By Liz Carey for The Daily Yonder. Broadcast version by Nadia Ramlagan for North Carolina News Service, reporting for The Daily Yonder-Public News Service Collaboration.

Rural hospitals, already struggling with financial strains due to COVID-19, face an even more significant threat, experts say: the workforce shortage.

Hospitals say they are short on workers in all areas of the health-care system, not just the clinical ones. According to the American Hospital Association, about 20% of all hospitals across the country expect worker shortages to reach dire levels.

"It (the pandemic) has really stressed the workforce in ways that we're not going to recover from for decades," said Julia Harris, a senior policy analyst with the Bipartisan Policy Center. According to Haris, 2021 saw the biggest drop in the number of nurses in the workforce in history. Over 100,000 nurses disappeared from the hospitals' nursing supply, putting a lot of pressure on smaller facilities to hire nurses.

"But then, the smaller rural hospitals really can't compete dollar for dollar with other centers and so workforce is their number one expense," she said. "When we're talking about competition to keep the people needed to run a hospital, it's very scary to think about what they're going to do when the federal funds dry up."

The pandemic hasn't stopped causing workforce issues, said Dr. James Hoekstra, president of High Point Medical Center, during a webinar hosted by the North Carolina Healthcare Association.

"The stresses that were put on the health-care systems, especially the rural hospitals, during the pandemic are actually continuing," Hoekstra said during the webinar. "We have lost a lot of providers to retirement. We've lost a lot of providers to going to different areas of the country to travel and earn more money. We've lost a lot of providers and staff to burnout and what we've been left with is a situation where we've had to hire a lot of what we call travelers or contract labor."

That leaves the hospital with higher costs.

During the pandemic, thanks to federal Covid funding, rural hospitals were able to pay top dollar for travel nurses, sometimes paying as much as $200 per hour. Those salaries were subsidized with federal COVID relief funds. Now, all hospitals pay between $7,400 and $1,400 per week, according to Vivian Healthcare, a health-care labor placement company. And with COVID funding drying up, hospitals are responsible for all of those fees.

Whitfield Regional Hospital in Demopolis, Alabama, lists a travel nurse opening on Vivian for just under $1,700 a week - which includes a more than $900 a week salary, plus a nearly $700 a week tax-free stipend for a 13-week assignment. The hospital currently has 20 openings for full-time nurses.

According to a Vivian spokesperson, staff nurses traditionally make far less than travel nurses. Currently, the national average for a staff nurse is about $37 an hour, while travel nurses make on average $3,600 a week, the spokesman said in an interview.

"Rural hospitals pay more generally, especially factoring in cost of living (e.g. Houston average weekly is $2,761. Lubbock, Texas, is $2,831). During the pandemic, wages have shown the strongest correlation to COVID case counts rather than geography," the spokesman said.

At Northeastern Vermont Regional Hospital in St. Johnsbury, Vermont, nurse positions start around $30 an hour, CEO Shawn Tester told Kaiser Health News. At the height of the pandemic, the hospital paid staffing agencies around $175 per hour. Now that fee is down to over $100 an hour, he said, but the hospital is working to negotiate that rate down further.

According to the U.S. Bureau of Labor Statistics, U.S. health-care organizations will need to fill nearly 200,000 nursing positions every year from now until 2030. Some studies even project that the country will face a shortage of more than 29,000 nurse practitioners by 2025.

Vivian's research into nursing shows the outlook for clinical staffing doesn't look good. Nearly 65% of the 3,000 nurses they surveyed said they were looking to transition out of the profession in the next five years. Almost half (44%) said they felt like their unit is short-staffed "all the time."

National organizations hope Congress will step in to do something about it.

In a letter to U.S. Reps. Rosa DeLauro, D-Conn., and Tom Cole, R-Okla., chair and ranking member of the House Subcommittee on Labor, Health and Human Services, Education and Related Agencies, the AHA said that 781 hospitals across the country, or 18.9%, said they would face critical staffing shortages.

"While the nation may be rounding the corner in the battle against COVID-19, the health-care workforce continues to contend with many immediate challenges related to the pandemic, as well as a health-care landscape that has been deeply altered," the AHA wrote.

The AHA is asking Congress for $1.51 billion to fund health-care workforce development programs for the 2023 fiscal year's budget, including $374 million for rural health programs. The request represents an increase of $43 million over levels approved in 2022.

"Rural health programs... are vital to ensuring that needed services remain available in America's rural communities," the AHA said. "We also urge Congress to support funding to establish a Rural Emergency Hospital Technical Assistance Program, to support rural hospitals who are making the transition to maintain critical services for their communities."


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President Donald Trump is set to impose sweeping global tariffs this week, a move expected to spark retaliation against a range of American products including food.

