Risks to rural hospitals grab big headlines in Arkansas

The lead story in today's Arkansas Democrat-Gazette is about the perils that Trump's "One Big, Beautiful Bill Act" poses to rural hospitals in the state.  Here's an excerpt from the feature by Neal Earley, which provides some excellent explanatory reporting: 

Rural hospitals in Arkansas will have to ready themselves for some major changes coming in the next few years that could mean savings for the federal government but fewer people with health care coverage.

The changes are part of the One Big, Beautiful Bill Act the U.S. House of Representatives passed on Thursday. It includes key changes to Medicaid and health care for low-income Americans that are projected to reduce federal spending on the program by $1 trillion over 10 years and lead to an increase in the number of uninsured people...

But some hospital officials worry the work requirements and bi-annual eligibility checks would mean a drop in coverage for many, shifting the cost burden to providers.

“You can take people off the rolls, but they’re still going to come to the (emergency room),” said Shelby Brown, administrator of Southwest Arkansas Regional Medical Center in Hope. “And small rural hospitals like we are in Hope, Arkansas — we don’t have the volume to absorb more people without insurance.”

The Kaiser Family Foundation says 813,000 Arkansans are enrolled in Medicaid, and 41% of those live in rural areas. 

Cuts to Medicaid would be felt more acutely by rural hospitals, as they don’t have the type of patient volume that suburban and urban hospitals have that could help them absorb a drop in revenue, Brown said.

* * *

Arkansas already attempted to implement work requirements in 2018, but it led to about 18,000 Arkansans losing coverage. In 2019, a federal judge struck down the requirement.

While the new requirement is designed to eliminate waste and force those who are able to seek health insurance through their work, Bo Ryall of the Arkansas Hospital Association said prior experience has shown health care providers are the ones who will observe the financial hit, saying, “Arkansas’s prior experience with work requirement enforcement and frequent re-determinations increased uncompensated care in hospitals.”

The story also quotes Stacy Harberson, CEO of Howard Memorial Hospital in Nashville, AR:

[R]ural hospitals (are) already operating at such a thin margin it could be very detrimental.

Deficits in warning systems exacerbate losses as historic floods strike Texas rural hill country

Dozens, including a number of children, were killed on July 4 by a flash flood in central Texas' hill country, primarily due to flooding of the Guadalupe River, whose headwaters are there.  One hard hit area was Camp Mystic, a camp for young and adolescent girls on the river's banks, near Kerrville (population 24,000) in rural Kerr County.  Christopher Flavelle of the New York Times is now reporting on the consequences of the area not having a better early-warning system--and on the fact that local taxpayers are unwilling to pay for that system. Here are salient excerpts: 

Texas officials appeared to blame the Weather Service for issuing forecasts on Wednesday that underestimated how much rain was coming. But former Weather Service officials said the forecasts were as good as could be expected, given the enormous levels of rainfall and the storm’s unusually abrupt escalation.

The staffing shortages suggested a separate problem, those former officials said — the loss of experienced people who would typically have helped communicate with local authorities in the hours after flash flood warnings were issued overnight.

The shortages are among the factors likely to be scrutinized as the death toll climbs from the floods. Separate questions have emerged about the preparedness of local communities, including Kerr County’s apparent lack of a local flood warning system. 

* * * 

In an interview, Rob Kelly, the Kerr County judge and its most senior elected official, said the county did not have a warning system because such systems are expensive, and local residents are resistant to new spending.

“Taxpayers won’t pay for it,” Mr. Kelly said. Asked if people might reconsider in light of the catastrophe, he said, “I don’t know.”  (emphasis added)

The National Weather Service’s San Angelo office, which is responsible for some of the areas hit hardest by Friday’s flooding, was missing a senior hydrologist, staff forecaster and meteorologist in charge.

* * * 

The Weather Service’s nearby San Antonio office, which covers other areas hit by the floods, also had significant vacancies, including a warning coordination meteorologist and science officer, Mr. Fahy said. Staff members in those positions are meant to work with local emergency managers to plan for floods, including when and how to warn local residents and help them evacuate.

