Without federal intervention, a new report warns, rural hospitals across the United States, including many in Nebraska, could be forced to reduce services or even close their doors after pandemic relief funds expire.

Nemaha County Hospital chief executive Marty Fattig said ending across-the-board federal spending cuts, known as sequestration, would be a good start. Since lawmakers haven't used cuts to bring down the national debt as promised, Fattig said, he believes hospitals should receive full reimbursement from Medicare.

"So, it looks to me like the only people that are paying for this thing are those of us that take care of Medicare patients," he said. "And we get 2% off of what we would normally get paid. That's kind of a big deal."

Researchers at the Bipartisan Policy Center found that 30 rural hospitals in Nebraska suffered financial losses for patient services over a three-year average. More than 20 hospitals had negative earning margins. Current and long-term financial liabilities exceed current assets for 18 Nebraska hospitals. Nationally, the report says 441 rural hospitals face multiple financial risk factors.

In addition to putting a pause on sequestration, the report recommends making higher Medicare payments permanent, and maintaining flexibility in telehealth until at least two years after the federal public health emergency ends.

Report co-author Julia Harris, the think tank's senior policy analyst, said 116 hospitals closed between 2010 and 2019, but that pace slowed as COVID peaked.

"So, the CARES Act and the American Rescue Plan really did a lot to stave off more hospitals from closing," she said, "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."

Fattig said lawmakers also should push back against efforts by drug companies to make it harder to get discounted medicines through a program known as '340-B.' He said those savings help pay for patient services that aren't financially viable otherwise.

"Right now 'Big Pharma,' the big pharmaceutical companies, are throwing all kinds of roadblocks down," he said, "so that they will not pay for the 340B program like they should."

Health advocates are promoting a package of bills this legislative session to make health care easier to get - and more affordable.

The Care 4 All California coalition, which includes more than 70 organizations, unveiled a set of 10 bills Wednesday in Sacramento.

Andrea Rivera, senior legislative advocate for the California Pan Ethnic Health Network, said grassroots support can make big things happen.

"Historically, communities of color, we're not invested in," Rivera pointed out. "Together, we are stronger, louder, and more powerful. Together, we cannot be ignored."

The coalition sees the bills as a series of steps on the way to achieving universal coverage by bringing down costs and removing barriers to care.

Right now, the Affordable Care Act bars undocumented people from purchasing health coverage through the Covered California marketplace.

Asm. Joaquin Arambula, D-Fresno, introduced a bill to ask the feds for a waiver.

"That's why I introduced a before this year, a bill that will end the unjust exclusion of our undocumented community from Covered California," Arambula explained. "We have to create a health care system that is more universal, affordable and equitable for all Californians."

Asm. Pilar Schiavo, D-Chatsworth, authored Assembly Bill 1208 to eliminate deductibles and lower copays for people on Covered California Silver plans. She wrote a second bill to allow Medi-Cal to offer additional services to new mothers.

"AB 608 would expand a mother's access to perinatal health workers who screen for postpartum depression, help with child nutrition, and provide a warm handoff to a host of other social services," Schiavo outlined.

Other bills in the package aim to eliminate surprise ambulance bills, require private health plans to cover things like wheelchairs when prescribed by a doctor, improve access to mental health care for youths, increase oversight of health care mergers, and improve financial transparency from medical groups.


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Colorectal cancer is second only to lung cancer in the number of lives it will take in Iowa this year. Now, doctors at the University of Iowa are studying ways to not only save lives, but reduce the number of colon cancer surgeries for patients.

Currently, colon cancer patients typically have to undergo surgery to have part of their colon removed or resected. Now, University of Iowa researchers are using immunotherapy to reduce surgeries and improve survival rates. If a patient's tumor biopsy has a certain genetic marker or mutation, they can receive targeted therapy instead of undergoing surgery.

Dr. Saima Sharif, Oncologist at the University of Iowa Holden Cancer Center, is directing a new treatment trial and said the number of people with the genetic mutation could be as high as 20%.

"So one in five patients who are getting their colonoscopy is a significant amount of patients," Sharif pointed out. "If we look in Iowa, we are expecting to have about 1,600 new cases diagnosed in 2023."

If doctors can detect the tumors early and treat them, they can reduce the number of people who need surgeries and, potentially, the number of deaths. Researchers began accepting patient applications for the clinical trial this week.

Cancer tricks the body's natural immune system into thinking abnormal cancer cells are normal, so the body will not attack them, allowing the cancer to grow. Immunotherapy turns the tables on cancer and uses the body's own cells and other drugs to attack it. Sharif noted immunotherapy makes the cancer fighting cells unrecognizable, which is what makes it successful.

"So what immunotherapy drugs do is it helps release the brakes off of the patient's immune system that the cancer has placed," Sharif outlined. "Preventing it to recognize cancer as abnormal, and this unleashes the patient's own immune system against the cancer to fight the cancer cells and kill them."

The trial will start with 25 patients. Sharif added they will grow the study depending on how many patients' tumors respond well to the treatment.

This March marks the 50th anniversary of National Nutrition Month.

Making sure children eat healthy can be tricky.

Chuck Larimer, an elementary school physical education teacher in Stayton, southeast of Salem, said his school has been part of the American Heart Association's Kids Heart Challenge for 23 years.

He observed students look forward to the program, but it's not just about getting active.

"There's more to it than just exercise, which is also important," Larimer explained. "It's that whole body wellness that's more of a focus"

The Kids Heart Challenge has been going on for nearly 45 years in elementary, middle and high schools across the country.

The American Heart Association said a few tips for parents can help introduce healthy foods to kids, even if they're picky eaters. Parents should include at least one item in meals everyone at the table likes. The group urged parents to shop and cook with their kids, and not get discouraged.

"I know at least with my boys' experience that taste buds do change and things that taste weird, or they might not like early on," Larimer noted. "That can change. And just try to continue to introduce different items."

Research has shown it can take at least 11 tries for a child to decide they like a new food, according to the American Heart Association. It also advised parents to offer fruits and vegetables when it is snack time to get them used to it.