck Briscoe wrote that the BLM showed no proof that coal to be mined in the basin could be easily mined elsewhere at a comparable price. "It did not refer to the nation’s stores of coal or the rates at which those stores may be extracted. Nor did the BLM analyze the specific difference in price between [Powder River Basin] coal and other sources; such a price difference would effect substitutability."

The case marks the first time a federal appeals court has ruled on the "perfect substitution" theory for coal leasing. Jayni Hein, policy director at New York University School of Law's Institute for Policy Integrity, told Gilmer "This opinion is significant because it means that future federal agencies cannot just rest on these questionable assumptions and will have to do meaningful analysis as to the actual greenhouse gas emission effects from their leasing decisions."

The ruling could be cited as a precedent in future cases to show that federal agencies must do due diligence in predicting the environmental impacts of decisions, Cama notes.

Report for America project aims to get 1,000 more reporters at local newspapers in next five years

A new project is trying to boost the number of reporters at local newspapers that have been decimated, or worse, by layoffs. Report for America aims to put 1,000 journalists at local papers in the next five years. It's modeled on organizations such as the Peace Corps, Americorps, and Teach for America, Kristen Hare reports for the Poynter Institute.

Co-founders Charles Sennott and Steven Waldman announced the project Sept. 18 at the Google News Lab Summit. RFA is a partnership between Google News labs and the Groundtruth Project, of which Sennott is the CEO. "RFA also gets support, and its reporters will get training, from the Center for Investigative Journalism, the Lenfest Institute for Journalism, the Solutions Journalism Network and the [John S. and James L.] Knight Foundation," Hare reports.

The program will be selective, since the co-founders say the program isn't worth it unless the reporters do great work. After the reporters apply, are selected and get further training, they'll work in a newsroom for one year. For that first year, each reporter's salary will be paid 50 percent by RFA, 25 percent by the newsroom, and 25 percent by local donors. After the year is up, the paper may choose to rehire the reporter and assume more or all of the cost of his or her salary. The program will also require the reporters to do other community service, such as helping a high-school newspaper.

Waldman says "Digital start-ups, public radio stations, newspapers, TV stations and journalism schools are all possible partners. But they have to make the case that they'll use the RFA journalist for civically important local journalism that's in the public's interest, not just clickbait."

Top Ky. lawmakers propose moving Appalachian agency from D.C., focusing it on poorest areas

ARC map shows most economically distressed counties in red. Click on it to enlarge.
Two powerful Kentucky Republicans have an idea to boost the economic development agency created to help Appalachia: "Move it out of the nation’s capital," Matthew Daly reports for the Associated Press. Senate Majority Leader Mitch McConnell and Rep. Hal Rogers, a House Appropriations Committee chair and former committee chair, "are sponsoring a bill they say will refocus the Appalachian Regional Commission to invest more in the poorest communities in 13 Appalachian states." ARC is a partnership of government at the local, state and federal levels that works to boost the workforce, economies, infrastructure, communities, and natural and cultural heritage of the Appalachian regions of 13 states, spanning from Mississippi to New York.

The legislation, introduced Sept. 18 in the House and Senate, would also increase funding to the poorest counties served by the ARC's Area Development Program. Of the 82 counties the ARC classifies as economically distressed, 35, or 43 percent, are in Kentucky.

McConnell and Rogers say other regional commissions modeled after ARC are headquartered on home ground, and that such a move would reduce administrative costs and make them more accountable to their communities. The lawmakers say the location for the headquarters would be chosen after the bill becomes law.

President Trump’s proposed budget targeted ARC for elimination, "but lawmakers from both parties pledge it will remain intact," Daly reports. McConnell said he supports ARC, but wants to improve it and make it more efficient.

Monday, September 18, 2017

Rural hospitals struggle to stock expensive drugs that could save lives

Rural hospitals are having trouble keeping certain life-saving drugs in stock because the government forces them to pay far more for them than large hospitals. A provision of the Patient Protection and Affordable Care Act, added without debate at the end of the drafting process, denies rural hospitals from getting discounts on so-called "orphan drugs" that are meant to treat rare diseases, Sarah Jane Tribble reports for NPR. Large hospitals can get bulk discounts on drugs; rural hospitals try to get lower prices by participating in a federal drug discount program approved in 1992, but still end up paying far more for some drugs than large hospitals that receive the bulk discounts.