That office’s warning coordination meteorologist left on April 30, after taking the early retirement package the Trump administration used to reduce the number of federal employees, according to a person with knowledge of his departure.

The vacancy rate in these federal offices is roughly twice what it was when Trump returned to office earlier this year.

Other posts about rural local governments unwilling to pay for services some might find critical--or at least important--are here and here.   This post discusses how reliant nonmetro counties and rural local governments are on higher scales of government for assistance in financing emergency management.   

Postcript:  This follow up story in the New York Times was published later on July 6, 2025.  

Eight years ago, in the aftermath of yet another river flood in the Texas Hill Country, officials in Kerr County debated whether more needed to be done to build a warning system along the banks of the Guadalupe River.

A series of summer camps along the river were often packed with children. For years, local officials kept them safe with a word-of-mouth system: When floodwaters started raging, upriver camp leaders warned those downriver of the water surge coming their way.

But was that enough? Officials considered supplementing the system with sirens and river gauges, along with other modern communications tools. “We can do all the water-level monitoring we want, but if we don’t get that information to the public in a timely way, then this whole thing is not worth it,” said Tom Moser, a Kerr County commissioner at the time.

In the end, little was done.

And here is coverage of the issue from the Wall Street Journal. 

A former sheriff pushed Kerr County commissioners nearly a decade ago to adopt a more robust flood-warning system, telling government officials how he “spent hours in those helicopters pulling kids out of trees here (in) our summer camps,” according to meeting records.

Then-Sheriff Rusty Hierholzer was a proponent of outdoor sirens, having responded as a deputy to the 1987 floods that killed 10 teenagers at a camp in nearby Kendall County. He made the comments in 2016, after deadly floods ravaged a different part of Texas the year before.

“We were trying to think of, what can we do to make sure that never happens here?” Hierholzer, who served as Kerr County sheriff from 2000 to 2020, recalled in an interview Sunday with The Wall Street Journal. “And that’s why we were looking at everything that we could come up with, whether it be sirens, whether it be any other systems that we could.”

"Minutes of their public meetings showed an inability to get state and federal funds has been a delaying factor," even as other counties on the Guadalupe River have adopted the systems.

P.P.S.  On July 7, Texas Lt. Governor Dan Patrick announced that a warning system would be in place on the Guadalupe River by next summer and that, if the local government cannot afford the system, the state will pay for it.  

Wisconsin Supreme Court details rural lawyer shortage in matter where criminal trial delayed 46 months

The Wisconsin Supreme Court decided State v. Ramirez last week, a matter about a criminal defendant who experienced a 46-month delay in being tried for an alleged crime. The court upheld his conviction, in part because he waited 32 months to assert his right to a speedy trial. This is one of the first cases in which I've seen a court acknowledge the legal relevance of the rural lawyer shortage.  Some excerpts follow:

¶1 Our federal and state constitutions guarantee criminal defendants the right to a speedy trial. The Sixth Amendment of the United States Constitution provides, "[i]n all criminal prosecutions, the accused shall enjoy the right to a speedy and public trial," and Article I, Section 7 of the Wisconsin Constitution says, "[i]n all criminal prosecutions the accused shall enjoy the right . . . in prosecutions by indictment, or information, to a speedy public trial." Luis A. Ramirez, as an inmate already serving a lengthy sentence for felony convictions, attacked and injured a corrections officer.  After a series of continuances and rescheduled trial dates, Ramirez was finally tried and convicted by a jury 46 months after he was criminally charged for the attack.

¶2 Ramirez moved for postconviction relief, alleging the 46-month delay violated his constitutional speedy trial right. The postconviction court denied his motion, and Ramirez appealed. The court of appeals reversed and ordered the only remedy available for constitutional speedy trial violations—dismissal of the charges. The State sought this court's review of a single issue: Whether Ramirez's constitutional right to a speedy trial was violated. We conclude it was not and reverse the court of appeals.

