The demolition derby at the Becker County Fair in Detroit Lakes, Minn. Read more about Kugel's rural adventures below.

[imgcontainer] [img:demo_derby.jpg] [source]Photo by Seth Kugel[/source] The demolition derby at the Becker County Fair in Detroit Lakes, Minn. Read more about Kugel’s rural adventures below. [/imgcontainer]

Medicaid Expansion. Expanding Medicaid under the Affordable Care Act, a.k.a. “Obamacare,” is a rural issue, says health economist Tim McBride of Washington University in St. Louis. Speaking at this week’s National Rural Health Association conference on rural hospitals, McBride said rural residents will be disproportionately hurt by states that have decided not to expand Medicaid participation, as allowed under Obamacare.

McBride said more than half of the people who would have qualified for Medicaid if their states had opted into the program live in rural areas. Twenty-one states have decided not to expand Medicaid under the Affordable Care Act.

McBride said even though those states are choosing not to expand enrollment, they will still have to put up with lower Medicaid reimbursement payments, which are funding part of the expansion.

M.L. Johnson of the Associated Press reports:

“Not expanding Medicaid . . . is a rural issue,” McBride said.

He warned those at the conference that their hospitals, as well as patients, are likely to be affected because the expansion is being paid for, in part, by cutting reimbursement rates. That means hospitals in states that have opted out won’t get any of the federal expansion money but will still see rate cuts.

“I don’t see an upside to not expanding,” McBride said. “The truth is, this will be really important money for rural hospitals, rural health providers, rural communities.”

The NRHA conference in Milwaukee concludes today.

“Too Poor” to Qualify for Help. Meanwhile, the St. Louis Post Dispatch and Kaiser Health News report that the failure of states to expand Medicaid creates a big gap for low-income uninsured residents, and the Affordable Care Act has no way to fix it.

Residents who make less than $11,490 ($15,510 for a couple) won’t get any help from the government in paying health insurance premiums because they make too little. Medicaid was supposed to cover folks in this income category. But people who live in states that don’t expand Medicaid won’t be getting that assistance, and the Affordable Care Act has no provision for helping these low-income residents with private health-insurance premiums.

The story estimates that the gap will affect nearly a quarter of a million residents in Missouri alone.

The Broadband Gap in Texas. In theory, 96% of Texas households could get broadband access if they were willing and able to pay for it. But only 69% of the state’s households actually subscribe to broadband, according to a story by Corrie Corrie MacLaggan in the Texas Tribune.

The story looks at a program designed to get more people to “adopt” broadband (which means to subscribe to broadband and use it). The nonprofit Technology for All offers classes to get people online in several cities and rural areas. Technology for All is looking for funding to continue the classes when a federal grant for the program expires at the end of the year.

The Texas Tribune report also quotes University of Texas-Austin Professor Sharon Strover, one of the authors of the Daily Yonder broadband series. (Here’s the most recent article in the series.)

Impact on Health Not Part of Strip-Mine Permit Process, Court Rules. The Army Corps of Engineers doesn’t have to consider the overall health impact on the surrounding community before it grants a permit for a surface mine, a U.S. district court judge has ruled.

Residents near a proposed strip mine in Knott and Perry County, Kentucky, had opposed a mining permit, in part because the “Corps  failed to consider an emerging body of evidence indicating that people who live near surface mines are more likely to suffer from cancer, heart disease, birth defects and other health problems,” the Lexington Herald-Leader reports.

The judge said the Corps didn’t have to consider such evidence. Rather, the agency only had to review the pollutants the coal mining operation discharges into streams.

The suit against the mining permit was filed by three residents, the Sierra Club and Kentuckians for the Commonwealth, a statewide community organizing group.

City Boy at the County Fair. Seth Kugel, the New York Times’ “Frugal Traveler,” winds down his summer road trip to “real America” with a visit to county fairs in Minnesota. The “big-city-guy-visits-small-town-America” formula is a perilous path for a journalist to walk. But Kugel makes himself the target of most of the good-natured humor in his last installment in this series. And, if you’ve been dying to see a New York Times reporter lead a cow, the accompanying video provides that opportunity.

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