Here's why this is particularly bad news for rural hospitals: many pharmaceuticals classified as orphan drugs do not actually treat rare diseases. "The Food and Drug Administration gives the orphan drug designation to a medicine as a first step when it agrees with a drugmaker's request to study whether the medicine can be used to treat a specific rare disease. And this can happen even if a drug is already FDA-approved and on the market for use in treating a common condition," Tribble reports. So widely used drugs such as the clot-busting Activase, which must be used immediately to help stroke victims, are too expensive to keep on hand. Activase has not been approved to treat a rare disease, but the FDA granted it orphan status in 2003 and 2014 because its manufacturer, Genentech, said it is researching possible ways for Activase to treat rare diseases.

"If we don't keep this drug [in stock], people will die," hospital pharmacist Mandy Langston told Tribble. Where she works, Stone County Medical Center in Mountain View, Ark., a single dose of Activase costs $8,010. But just miles down the road, regional hospital White River Medical Center pays only $1,600 per dose.

The orphan drug clause affects cancer drugs too. At Cass County Memorial Hospital in Atlantic, Iowa, cancer patients may have to wait a few days to begin treatment so the hospital can order the medications, otherwise too expensive to keep on hand. And "in Vermont, North Country Hospital closed its infusion center this spring due to the soaring cost of medicines," Tribble reports. Cancer patients who live nearby must now drive 45 minutes for treatment.

Some drugmakers, such as Janssen Pharmaceuticals, voluntarily offer discounts to rural hospitals on all of their orphan drugs. "In contrast, drugmaker Genentech sent letters to rural hospitals on Jan. 1 listing dozens of drugs that would not qualify for discounts — including Activase and cancer drug Avastin," Tribble reports.

Wildfires costs hit new record; Perdue endorses new funding scheme; weather helps Montana

The historic Sperry Chalet in Glacier National Park. (AP photo)
The 2017 wildfire season has now cost more than $2 billion to fight, making it the most expensive in the nation's history. "The Department of Agriculture, which oversees the federal Forest Service, says it’s had to dig deeper into budgets to ward off the flames – even dipping into fire prevention funds," James Dawson reports for Boise State Public Radio in Idaho. "That leaves little to no money for prescribed burning and other forest management techniques that can prevent a manageable blaze from growing into a behemoth."

Agriculture Secretary Sonny Perdue says he wants Congress to change how the USDA pays for fighting wildfires, endorsing a bill introduced by Rep. Mike Simpson (R-Idaho) that would treat wildfires like natural disasters such as hurricanes, with money to fight them coming from special emergency relief funds, Dawson reports.

Wildfires this season have burned about 8.4 million acres, almost 3 million more than the average of the past decade, Phil McCausland reports for NBC News. As of today, the fires cover about 1.7 million acres in Western states; some seem to be slowing down due to rain, snow and ice in hard-hit Montana.

Memo reveals Interior's recommended changes to monuments, three new ones for people of color

Petroglyphs at Gold Butte National Monument in Nevada. (AP photo by Christian Lee)
A copy has been leaked of the memorandum that Department of the Interior Secretary Ryan Zinke sent to President Trump last month, in which he recommended that the size of some national monuments be reduced in order to again open up those lands for commercial use. The memo revealed that Zinke recommended modifying 10 monuments, which includes shrinking the boundaries of at least four Western sites. Zinke also recommended that local officials and affected industries be able to weigh in on the way the targeted monuments are managed, and said that "the administration should permit 'traditional uses' now restricted within the monuments’ boundaries, such as grazing, logging, coal mining and commercial fishing," Juliet Eilperin reports for The Washington Post.