What follows is an excerpt from the concurrence by Chief Justice Ann Walsk Bradley, with whom Judge Janet Protasiewicz joined.  

¶80 In this case Ramirez's claim was doomed by his 32-month delay in asserting his speedy trial right and his failure to persuade that the 14-month duration from his assertion of the right to his trial violates the constitution. However, I cannot join the majority's approach because it could give the State a pass in cases involving delays even longer than the 46 months at issue here.

¶81 At a time where defendants are experiencing significant delays in appointment of counsel, this concern is especially acute.[5] Delays due to the lack of available attorneys can stretch into the triple digits. See Lee, 401 Wis. 2d 593, ¶6 (Dallet, J., dissenting) (setting forth that the defendant was held in custody "for 113 days before a preliminary examination, 101 of which were prior to the appointment of counsel").[6] In 2022, the state public defender opined that it would "take several years to clear a backlog of roughly 35,000 cases because of a shortage of public defenders."[7]

¶82 In Wisconsin's vast rural areas, especially in the northern part of the state, the problem has reached crisis levels. Although the data is admittedly at least seven years old, an article published in 2018 describes how "[o]ver 60% of the state's attorneys practice law in major urban areas, leaving some counties in rural Wisconsin with attorney-to-resident ratios as high as 1:4,452." Lisa R. Pruitt et al., Legal Deserts: A Multi-State Perspective on Rural Access to Justice, 13 HARV. L. & POL'Y REV. 15, 81 (2018) (footnotes omitted). In comparison, the statewide ratio is about 1:389.[8]

¶83 Additionally, the population that is practicing law in the rural north is rapidly aging. As of 2018, "[a]cross the northern half of the state, only six of the forty attorneys in Vilas County are under the age of fifty, and Florence and Pepin counties have no lawyers under fifty. Oconto County has two, and no new attorneys have moved into the county in the last decade." Id. at 81-82 (footnotes omitted). In total, as of that time, "[n]ine counties in northern Wisconsin ha[d] ten or fewer active attorneys." Id. at 82 (footnote omitted). Although this data is now seven years old,[9] the problem has certainly not abated. In fact, it has only worsened.[10]

¶84 As of 2024, the number of active attorneys in Wisconsin had dropped four percent over the last four years, while the number of attorneys in rural Wisconsin had plummeted by seven percent.[11] Eight counties have no certified private bar attorneys to take cases when the state public defender cannot represent a defendant.[12] Such a shortage "not only impacts the constitutional rights of defendants—it also affects victims and our communities."[13] Despite intervening attempts to address the root causes of the shortage, the problem persists.[14]

¶85 The shortage of lawyers in rural areas is a systemic problem, not an intentional one, putting it at risk of being termed "neutral" in the parlance of the majority's speedy trial analysis.[15] It is possible that a defendant could spend months or even years awaiting the appointment of an attorney, a necessity for any trial, much less a speedy one. And as the majority opinion demonstrates, when a delay is termed neutral, good luck to a defendant in succeeding on a speedy trial claim.

¶86 This court should not give its seal of approval to such an approach. Rather, the court of appeals approached this case the right way by breaking down the periods of delay and determining the reasons behind them and the weight to be given in the Barker analysis. The analysis conducted by the court of appeals represents a more nuanced approach that is better suited to the fact-specific nature of a speedy trial determination. See Urdahl, 286 Wis. 2d 476, ¶11.

"Rural" all over the news as Senate passes "Big Beautiful Bill" that will undermine rural services, especially health care

Analysis of what Trump's "Big Beautiful Bill" would do to rural health care has been in the news for several weeks, and it stayed there today as the Senate passed the Bill by a vote of 50-50, with Vice President J.D. Vance breaking the tie.  

What follows appeared on the Ezra Klein Show today, July 1, but much of it was recorded in advance in anticipation that the bill would pass.  Here, I'm just going to highlight the bits about rural health care, including as they relate to "red state" voters: 

Klein: [T]hey are very substantially cuts to the Republican Party’s voters. They’re cuts to Republican states. They’re cuts to Republican hospitals — rural hospitals in areas that vote for Republicans and are very dependent on the care that gets financed by Medicaid in order to stay open.  (emphasis added)

This is the Republicans’ old ideology coming into conflict with their new coalition.

