Rural hospitals in Nevada and across the country will be in dire economic straits once the COVID funding runs out, according to a new report.

Researchers at the Bipartisan Policy Center found 441 rural hospitals have multiple financial risk factors.

Julia Harris, senior policy analyst at the Bipartisan Policy Center and the report's co-author, said 116 hospitals closed between 2010 and 2019, and then the pace slowed during COVID.

"So, the CARES Act and the American Rescue Plan really did a lot to stave off more hospitals from closing," Harris acknowledged. "But that aid masked the fact that the underlying finances of rural hospitals continue to deteriorate, especially with new pressures brought on from the pandemic. "

All hospitals and especially rural facilities, have been hard hit during COVID with huge staff shortages and supply-chain issues driving up the price of goods they must purchase. And hospitals with a low volume of patients generally receive less funding.

According to an analysis from Becker's Hospital Report in March, six of Nevada's 13 rural hospitals are at risk of closing.

Joan Hall, president of Nevada Rural Hospital Partners, said some are considering joining a new federal program which would allow them to pare down their services but keep their emergency room.

"Some hospitals would not have inpatient services available," Hall explained. "They would have an emergency room and outpatient services, diagnostic labs, imaging, but perhaps you wouldn't be able to stay in the hospital if you needed. You'd have to be transferred."

The report recommended the administration and Congress hold off on scheduled budget cuts, make higher Medicare payments permanent, and keep flexibility in telehealth until two years after the public health emergency ends. Meanwhile, the state is collaborating with the University of Nevada Reno and the University of Nevada Las Vegas to train or recruit more medical professionals, especially nurses and respiratory therapists.

The chair of the Federal Trade Commission will be in rural Iowa this weekend to hear from farmers and other residents about the proposed sale of Iowa Fertilizer to Koch Industries.

The sale is pending FTC approval. Iowa spent $500 million to build an Iowa Fertilizer factory in Weverly to create competition in an already consolidated industry.

Aaron Lehman, president of the Iowa Farmers Union, said he plans to tell FTC Chair Linda Khan a sale to Koch Industries would backtrack on any competitive progress the state has made.

"Our concern is that an industry that already lacks competition and has all sorts of monopoly problems would only get worse if this sale is allowed to go through," Lehman explained.

Koch and other corporate ag conglomerates have said consolidating allows them to provide better products to farmers more efficiently. The hearing is set for Saturday on Main Street in Nevada.

In addition to reducing competition for fertilizer, Lehman argued the sale would increase prices for farmers, and ultimately mean higher food prices for Iowans. He wants Khan to hear stories firsthand, from the people on the ground in Nevada.

"We know that we might not be able to have a dialogue with the people who are investigating this situation, because they need to be impartial," Lehman acknowledged. "But our farmers need to tell their story about how the industry is already in a monopoly state."

Some 18 other ag organizations have joined the Iowa Farmers Union calling on the FTC and the Justice Department to investigate the proposed sale.

A farm group is helping Iowa agriculture producers find ways to reduce the amount of nitrogen they use on their crops.

Excess nitrates can wind up in ground and surface water, and cause health problems.

Practical Farmers of Iowa is encouraging farmers to find just the right amount of nitrogen they need for their crops - while avoiding applying too much, which the group says is common.

PFI's Field Crops Viability Coordinator - Chelsea Ferrie - said thanks to federal grants and private funding, the group will pay farmers up to $35 for every acre that has a lower than normal yield if they didn't apply enough nitrogen.

"No cost to the farmer, either," said Ferrie. "We're trying to help incentivize them. This is something that farmers want to do - I mean, they want to be good stewards of the land - but also, that they need to have a profitable farm."

The application period for the program is open through the end of April.

To help them reach the right nitrogen balance, Ferrie said PFI will help farmers on the front end of the process, too - so they aren't left guessing how much to apply.

"Talk through what your typical fertilizer plan is, and what your reduction plan would be," said Ferrie. "Then you would implement this year, going into the spring and into the season."

Farmers have relied on nitrogen-based fertilizers for generations - but when applied in excess, nitrates run off into ground and surface water, posing health concerns for animals and people.




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Pesticides are still common in agriculture. Organic producers who avoid them have seen ups and downs in pushing for stronger regulations, and they point to a South Dakota example of the harm associated with widespread use among neighboring farms.

At the heart of the regulatory fight is the application of the weed-killing pesticide dicamba, and how it can drift from one farm to another. Last month, a federal court blocked "over the top" spraying of dicamba products, but the EPA followed with an order to allow the spraying of existing supplies.

Glenn Pulse, co-owner of an organic farm in Vermillion, said a 2017 drift incident had a big impact on his operation.

"Our entire farm was covered. We lost a lot of livestock, and thousands of bees were killed," he explained.

It also resulted in health concerns for his family, having to regain his organic farmer certification, and a legal battle over restitution. Groups such as the National Family Farm Coalition have been fighting what they call the deregulation of these chemicals, arguing the drift and runoff effect has damaged millions of crops.

Dicamba-manufacturing companies deny responsibility, instead blaming farmers who apply it for not following guidelines.

The EPA has said there were already millions of gallons of dicamba in circulation prior to the court's ruling, prompting the agency's order. Pulse feels there are farmers who are careful in spraying chemicals, but he wants stronger enforcement against those he describes as "loose cannons."

"The guys that are not following the labels and they're spraying in weather conditions that are not favorable, that is where, I would say, 90% of the problems are happening with drift incidents," Pulse said.

His calls for better responses to these incidents coincide with policy demands to heavily restrict dicamba products. Meanwhile, Rep. Dusty Johnson, D-South Dakota, is the main sponsor of a bill supporters say would assure uniformity in national pesticide labeling under federal law. But opponents argue it would limit longstanding state and local pesticide safety rules.