The memo "does not specify exact reductions for the four protected areas Zinke would have Trump narrow — Utah’s Bears Ears and Grand Staircase-Escalante, Nevada’s Gold Butte, and Oregon’s Cascade-Siskiyou — or the two marine national monuments — the Pacific Remote Islands and Rose Atoll — for which he raised the same prospect," Eilperin reports. "The two Utah sites encompass a total of more than 3.2 million acres, part of the reason they have aroused such intense emotions since their designation."

Zinke also suggested establishing three new national monuments to recognize either African American or Native American history: Camp Nelson south of Nicholasville, Ky., where African Americans joined the Union Army and began Kentucky's change of heart in favor of the Confederacy; the Jackson, Miss., home of Medgar Evers, where he was murdered; "and the 130,000-acre Badger-Two Medicine area in Zinke’s home state of Montana, which is consider sacred by the Blackfeet Nation," Eilperin reports.

The issue may create legal precedent for a president's ability to act under the Antiquities Act, since conservation groups such as the Wilderness Society have vowed to fight Zinke's recommendations in court if they become a reality. "No other president has tried to eliminate a monument, but some have trimmed and redrawn boundaries 18 times, according to the National Park Service," Matthew Daly reports for The Associated Press. President Trump ordered Zinke's review after complaining that former presidents had misused the authority granted by the Antiquities Act to create too-large monuments that hamper important commercial activities.

All U.S. counties again have Obamacare plans after Anthem steps in to serve Va. counties left bare

Health insurer Anthem Inc. announced Sept. 15 that it will sell individual Obamacare plans next year in the parts of Virginia that were in danger of having no such coverage. So, as of now, no U.S. counties lack an individual Obamacare insurer, though an increasing number will have just one when government marketplaces open enrollment Nov. 1.

"Last week, Virginia officials said there were 48 counties and 15 cities in that state expected to be bare as a result of Optima Health's decision not to expand its footprint as much as it had earlier expected,"  Dan Mangan reports for CNBC. "Anthem had announced in August that it would stop selling its Blue Cross Blue Shield Obamacare plans in all of Virginia. Two other large insurers, Aetna and UnitedHealthcare, previously said they would exit the Obamacare market there."
Bloomberg's county-by-county map shows number of marketplace insurers as of Sept. 18. Click here for the interactive map; click on the image for a larger version.
The marketplace has been in frequent flux as insurers decide whether, or to what extent, to participate in the marketplaces created under the Patient Protection and Affordable Care Act. Insurers must submit final plans to the federal government by the end of September. Anthem is significantly scaling back its ACA plans in nine of the 14 states where it currently sells individual marketplace plans. A few weeks ago, the insurer announced it would cut in half the number of Kentucky counties in which it would offer such plans.

News to use about Farm Safety and Health Week

This is National Farm Safety and Health Week, which serves as an annual reminder that farming is one of the most dangerous occupations. This year's theme is "Putting Farm Safety into Practice," and each day has a related focus:
Monday: Tractor Safety
Tuesday: Farmer Health
Wednesday: Child/Youth Health and Safety
Thursday: Confined Spaces in Agriculture
Friday: Rural Roadway Safety

The National Education Center for Agricultural Safety has a page with informative documents for each day's topic. In addition, the AgriSafe Network will post a webinar from 12 to 1 p.m. Central Time each day this week focusing on the day's topic. Click here to learn more about and register for the webinars. And the U.S. Agricultural Centers has posted 100 safety and health videos about agriculture, forestry and fishing to its YouTube channel. The centers are funded by the National Institute for Occupational Safety and Health.

Friday, September 15, 2017

Cassidy-Graham ACA repeal bill gains steam; hospitals alarmed, but bill has a rural skew

Republican Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana have offered up what may be the GOP's last-ditch effort to offer up an alternative to the Patient Protection and Affordable Care Act. Sens. Dean Heller of Nevada and Ron Johnson of Wisconsin were also involved in the planning. The Republicans must repeal the ACA by Sept. 30 if they want to do so by a simple majority. Sarah Kliff of Vox says the Graham-Cassidy plan is, in many ways, "the most radical one yet."