Yglesias:  Absolutely. If you look at the share of people who are on Medicaid by state, there are seven states where more than a quarter of the population is on Medicaid.

One of them is New York, and one of them is California. But the other five are New Mexico, Louisiana, Arkansas, Kentucky and West Virginia.

And then you look at states like Mississippi and Alabama: If they would accept Medicaid expansion funding, there’s a huge, potentially eligible population share in those states.

It’s a big conflict inside the heart of Republican politics. [Details about Mitch McConnell and Kentucky] 

There’s just a conflict between the Republican Party electorate and their ideology, which has shifted in some ways but really remains focused on low taxes, on investment income, low corporate taxes and wanting to cut spending on programs for the poor.

About work requirements and how they've worked out so far, Klein and Yglesias shared this conversation:

The most conservative states don’t accept Medicaid expansion funds. They have tried to impose work requirements in Arkansas, for example.

(Read more about the Arkansas experiment here and here.) 

So we ran the experiment: Does putting work requirements on Medicaid increase employment? And the answer was no. When they did it, employment didn’t go up. People did lose coverage, but employment didn’t go up.

And Republicans didn’t reverse course after that. They didn’t say to themselves: Oh, our goal here was to get more people working, but we didn’t succeed at that. They said: You know what? This cut the rolls. It cut spending. We’re happy with that.

That’s a free market view: If you want a television, you’ve got to pay for it yourself. If you want chemotherapy, you’ve got to pay for it yourself.

On work requirements, I published this three years ago in Politico.   

Here's more from Yglesias, on perverse incentives: 

There’s this threat that hospitals will go out of business. I’m in Maine right now in a very rural area, and hospitals don’t have a ton of customers here. If they lose let’s say 10 percent or 15 percent of their customer base and have higher uncompensated care burdens — some of the facilities will just close.

Senate Republicans have discussed creating a hospital bailout fund to prevent this, but it seems crazy to me to address hospitals’ business model problems by giving them direct payments to stay in business even though they’re not treating patients, rather than just letting people get the treatment they need.  (emphasis added)

Senator Lisa Murkowski of Alaska ultimately voted for the bill, but only after she was offered big concessions for her state.  Read more about those here.  Apparently, one of those concessions was to double to $50 billion (from an initial $25 billion) the amount in a fund that would support rural hospitals.  Another related to how SNAP will be administered in Alaksa. 

Also instructive is this interview by NPR with Kaiser Health News reporter Sarah Jane Tribble, published yesterday, leading with Juana Summers questioning Tribble: 

SUMMERS: Rural America is poised to be greatly impacted by these proposed cuts. Roughly 20% of the U.S. population lives in rural areas where Medicaid covers 1 in 4 adults. Here to talk about what could be at stake for those communities is Sarah Jane Tribble. She's the chief rural correspondent for KFF Health News. ...

Sarah, just start if you can by telling us a bit about what you have been hearing from people in rural communities across this country about these proposed cuts.

TRIBBLE: Yeah, I'm not hearing good things. They're very concerned, because Medicaid rates are so high in rural America, that these cuts will be very detrimental, they'll cause more hospitals to close, they'll tax rural health clinics. I was sitting next to a CEO of a rural hospital from Colorado. He has a 25-bed critical access hospital, the only hospital between the Kansas border and Denver on the Colorado I-70 corridor. And he had been talking about the cuts and not happy about them. And then we heard about the rural transformation fund that the Senate has been working on to sort of help offset the cuts. And he leaned over and he just scoffed. He just said, that's just not going to be enough. So I think that there's a lot of concern out there in rural America.  (emphasis added) 

Here's a late June NPR story about the ripple effects the cuts are likely to have on hospitals in rural Colorado, this one focused on the San Luis Valley in the southwest part of the state.  Here is a key excerpt from the story by John Daley: 

"I'm trying to be worried — and optimistic," said Konnie Martin, CEO of San Luis Valley Health in Alamosa. It's the flagship health care facility for 50,000 people in six agricultural counties — Alamosa, Conejos, Costilla, Mineral, Rio Grande and Saguache.

