Health care changes spark stories

Jun 12, 2017

By Al Cross
Into The Issues

The debate over changes to the Patient Protection and Affordable Care Act is especially significant to rural areas, and The Rural Blog has several stories that can help inform your local coverage.

Obamacare’s private-insurance options are on life support in much if not most of rural America. A third of counties, mostly rural, had only one insurer offering Obamacare plans for this year, and that lack of competition made the plans more expensive. That was also true even in areas with two Obamacare insurers, a study found, as we reported on it at

As Congress debated what to do in late May, the Trump administration was asking for more time to decide whether to continue cost-sharing subsidies that help lower-income people pay Obamacare deductibles and copayments. State insurance departments are letting insurance companies delay filing their plans, and rural areas could be hit hard if Congress and the administration “don’t send signals that they’re committed to keeping Obamacare’s insurance marketplaces stable,” reported The Hill, which covers Congress. With our pickup item, we ran a map showing the number of Obamacare insurers in every county. Get it at

The bill drafted by House Republicans “would largely hurt people in areas where coverage is high, predominately rural areas where there are few hospitals or few insurers, The New York Times reported in March. The bill passed in May differed little from the original on those points, so the story and the Kaiser Family Foundation map we ran with it are still good references. See them at

Obamacare has covered fewer people through subsidized private insurance than through expansion of Medicaid, which the Supreme Court made optional for states, not mandatory. The expansion probably saved some rural hospitals in states that expanded Medicaid, and probably led to those closures of some in states that didn’t. We’ve had many items about rural hospitals on The Rural Blog, which is searchable; one with a good explanation of the issue is at


Other health issues

The opioid epidemic is worse in rural America, which depends more on non-physicians to provide primary health care, but most states don’t let them use a federal license to prescribe a potentially life-saving medicine for opioid addiction “unless they are working in collaboration with a doctor who also has a federal license,” Stateline reported. Half of all counties in the U.S., mainly in rural areas, “do not have a single physician with a license to prescribe buprenorphine.” Read the story at

The opioid epidemic appears to be making suicide more common, and suicide rates are increasing faster in rural areas than in metropolitan areas, according to a federal study. We excerpted it at

Suicide is a leading cause of death among teenagers, and that was a focus of a 13-part Netflix series, “13 Reasons Why,” based on the novel of the same name. In it, 13 people receive messages from a teenage girl who committed suicide, detailing how they played a part in her decision. The National Association of School Psychologists recommended that “vulnerable youth, especially those who have any degree of suicidal ideation,” not watch it. The Washington Post reported on a group of high-school students in Michigan who responded to the series with a project, “13 Reasons Why Not,” and we picked it up at

Nutrition is a big factor in health, and many school-nutrition directors were happy to hear that new Agriculture Secretary Sonny Perdue relaxed some of the Obama administrations rules for school meals. The changes delayed another reduction in the amount of salt allowed in meals, gave states the ability to allow some schools to serve fewer whole grains, and allowed schools to serve 1 percent milk rather than only nonfat milk. See


Trade, agriculture, rural jobs

Perdue appeared to play a key role in persuading President Trump not to withdraw from the North American Free Trade Agreement, but to renegotiate it with Mexico and Canada. That was good news for farm interests that depend on exports. As those lobbies asked for protection in the negotiations, Perdue’s USDA ran against Trump’s anti-trade theme and actively promoted the value of agricultural trade to the U.S. We wrote about it at

Cattle farmers suffering from lower prices got good news in May, when the administration cut a trade deal with China to allow U.S. exports of beef, 13 years after a case of mad-cow disease prompted the Chinese to block them. In return, the U.S. will find ways to allow Chinese cooked poultry to be exported to the U.S. It’s big news in farm and ranch country, and we picked it up at

Trump’s special assistant on agriculture, trade and food assistance told reporters that the White House’s new Task Force on Agriculture and Rural Prosperity would focus on agriculture because it’s “the No. 1 driver in these rural communities.” However, the Daily Yonder noted that agriculture is not the top economic sector in rural areas. The federal Bureau of Economic Analysis, which ranks seven rural economic sectors, says agriculture is fifth in earnings and sixth in jobs. The Yonder also ran a county-level map of dominant economic sectors, and we picked it up at

Some states are enacting policies to generate or keep jobs in rural areas, such as tax credits for investment. Critics say such laws have failed to deliver, with investors profiting from the deals even if the businesses they fund never create a job, Stateline reported. We picked it up at

Rural areas sometimes lose jobs because local business owners can’t find the right buyer or successor when they want to retire. A growing number of services match rural entrepreneurs nearing retirement with younger people looking to run a business, Forbes reported. Read it at

If you see news with rural resonance that should be on The Rural Blog, email me at


Al Cross edited and managed rural weekly newspapers before spending 26 years at The (Louisville) Courier-Journal and serving as president of the Society of Professional Journalists. Since 2004 he has been director of the Institute for Rural Journalism and Community Issues, based at the University of Kentucky. See