"The proposal would eliminate the health-care law’s subsidies for private insurance and end the Medicaid expansion. States could allow for waivers that let insurers charge sick patients higher premiums and stop covering certain benefits required under the Affordable Care Act, like maternity care or prescription drugs. The health insurance marketplaces would no longer exist as they are envisioned to continue under other Republican proposals," Kliff reports. "The federal government would convert some (but not all) of that spending into a lump-sum payment to states. States could choose to spend this money on providing insurance — or they could use it to fund high-risk pools, or do other activities to pay the bills of patients with high medical needs. States wouldn’t get this money for free: They’d be required to kick in a small percentage themselves."

Kliff writes that the plan leans toward rural states. "The complex funding formula used to divvy up the big pot of money would tilt more funding toward sparsely populated states. It advantages rural states that have fewer people per square mile than those with denser, more urban populations." As a Senate bill, that is not surprising.

Some hospital groups say the plan alarms them at first blush, but say they're still studying it, Harris Meyer reports for Modern Healthcare. "It will decimate the Medicaid program in California," said Jan Emerson-Shea, vice president for external affairs at the California Hospital Association, who estimated that as many as  5 million people in her state could lose coverage under the bill. "The redistributive effect of this proposal is worse than any other proposal surfaced this year."
L-R: Sens. Dean Heller, Bill Cassidy, Ron Johnson, and Lindsey Graham at a press conference this morning to discuss their bill. (Associated Press photo by Andrew Harnik)
Trump has guardedly supported the plan, saying in a tweet that he "applauds the Senate for continuing to work toward a solution to relieve the disastrous Obamacare burden" and "sincerely hopes that Senators Graham and Cassidy have found a way to address the Obamacare crisis."

In an interview with Al Cross, director of the Institute for Rural Journalism and Community Issues, Senate Majority Leader Mitch McConnell said the bill will come to the floor if his allies can find the votes. "There’s a lot of discussion, but the time is running on that," he said. "It could well come up. If we have 50 votes, we’ll go to it." At a press conference this morning, Cassidy "said his informal whip count stands at '48 or 49' GOP votes," Tom Howell reports for The Washington Post. With 50, Vice President Mike Pence would break the tie for passage. The last repeal-and-replace effort got 49, with Graham's running buddy, John McCain of Arizona, casting the deciding vote against it.

How the ACA affected every state, in 51 graphs

The Washington Post has offered a real treat for data wonks with a story compiling how the Patient Protection And Affordable Care Act affected each state in 51 graphs--one graph per state. The 51st graph highlights how the percentage of uninsured Americans has dropped more in states that expanded Medicaid, though the rate dropped in both groups.
Washington Post graphic
Philip Bump points out interesting trends in the data, such as how Delaware had a slower rate of decline in its uninsured rate than other states, but that may be because it had a lower rate of uninsured people to begin with: "In only three of the above graphs did the lines go up between years: South Dakota had an increase in 2015, and D.C. and Nebraska had increases in 2016. Every other year in every other state, the rate of the uninsured fell."

Verizon drops thousands of rural wireless customers, on grounds they're using too much data

Verizon is disconnecting wireless service to rural users in several states, including Maine and Montana, saying they use too much data to make service profitable. The issue centers on Verizon's LTE in Rural America program, which Verizon says has brought coverage to more nearly 2.4 million people since its inception in 2010. Verizon partners with 21 small rural carriers around the country and pays them when its customers end up roaming off Verizon's cell network and onto the rural carriers' network. The affected customers have Verizon's "unlimited" data plan, but don't live in Verizon's native service area. Verizon may be losing money on these perpetually roaming customers, Jon Brodkin reported for Ars Technica in June, when Verizon first began cutting off rural customers.

That brings us to now, when Verizon just announced it is dropping 2,000 customers in Washington County, Maine, and dozens of small towns in Montana. And on a discussion board about mobile services, posters from several states, including Kentucky, have also claimed that rural users are being kicked off their Verizon plans.