The numbers out of the bill about deep Medicaid cuts were "incredibly frightening," Martin said, "because Medicaid is such a vital program to rural health care."

Martin's hospital is not alone. "I think in Colorado right now, nearly 70 percent of rural hospitals are operating in a negative margin," in the red, Martin said.

Here's a late June Washington Post story about Medicaid as a "lifeline" in West Virginia.  

iPhone factory rises in rural India. Does it provide rural development lessons for the United States?

Alex Travelli and Hari Kumar report from Devanahalli, India in yesterday's New York Times on the pending opening of an iPhone factory.  The story features many descriptors suggesting the remoteness and rurality of the place and concludes with a brief comparison to rural development efforts in the United States.  The plant, which will be fully functioning and employing 40,000 people by the end of this calendar year, responds to Prime Minister Narendra Modi's “Make in India” policy, announced in 2015.  The Modi government has committed $26 billion to subsidizing strategic manufacturing goals since 2020. 

A new iPhone factory in an out-of-the-way corner of India looks like a spaceship from another planet. Foxconn, the Taiwanese company that assembles most of the world’s iPhones for Apple, has landed amid the boulders and millet fields of Devanahalli. 

* * *

By the end of 2025, with the Devanahalli plant fully online, Foxconn is expected to be assembling between 25 and 30 percent of iPhones in India.

* * *

The effects on the region are transformative. It’s a field day for job-seekers and landowners. And the kind of crazy-quilt supply chain of smaller industries that feeds Apple’s factory towns in China is coalescing in India’s heartland. 

* * *

India’s most urgent reason for developing industry is to create jobs. Unlike the United States, it does not have enough: not in services, manufacturing or anything else. Nearly half its workers are involved in farming.

* * *

India is thick with people. A five-minute walk away, a village called Doddagollahalli looks the same as it did before Foxconn landed. Nearly all the houses clustered around a sacred grove belong to farming families growing millet, grapes and vegetables.

Some villagers are renting rooms to Foxconn workers. Many more are trying to sell their land. But Sneha, who goes by a single name, has found a job on the Foxconn factory’s day shift. She holds a master’s degree in mathematics. She can walk home for lunch every day, a corporate lanyard swinging from her neck.

It is people like Sneha, and the thousands of her new colleagues piling into her ancestral place, who make Foxconn’s ambitions for India possible. Mr. Trump wants to revive the fortunes of left-behind American factory towns, but the pipeline of qualified young graduates is not there.

Thus, while Trump wants this to happen in the United States, it probably won't, "without sustained government financial support to revive U.S. manufacturing and training to expand the pool of qualified factory workers."   

Op-ed by Alaska legislators decries likely effect of "Big Beautiful Bill, "especially in rural areas

Bryce Edgmon and Cathy Giessel of the Alaska legislature have published an op-ed in today's New York Times, "Our State Cannot Survive this Bill:"  One of the legislators is a Republican and the other an Independent, and they focus on their bipartisanship.  In some ways, this piece echoes analysis we are seeing about how many "red states" will suffer particularly under Trump's "big beautiful bill," but it also features some Alaska specifics.

Here's the lede: 

Across the country, state lawmakers like us are bracing as the federal government considers a bill that will throw state budgets into chaos and add red tape that our social service agencies do not have the capacity to administer. If the budget reconciliation bill passes Congress in anything like its current form, we will be left to deal with the fallout.

The likely impacts from the “big, beautiful bill” are particularly ugly for our home state, Alaska: Nearly 40,000 Alaskans could lose health care coverage, thousands of families will go hungry through loss of benefits from the Supplemental Nutrition Assistance Program, or SNAP, and the shift in costs from the federal government to the state will plunge our budget into a severe deficit, cripple our state economy and make it harder to provide basic services.