Tad DeHaven, policy analyst at the libertarian think tank the Cato Institute, said farmers in Colorado and across the U.S. who endured losses during Trump's first-term tariffs are again facing uncertainty.

"What's frustrating to me is that taxpayers end up footing the bill," DeHaven pointed out. "Last time around, it cost taxpayers $23 billion in farm bailouts, and I think it looks like we're headed down that road again."

Trump said tariffs, which are taxes on imports mostly paid for by U.S. consumers, will compel companies outsourcing labor to places like China to move their operations back to the U.S. Trump has also floated the idea of replacing income taxes with tariffs in what would amount to a national sales tax.

DeHaven believes Trump's tariff strategy will backfire.

"The administration talks about shrinking government and cutting waste," DeHaven observed. "But I'd argue these trade wars create exactly the opposite: more bailouts, more government spending and more taxpayer-funded damage control."

Republicans in Congress have proposed $230 billion in cuts to ag funding, mostly from SNAP, formerly food stamps. But a recent poll found 60% of Trump voters said cutting SNAP is unacceptable. Trump has also canceled $13 million in funding for Colorado food banks and schools to buy food from local producers.

DeHaven added many U.S. farmers still have not recovered from Trump's first-term tariffs.

"You have to feel bad for farmers, they're getting squeezed from both ends," DeHaven emphasized. "Not only are they losing foreign markets but they are also seeing higher costs at home for essentials like equipment and fertilizer, all thanks to tariffs."


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Cuts at the U.S. Department of Agriculture have affected farming communities nationwide but a national group said its Black farmers remain unaffected.

The Memphis-based Black Farmers and Agriculturalists Association represents more than 20,000 heirs of Black landowners and ranchers across the country.

Thomas Burrell, president of the association, said because of long-standing discrimination, its members, many of whom are farmers or descendants of farmers, have not been impacted by the USDA freeze.

"What our concern has always been, notwithstanding any administrative efforts or the lack thereof, is the constant, unfortunately, of discrimination that prevents our members from being able to participate," Burrell explained. "Key phrase is 'food production.'"

Burrell noted the association's farmers operate under the USDA and still face challenges from the Pigford v. Glickman settlement. He added Congress has introduced multiple measures this year to compensate Black farmers for past discrimination. Last summer, the Biden administration provided more than $2 billion in direct payments to minority farmers affected by USDA discrimination.

Burrell argued tariffs will have both short- and long-term effects on Tennessee farmers and beyond. Agriculture Secretary Brooke Rollins recently announced the USDA will distribute up to $10 billion to agricultural producers through the Emergency Commodity Assistance Program for 2024 crops, with another $20 billion for disaster-affected farmers.

"Now the administration is going to use this $30 billion to sustain these farmers," Burrell observed. "While that pain is being as a result of the tariffs, and hopefully, in theory, at least once the ship rights itself again, it's full speed ahead, and the economy should benefit in the long term."

Burrell pointed out the Secretary of Agriculture has promised tariffs will not harm them and disaster and commodity payments should help. But Black farmers who are long victims of discrimination still struggle to access the benefits. The core issue remains: Are they receiving equal resources to stay competitive?


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A new study says agriculture co-ops are a strong economic force in states like South Dakota - but their future is murky, because of federal tax cuts set to expire.

Farm cooperatives have been around for more than a century, allowing smaller farmers to pool together resources to buy supplies and market their products.

South Dakota State University Ness School of Management and Economics Associate Professor Matthew Elliott helped lead research into co-op profits in North and South Dakota and Minnesota.

Even though corporations and industrial farms have a growing presence in agriculture, he said co-ops have staying power.

"There is consolidation going on to achieve efficiencies, but generally we see cooperatives still maintaining a good business volume in these industries," said Elliott, "and that's been pretty consistent, steady, for a long time."

He said co-ops benefit from the tax cut law enacted during the first Trump administration by allowing income from member sales to be taxed at lower rates.

The study says in 2022, that newer deduction helped generate $255 million in economic activity in South Dakota farming towns.

Republicans in Congress want to extend the broader tax cuts. But skeptics say that would require drastic spending cuts, which would harm rural communities and eat away at farmers' profits.

When focusing solely on the co-op tax deduction, Elliot said it's likely a more effective tool in this part of the country.

"It can be a struggle to get investment interested in our region," said Elliott. "It's one of those ways the dollars we do generate, we can keep here and keep multiplying and growing our economy."

He said those are extra dollars farmers can use to boost worker pay or buy equipment from local dealers at a time when small towns struggle with population loss.

If the deduction expires, observers say these farmers will have higher tax bills.

Overall, the planned extension of the Trump tax cuts has renewed debate about whether they mostly benefit wealthier Americans, and leave middle- and low-income workers behind.




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