In Maine, the announcement comes three years after Verizon signed a multimillion dollar deal with Portland-based Wireless Partners to upgrade and improve cellular service in Washington County. To hold up its end of the deal, Wireless Partners built 13 new cell towers in the county, the easternmost in the U.S. "Customers are now getting notices in the mail that tell them they’ve been using a significant amount of data while roaming off the Verizon Wireless network. The letters then informed the customers that their service is being terminated," A.J. Higgins reports for Maine Public Broadcasting. Affected customers have until Oct. 17 to sign up for another wireless service if they want to keep their current numbers. A Wireless Partners spokesperson told Higgins that the company plans to hold Verizon accountable for not holding up its end of the deal after all the money Wireless Partners has invested in improving infrastructure.

In Montana, it's the same story, but over a larger area. "The list of towns affected by the contract termination is in the dozens, from Alzada to Homestead to Zortman," David Erickson reports for The Missoulian. Verizon spokesperson Meagan Dorsch told Erickson that the company sent out notifications this month to 919 Montana customers with 2,035 lines that Verizon will no longer service. One, Kyle Wasson, a farmer near Loring, said his farm uses cell data to check water in cows' tanks, order new parts when machinery breaks down, and communicate with hired hands. "It’s amazing how much we use cellphones and data out here,” he told Erickson. "It’s what we gotta do." Montana lawmakers are criticizing Verizon for the move. U.S. Sen. Steve Daines said Verizon's actions were "unacceptable" and that "This is yet another example of the rural-urban divide and choosing a bottom-line over a commitment to Montanans."

Rural Florida residents, crops still reeling from Irma

Rural Florida is still reeling from Hurricane Irma, with many still waiting for aid. "Florida's rural counties say they are facing unique challenges created by Irma and don't want to be overshadowed by the concerns of larger, urban areas," Jake Stofan reports for WCTV, which covers the Gulf Coast's Big Bend, where the peninsula meets the panhandle. As of Sept. 13, many gas stations were still dry and grocery stores depleted of supplies.

In Monticello, Fla., many businesses and residents are still without power, WTXL-TV reports. A spokesperson for the Tri-County Electric Co-Op says "We were advising our members to prepare for that, for seven to ten days." As of Sept. 13, power was still out for about half of the homes and businesses affected by Irma, about 4.3 million customers. "The total number of customers still out, representing about 9 million people in Florida, Georgia and the Carolinas, dipped from a peak of more than 7.8 million customers, or over 16 million people, on Monday," Scott DiSavino reports for Reuters. The largest utility in Florida, Florida Power & Light, warned customers it could take weeks to restore the power in some areas.

Electricity isn't the only problem. In the rural southern town of Immokalee, near the Everglades, the storm destroyed the homes of many impoverished farm workers. "Many homes — mostly uninsurable trailers — are gone or heavily damaged. The fields where they work have been flooded or scoured by wind. They have families to support, mouths to feed, trailers to fix, looters to watch out for and no idea when they’ll have an income again," Kate Irby and Lesley Clark report for The Miami Herald.

The damage to Florida's crops is another long-term possible problem. Florida is the second-largest produce grower in the U.S. and accounts for almost 10 percent of the nation's land dedicated to fresh fruits and vegetables, Alan Bjerga reports for Bloomberg. Irma "could devastate the farm economy of Florida, a state with a unique history as a producer of winter fruits and vegetables given its warmer climate. Damage to croplands could affect U.S. food prices and farmer finances in the months and years to come."

Read more here:

Thursday, September 14, 2017

Using rural examples, Economist writer says Trump misuses his 'rare understanding' of Americans

"America remains an indispensable nation" for the world, but each generation of Americans must be reminded of that, and President Trump is only dividing the country and making it look inward, our British friend David Rennie writes in his final "Lexington" column for The Economist, as he leaves Washington for a posting in China.

David Rennie
"A natural demagogue, he spotted how, after years of the war on terror, America was weary of trying to fix an ungrateful world," Rennie writes. "He grasped how, at home, millions could conceive of no benign explanation for economic and social changes that worried or disgusted them, and heard no argument from the two main parties that reassured them. He sensed that voters are more than adding machines, weighing the costs and benefits of this stale tax plan or that tired promise of help. He won in part by understanding how much people need to feel that they are useful, respected and heeded. A better man than Mr. Trump could have done great things with that insight."