And in these paragraphs, the writers get around to the rural angle: 

The benefits of Medicaid and the SNAP program permeate the entire fabric of the Alaska economy, with one in three Alaskans receiving Medicaid, including more than half of the children. In remote Arctic communities, Medicaid dollars make medical travel possible for residents from the hundreds of roadless villages to the communities where they are able to receive proper medical treatments.

We fear that if this bill passes, a village in rural Alaska might lose its one and only grocery store because of a drastic decline in SNAP dollars. It might also lose its sole health care clinic or hospital because it cannot sustain its services with decreased Medicaid reimbursements. The reconciliation bill does not take into account the uniqueness of Alaskan lifestyles and geographic remoteness.

The legislators explain that the federal cuts will cause costs for many services to be shifted to the state budget, which will cause great strain.  It also takes up the fact that work requirements for public benefits are an ill fit for rural Americans.

Alaska cannot afford to lose health care funding. Our state is near the top of the list for the highest rates of suicide, tuberculosis and sexually transmitted infections in the nation. It is also severely lacking in adequate behavioral health services. The cuts will only make these problems worse.

Work requirements instituted in Medicaid are untenable for rural Alaska, with many communities facing limited broadband access and job opportunities.

Here's a piece in The Atlantic, by Russell Berman, suggesting that Kentucky Republicans are not afraid to stand up to Trump. 

Supreme Court decision on Planned Parenthood and Medicaid will undermine rural health

The U.S. Supreme Court today ruled (quoting the Associated Press) that 

States can block the country’s biggest abortion provider, Planned Parenthood, from receiving Medicaid money for health services such as contraception and cancer screenings.  

 The case rose to the Supreme Court from South Carolina.  The Associated Press explains: 

South Carolina Gov. Henry McMaster, a Republican, said Planned Parenthood should not get any taxpayer money. The budget bill backed by President Donald Trump in Congress would also cut Medicaid money for the group. That could force the closure of about 200 centers, most of them in states where abortion is legal, Planned Parenthood has said.

Several news outlets have mentioned the impact that this decision will have on rural healthcare.  NPR brings us this: 

Planned Parenthood's president and CEO, Alexis McGill Johnson, in an interview with NPR, said the decision would have widespread ramifications and would allow seventeen states to strip Planned Parenthood clinics of the ability to provide non-abortion medical services to rural and low income people.  (emphasis added)

The story further quotes Johnson:  

It's a dark time [when] a health center has to close, any time a patient is not able to get the care that they need.  That is a dark time because we can provide that care for our nation's most vulnerable. 

A distinctive angle on shifting rural livelihooods

Marketplace (American Public Media) reported this week on the impact of the rising price of silver on the livelihoods of indigenous silversmiths.   The story by Savannah Peters features a Navajo and Hopi silversmith, JJ Otero.  Here's a key quote that touches (at the end) on the implications  for rural livleihoods of the rise in price for raw materials: 

Otero recently raised the price of his jewelry by about 10% across the board to account for his rising material costs. He said he can do that because he’s been smithing for over a decade and has curated a loyal following on social media, where he markets his work to wealthy clients all over the country.

“The folks that have the means, they’re not bothered by the increase in price,” Otero said.

Business is moving a bit slower, but Otero said he’s still able to find a home for his pricier work. But not all Indigenous artists have the social media prowess or even internet access that would allow them to follow Otero’s business model. He said those who sell roadside or via middle-men like trading posts and galleries have less pricing flexibility.

“I’m always reminded of what my dad told me that first year when I started making jewelry,” Otero said. “He would say it in Navajo, that my tools and the things I make with my tools are gonna take care of you.”

Today, Otero’s jewelry business takes care of him and his family. It allowed him to leave his career in IT and move from Albuquerque home to Torreon, on the eastern edge of the Navajo Nation, and support his parents as they grow older. But for Indigenous artists just now getting their start, he worries that parh to a rural livelihood could be slipping out of reach.

