An Alabama group is sounding the alarm about the need for Medicaid expansion, in part to keep rural hospitals in business.

Many hospitals in Alabama are becoming what's known as Emergency Rural Hospitals, reducing their services to emergency-only operations and eliminating inpatient care.

Debbie Smith, Cover Alabama campaign director for the group Alabama Arise, said it is largely due to financing, noting Medicaid reimbursement rates are too low to cover the cost of care.

She is particularly concerned without inpatient services, maternity care may be limited, sending women to other areas, even for routine care.

"A lot of women just can't afford to do that," Smith pointed out. "They don't have the transportation, or a lot of people would have to take off the full day of work just to go see the doctor. So, it's really concerning, and I think that's a real deterrent for people to even go see the OB/GYN and get their regular checkups, which can lead to a lot of issues down the line."

She emphasized the service cutbacks could also limit critical mental health and specialty care access across the state. Grove Hill Memorial Hospital in Clarke County is one of the latest to announce its move to Emergency Rural Hospital status. Hospitals in Bullock, Chambers and Monroe counties have done the same.

The Emergency Rural Hospital designation was created by Congress under the 2021 Consolidated Appropriations Act. It provides hospitals with higher reimbursement rates and financial assistance to help keep them afloat.

Smith believes one way to improve health outcomes is through Medicaid expansion.

"We have seen from other states that there's a much less likely chance of our rural hospitals closing in expansion states; it's proven," Smith asserted. "Medicaid expansion can really help with helping out on those costs and helping with uncompensated care costs."

Smith added Gov. Kay Ivey could use her executive authority to expand Medicaid. Alabama is one of only 10 states to have not done so, leaving nearly 300,000 people in the "coverage gap," who work but make too much money to qualify for Medicaid and not enough to afford traditional health insurance.

The Missouri Foundation for Health is partnering with The Marshall Project on the launch of a St. Louis nonprofit newsroom highlighting the legal system's effect on health, especially in marginalized communities.

The Marshall Project focuses on investigative, data-driven journalism to explain the justice system, especially to those affected by it. With the foundation's support, its St. Louis newsroom will cover topics like the death penalty, juvenile justice, health care in prison conditions and reentry challenges.

Molly Crisp, senior communications strategist at the foundation, shared the goals of the new partnership.

"We recognize that the criminal justice system disproportionately harms certain populations and that exacerbates health inequities," Crisp explained. "We're hoping through this partnership that we're bringing to light some of the issues that are rampant in the legal system and that we can address those issues."

Statistics show low-income marginalized communities face higher pollution, increasing asthma risk, along with other health problems, and incarcerated individuals often endure long waits for medical care and face barriers to mental health treatment due to staff shortages and limited resources.

Katie Moore, a reporter for the Marshall Project, said its goal is to investigate such issues both locally and statewide.

"We have been talking with different groups, individuals who are connected to the criminal justice system in some way," Moore noted. "To see what their concerns are, what they see as being missing in the media landscape in St. Louis in terms of coverage of some of these more in-depth investigative issues."

With an increasing number of older people who are incarcerated, Missouri prisons face growing health care demands, including the need for geriatric care and hospice services.

Ohioans are seeing changes in their water infrastructure as cities work to replace lead service lines, a requirement under federal regulations.

But concerns have risen over the materials being used for replacements.

Teresa McGrath, chief research officer with the group Habitable, said while lead exposure poses significant health risks, she cautions against replacing these pipes with polyvinyl chloride due to its environmental and health implications.

"It's important to get those lead pipes out. Let's prioritize that," said McGrath. "But let's not make a regrettable substitution while we do that."

PVC production involves hazardous chemicals, including vinyl chloride, a known human carcinogen. However, PVC remains a popular choice because of its lower cost and ease of installation.

Environmental health advocate Yvette Jordan - the chair emeritus of the Newark Education Workers Caucus, and a steering committee member at Lead Free NJ - underscores the importance for Ohioans to be well informed about their environments.

"What is in their home?" said Jordan. "If they have a service line, is it plastic? Copper? What exactly is it and how does that affect their health, their community, and most importantly their families and children who are most affected by this?"

McGrath highlighted specific concerns about PVC and alternative materials that could be safer.

"The best available water pipe that we have evaluated for use inside a home is copper pipes," said McGrath, "and we will be the first ones to tell you that copper pipes are not perfect, but it is the best available."




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March is National Nutrition Month and rising grocery costs, and food recalls have consumers revisiting the idea of growing their own healthier and more affordable food. Research from gardening site, Gardenp.com shows the average garden produces $600 worth of produce. Indiana farmer's markets attract large numbers of Hoosiers who want fresh, farm-grown fruits, vegetables, and other staples at reasonable prices.

Philip Hartman, president of InstaFarm, which creates countertop food gardens, said foods grown in the healthiest chemical-free soil will produce optimum crops.

"So your food that you buy at the grocery store, your produce, has typically lost up to around 50% of its nutritional value by the time it gets to the store. Also, you don't know how it was grown. So the quality of your produce is linked to the quality of your soil," he said.

Lower costs, convenience, and fewer pesticides make garden-to-table food even more appealing. Hartman advises beginner gardeners to use healthy, nutrient-rich soil because it improves the nutritional value of fruits and vegetables. Gardens use a large amount of soil nutrients and when soil is depleted of these necessary nutrients, the crops are affected too.

Hartman works with students from kindergarten through high school and is passionate about helping children understand where their food comes from. He notes children don't get to see a farm or where their food is grown until they are well into their late teens.

"It's amazing, you know, children that don't usually like vegetables, when they engage in the growing process, all of a sudden, they're inspired to eat this and it's a great way to train them about what's good for them and how to recognize healthy foods," he added.

Gardenpals.com says millennials make up 29% of gardener demographics. Indiana is home to over 60,000 farms covering over 19 million acres. The state ranks in the top five for growing corn, soybeans, blueberries, tomatoes and melons, according to the Indiana Department of Agriculture.