Rennie uses some rural examples to illustrate voters' feelings: dislike of federal land-management policies in eastern Oregon, and a study of "why middle-aged men were buying fewer licences to hunt deer" in Wisconsin. "With women gaining economic and social power, the study found, men feel less able to head to the woods for a week’s deer camp, supremely confident in their authority as breadwinners. To be good fathers, they feel less able to skip children’s sports. 'The ladies all hollered at me,' one research subject recalled after a deer-related conflict, in tones of baffled hurt. . . . Partisans on the left sometimes scoff at conservatives ascribing voter anger to 'economic anxiety,' arguing that this is really prejudice at work. In real life, differing forms of anxiety cannot easily be separated."

Rennie concludes, "There are plausible scenarios in which Mr. Trump, a cynical and undisciplined bully, brings catastrophe to the country that Lexington was raised to love, and where both his children were born. For now consider a disaster that is already certain. Mr. Trump has a rare understanding of how change has left millions feeling disrespected, abused and alienated from mainstream politics. Alas, he has used that gift only to divide his country, for selfish ends. This is a tragic waste." (Read more)

What Hillary Clinton, in her new book, has to say about rural America and why she lost it so badly

Hillary Clinton did terribly in rural areas in the 2016 general election against Donald Trump, and lost them in the 2008 primaries against Barack Obama. In her new book, What Happened, Clinton promises to offer an unflinching account of what went wrong in her last campaign. Part of that was a disconnect with rural America. Does she acknowledge the role it played in her loss?

The answer is: sort of. Clinton writes that she has spent a great deal of time since the election thinking about why she failed to connect with "working-class whites," meaning those without college degrees, which can be a rough analogue for rural residents. Some commentators, she says, talk as though it was because of her weaknesses and Donald Trump's populist appeal, pointing out all the rural voters who switched from Obama to Trump as evidence. But she believes the problem is older than that, and notes that Democrats have steadily lost ground in rural areas since 2000. Part of that, she acknowledges in a different section of the book, is because socially conservative voters are dismayed at the changing culture of America. Research bears that out.

While rural areas are increasingly Republican strongholds, Clinton may be too quick to gloss over her personal lack of appeal in rural areas. After all, she lost rural areas by 2.1 million votes to Obama in 2008. Rural votes for Trump may have also stemmed from her lack of personal appeal than general anti-Democrat sentiment.

So why does she think she lost in rural America? "The most prominent explanation, though an insufficient one on its own, is the so-called war on coal," she writes. "Democrats' long-standing support for environmental regulations that protect clean air and water and seek to limit carbon emissions has been an easy scapegoat for the misfortunes of the coal industry and the communities that have depended on it." The Obama administration, she says, did not do enough to combat the zero-sum narrative of environment vs. coal jobs.

And too, she acknowledges the disastrous fall-out from her notorious gaffe about putting coal miners out of work. In the tradition of memoirs, she's anxious to set the record straight about that, insisting that context was essential to understanding the meaning of her remark. "Stripped of their context, my words sounded heartless," she writes. In context, that sentence is part of a larger point about how she wanted to make sure that coal miners who had lost their jobs to the increasing popularity of natural gas and renewable energy were not forgotten.

Overall, Clinton comes off as very knowledgeable about rural policy, but also still very angry about the results of an election she felt she deserved to win.

Senate deal to fund Children's Health Insurance Program would end federal support for it in 2021

The Children's Health Insurance Program pre-dated the Patient Protection and Affordable Care Act by more than a decade, but the ACA boosted it and made it part of the overall plan for coverage of populations that had difficulty getting it. Now Senate negotiators have come up with a five-year plan that would cut federal contributions to the program in half in 2020 and eliminate them in 2021, leaving states to fend for themselves.

"The announcement from Chairman Orrin Hatch (R-Utah) and ranking member Ron Wyden (D-Ore.) came with Congress careening toward an end-of-the-month deadline to extend federal funding for a program that covers roughly 9 million low-income children," reports Rachana Pradhan of Politico.

The House has yet to come up with its approach to the issue. Without reauthorization by Sept. 30, some states would have to start winding down the program. Here's a map from the Kaiser Family Foundation, which has more background on the program here.