Buffalo National River watershed finally gets permanent protection from industrial agriculture

I've written a great, great deal about the Buffalo National River over the years, including when a hog CAFO was sited on the banks of one of its tributaries in 2012.  After a great deal of wrangling, that CAFO was ultimately bought out by the State of Arkansas for $6.2 million under former governor Asa Hutchinson.  

Here's an excerpt from a post about these recent events on Arkansas Outside, which explains that .  

The Arkansas Legislative Council on Friday gave final approval to a permanent moratorium on medium- and large-scale hog concentrated animal feeding operations (CAFOs) within the Buffalo National River watershed, cementing over a decade of advocacy from conservation groups and marking a significant milestone in the state’s environmental policy.

The decision, passed without debate, follows years of temporary protections and stems from heightened concerns about the impact of industrial swine farms on water quality in the nation’s first designated national river. The new rule permanently bans CAFOs, as defined by the Environmental Protection Agency, that are medium or large in size, based on animal count and waste production.

Environmental groups, including the Buffalo River Watershed Alliance, the Ozark Society, and the Arkansas chapter of the Sierra Club, hailed the decision as a crucial step to safeguard the river’s karst terrain, which is particularly vulnerable to groundwater pollution.

The move follows years of public outcry sparked by C&H Hog Farms, a large-scale swine operation permitted in 2012 under a general permit process that lacked public input. The farm, located near the town of Mount Judea, drew criticism and concern after manure from thousands of hogs was applied to fields near tributaries that feed the Buffalo.

* * * 

Agricultural interests, including the Arkansas Farm Bureau and the Arkansas Cattlemen’s Association, opposed the permanent moratorium. In comments to the state, they argued the ban was based on public perception rather than scientific evidence, and they warned of regulatory overreach that could limit farmers’ land use rights.

* * *

The rule change came under the broader context of Senate Bill 290, legislation initially intended to overhaul the state’s rulemaking process. The bill was amended during the legislative session to preserve moratoriums on CAFOs in the Buffalo River and Lake Maumelle watersheds. Future bans will now require legislative approval, reducing the ability of state agencies to act independently.

Governor Sarah Huckabee Sanders, who has expressed support for protecting the Buffalo River, reportedly threatened to veto the original version of the bill until amendments preserving the moratorium were included.

Read more about this year's legislative wrangling over the Buffalo and CAFOs here.  

Black lung spreads to younger miners due to complications from silica

Kate Morgan reports from the New York Times from a trip across Appalachia to learn about black lung disease's newest manifestation, which implicates silica and is affecting younger miners.  Some key excerpts follow:

Modern miners are contracting [black lung disease] at younger ages and at rates not seen since the 1970s. For 20th-century miners, it could take decades to develop severe black lung. For men of Aundra Brock’s generation, just a few years can be enough. Nationwide, one in 10 working miners is now estimated to have black lung. In the heart of the central Appalachian coal fields, it’s one in five. Often, their disease is more severe, the progression faster. Doctors are seeing larger masses and more scarring in the lungs. Transplants, disability claims and deaths are all on the rise.

* * *  

In an old industry, the reasons are modern. Centuries of extraction have altered the landscape, making the mountains more dangerous to mine, researchers say, and the men beneath them vulnerable not just to black lung, but to another lung disease called silicosis.

* * * 

Silicosis is caused by inhaling a mineral called crystalline silica that is typically found in sand, stone and concrete. It is a building block of the Appalachians. But in the air, it is dangerous, able to create much worse scarring in the lungs than coal dust alone. Breathing the coal and silica dust together can create a kind of hybrid disease that quickly leads to progressive massive fibrosis.

Scientists and miners alike have long understood the dangers of the rock dust. “You can tell there’s silica when you see the flicker in it,” said Charles Thacker, a 69-year-old former miner from Norton, Va., who now has black lung. “It looks like bits of glass flashing in the light. It’s almost pretty. But that’s what gets in your lungs and cuts you up.”

Don't miss the rest of the story, which is chock full of human interest context.   Also, I want to mention that the ravages of silica on miners was a topic of discussion at this event at West Virginia University College of Law this spring.  (See the panel at 11:00 am).