Air Force spraying insecticide over 6 million acres in Texas to combat post-Harvey mosquitoes

Texas is using huge U.S. Air Force planes to spray 6 million acres for mosquitoes breeding in the standing water left by Hurricane Harvey.

Devika Krishna Kumar reports for Reuters, "C-130 cargo planes began spraying insecticides over three eastern Texas counties over the weekend and will expand to other areas over the next two weeks, officials from the Texas Department of State Health Services said. . . . Most mosquitoes that appear after floods are not the disease-carrying varieties but can hurt recovery operations by swarming residents and disaster workers during cleanup efforts."

The spraying is using naled, an insecticide banned in the European Union but commonly used in the U.S. and supported by American health officials. "Both the Centers for Disease Control and the U.S. Environmental Protection Agency stand behind naled, saying the small amount of the insecticide sprayed from planes doesn’t expose people enough to pose a health concern," Zoe Schlanger of Quartz writes for Route Fifty. "The chemical has caused controversy in recent years. In 2016, naled spraying inadvertently caused millions of honeybee deaths in South Carolina."

EPA postpones Obama-era limits on toxic metals in wastewater from coal-fired power plants

Federal regulators have delayed until 2020 an Obama-era rule that set new limits on pollutants such as lead, mercury and arsenic in the wastewater of coal-fired power plants.

"The Environmental Protection Agency’s move 'resets the clock' for the effluent guidelines for power plants, providing relief to the plants from existing regulatory deadlines while the agency studies the regulation, EPA Administrator Scott Pruitt said in a statement. The plants now will have until Nov. 1 2020 to comply with the rule, instead of Nov. 1, 2018," Timothy Gardner and Eric Walsh report for Reuters.

Pruitt announced plans to delay the rule back in August. The Small Business Administration and the Utility Water Act Group had both petitioned the EPA to delay the rule, which environmental groups supported. "EPA estimates that annual compliance costs to coal plants, once the rule goes into effect, will be $480 million. Benefits associated with the pollution reductions will be worth $451 million to $566 million a year, it estimates," Gardner and Walsh report.

The delay is one of several by President Trump's administration to walk back President Obama's tougher environmental standards, some affecting farmers, some affecting coal and oil industries.

4 senators (2 Rs, 2 Ds) offer 19 recommendations to boost economy and health in Appalachia

"Four U.S. senators and the nonprofit Bipartisan Policy Center on Wednesday proposed 19 measures to boost the economy in Appalachia, including expanded broadband and telemedicine and tapping the region's 'vast' natural gas reserves for chemical and advanced manufacturing facilities," Michael Virtanen reports for The Associated Press.

Democrats Joe Manchin of West Virginia and Mark Warner of Virginia, along with Republicans David Perdue of Georgia and Thom Tillis of North Carolina, each led one of four policy roundtables with regional and national stakeholders to introduce and discuss ideas for improving the region. Those and other data gathering led to the recommendations in the report, which relies heavily on data gathered by the Appalachian Regional Commission. Here's a brief summary of the report's recommendations:
  1. Provide flexibility, incentives and leadership to empower local leaders to build education and workforce development strategies and programs. In most cases, the report says, successful education and job training programs are built at the local level.
  2. Reform Pell Grant eligibility to include more non-traditional students, such as part-timers, older students, students in community college credentialing programs, and students enrolled in apprenticeships or other work-and-learn programs.
  3. Legislators and the departments of Labor and Education should include virtual learning options in new grant programs that target high-demand skills and post-secondary credential attainment.
  4. Regional and town leaders, or the private sector, should foster "domestic study abroad" programs to share innovative ideas and build connections across the region. An exchange program "that pairs leaders and students from newly prospering communities with counterparts from distressed communities, could increase learning and help build regional connections."
  5. Provide a tax credit to companies that provide professional development training to help workers gain more skills.
  6. Reduce overlap and duplication in the federal government's financial regulatory structure, and give regulators more flexibility to decide when more regulatory supervision is need.This could help ease the burden that stricter banking regulations have placed on small community banks, which are more likely to lend to small businesses.
  7. Establish a Senate Task Force on Intergovernmental Affairs, like the House just did. This would be a bipartisan group focused on balancing the interests of federal, state, tribal and local governments. It could help figure out where the government could lessen regulations to help rural entrepreneurs and business owners.
  8. Expand federal programs that facilitate workforce-related public-private partnerships. The lack of skilled workers is a barrier to job creation in Appalachia; private companies could work directly with universities to develop workers with the skills needed to succeed in jobs there.
  9. Identify barriers that prevent Appalachian businesses from accessing existing workforce programs. The Senate task force recommended above would be ideal for this effort, the report says.
  10. Use Appalachia's natural-gas reserves to build up chemical and advanced manufacturing industries. The first step would be to develop a storage and trading hub for natural gas liquids. This could help Appalachia become a natural gas hub that could one day rival the one on the Gulf Coast.
  11. Conduct more federal research to develop widely useable technology to extract rare-earth elements from coal byproducts. The U.S. currently relies on other countries like China for rare-earth elements, which are important for national defense, electronics, and medications. Researchers say Appalachian coal has some of the highest concentrations of rare-earth elements in the country.
  12. Accelerate the commercialization of carbon capture, utilization and storage technologies. The report says that's necessary to ensure that American coal is competitive in domestic power generation markets and that the U.S. will be a leader in exporting clean coal technology to developing nations.
  13. Complete the Appalachian Development Highway System to help distressed rural communities improve their infrastructure. The system is 90 percent complete. 
  14. Improve and streamline the complicated and often-lengthy federal permitting process while maintaining environmental protections.
  15. The U.S. Chamber of Commerce and the National Association of County and City Health Officials should combine forces with local affiliates in rural Appalachia to improve local health outcomes.
  16. Direct federal agencies to take action needed to expand and require opioid training for health-care professionals. Too many opioid prescriptions are being issued, and for too long, at too high a dose, the report says. 
  17. Improve nutrition in rural Appalachia through evidence-based policies and programs.
  18. Local and state officials should consider policies and initiatives to promote lifelong dental hygiene.
  19. Support telemedicine and efforts to stretch the health professional workforce in innovative ways.

Wednesday, September 13, 2017

Trump's election spurs colleges and universities to seek more rural, white and poor students

Trump and Education Secretary Betsy DeVos (Glamour photo)
"A sizable share of college admission directors say they have intensified efforts to recruit in rural areas and find more white students from low-income families following Donald Trump’s unexpected victory in the 2016 presidential election," Nick Anderson reports for The Washington Post, citing a poll-based story in Inside Higher Ed.

"The 2016 election and President Trump’s statements and actions since taking office posed challenges for higher education in multiple ways," Anderson writes. "His campaign capitalized on heavy support from rural America and from white voters without college degrees — sectors of the population many colleges historically have struggled to reach."

Inside Higher Ed and The Gallup Organization surveyed college and university admissions directors and found that 38 percent of the respondents said they had "stepped up recruitment in rural areas since the election," Anderson notes. "Thirty percent reported the same about recruiting students from poor white families. . . . Eight percent said their schools are seeking more politically conservative students."

A plurality of admissions directors in the survey supported "the view that the election shows colleges, especially elite colleges, should do more to recruit in rural areas," Anderson reports. "Thirty-six percent agreed with that idea, while 22 percent disagreed. A large majority — 76 percent — agree that Trump’s statements and policies have made it harder to recruit international students." The survey was taken July 20 to Aug. 16. "Of more than 3,500 invited to participate, 453 completed the surveys," Anderson reports. "Two hundred were from public colleges and universities, 245 from private, nonprofit schools, and eight from the for-profit sector."

Inside Higher Ed Editor Scott Jaschik told Anderson that Trump’s win caused “soul-searching” among college officials political disconnection between campuses and their neighbors. “There are college towns all over America, where most people who work at or are enrolled in the college voted one way, and they woke up and realized that people in the surrounding towns and counties voted another way,” Jaschik said, adding that some are now reaching out to those rural areas for students. “It is not good if you’re a public or private institution and if only suburbanites think of you as a great place to go to college,” he said.