Another rural hospital at risk, this one in northern California

Ana Ibarra reports for Cal Matters from Willows, in Glenn County. home of a small hospital, the Glenn Medical Center, which is under threat of closure.   The reason for the new threat:  a new interpretation of a provision on distance in relation to a regulation that requires facilities with the "critical access" designation to be at least 35 miles from the nearest medical center.  Here's an excerpt: 

Glenn Medical Center, a 25-bed hospital in the rural agricultural town of Willows, north of Sacramento, is about to lose its “critical access” title. Without it, administrators say the hospital couldn’t afford to stay open because it would lose its increased Medicare reimbursements and regulatory flexibilities.

Glenn Medical Center received a letter in April from the U.S. Centers for Medicare and Medicaid Services notifying the hospital that it was no longer in compliance with the distance requirement to qualify as “critical access.” That requirement states that hospitals must be more than a 35-mile drive on primary roads — or a 15-mile drive on mountainous or secondary roads — from the next nearest hospital.

The next closest hospital is Colusa Medical Center, which the federal Medicare and Medicaid agency places at 32 miles south of Glenn Medical Center. That makes Glenn County’s hospital three miles short of the qualifying distance for the critical access title. But local health officials and the Willows Fire Department say ambulances and most patients take the “more reliable” route of I-5 and Highway 20, which makes the distance between the hospitals 35.7 miles — far enough to qualify.

About 40% of Glenn County’s 30,000 residents rely on public health insurance programs — Medicaid and Medicare — and 12% live under the poverty line.

“We treat and see and care for a lot of people who are unseen in the community. A lot of behavioral health crises, a lot of justice-involved folks, a lot of elderly, a lot of people without transportation. And we are truly a lifeline for those folks,” said Lauren Still, chief administrative officer at Glenn Medical Center.

About 40% of Glenn County’s 30,000 residents rely on public health insurance programs — Medicaid and Medicare — and 12% live under the poverty line.

“We treat and see and care for a lot of people who are unseen in the community. A lot of behavioral health crises, a lot of justice-involved folks, a lot of elderly, a lot of people without transportation. And we are truly a lifeline for those folks,” said Lauren Still, chief administrative officer at Glenn Medical Center.

Closing the only hospital in this Sacramento Valley county would mean residents would have to travel farther for emergency care and ambulances would take longer responding to 911 calls.

Dr. Jared Garrison, Glenn County’s health officer, said losing the hospital would be a devastating blow to the community. Garrison worries about the elderly who may be afraid to drive at night and people who don’t have transportation to make it out of the county. Heart attacks, strokes, traumatic injuries and overdoses can become more deadly when hospital treatment is delayed.

“If Glenn Medical Center closes, it’s not just a health crisis — it’s an economic and social crisis,” Garrison said. “We’ll see longer emergency response times, job losses, declining local businesses, and worsening health outcomes for our most vulnerable neighbors.” 

* * * 

Both hospitals, Colusa and Glenn, have been at the same location since their construction decades ago. In 2001, Glenn Medical Center was first approved to participate in the federal Critical Access Hospital Program under the same distance rule. Hospital and county health officials say geographically nothing has changed.

“We tried to send some emails back and forth and say, ‘Hey, this is not the road people would take. This is not the road the ambulance takes. This is just not accurate,’” Garrison said. The “shorter” route, he explained, actually takes longer because it includes a county road that often floods and is primarily used by farm equipment.

The hospital’s appeals to the federal agency have been unsuccessful. Still said she is clinging to one last hope that U.S. Rep. Doug LaMalfa, a Richvale Republican, can make the hospital’s case.

Mark Spannagel, chief of staff at LaMalfa’s office, told CalMatters that no resolution has been reached yet, but that conversations with the federal agency continue and that the hospital’s situation is under “heightened review.”

The federal Medicare and Medicaid agency is supposed to review critical access hospitals’ eligibility periodically. This review started last year and the issue seems to be a reclassification of roads, Spannagel said.