This month, a North Dakota network of rural hospitals enters its second year of trying to make local operations more efficient, so they can keep the doors open for patients and keep their local communities thriving.

The Rough Rider High-Value Network was announced in October 2023. It is made up of 23 independent, critical access hospitals in smaller towns and cities across the state. Leaders from the facilities share best practices and ways to keep costs lower.

Kylie Nissen, executive director of the North Dakota Rural Health Association, said she is encouraged by the effort, knowing the long-standing struggles hospitals and clinics in these areas have faced.

"It's not only closures that we're concerned about, it's rural community members (who) don't want to see their hospital bought out by a large system, too," Nissen observed. "Because then, the decision-making and the care for their local community just isn't there."

Since it began, the collaborative has secured at least two desirable contracts with commercial health insurers, benefiting all member hospitals. In its August forecast, Becker's Hospital Review reported five North Dakota hospitals were at immediate risk of closing within the next two to three years.

Nissen pointed out the ripple effect of keeping the hospitals independent and running efficiently, while improving patient care, can be felt across an entire community.

"Health care is huge when it comes to economics," Nissen stressed.

She added a healthier population, that does not have to travel as far for appointments or other care needs, results in a stronger workforce. She acknowledged they are still navigating challenges, like reducing maternal care "deserts," noting federal grants are competitive. The state of North Dakota chipped in $3.5 million to help get the Rough Rider Network started.


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Indiana lawmakers paused action this week on a bill which aims to prevent crashes caused by dangerously overgrown rural intersections after concerns arose about liability.

The bill originated after Riley Settergren, 17, died in a 2017 collision at a Hancock County intersection.

Jay Settergren, his father, testified Monday before lawmakers, urging stronger rules to prevent similar tragedies.

"Just days before his senior year, Riley was taken from us by a piece of farm machinery that could not see at an intersection because it was obstructed by corn," Settergren recounted. "They had to move out further into the road. The truck Riley was a passenger in was struck. Riley was killed instantly."

The current proposal would mandate property owners or renters near rural intersections clear all vegetation or obstacles above three feet, ensuring drivers can see approaching traffic. However, farm groups oppose the measure, citing liability risks and potential loss of productive farmland.

After Riley's death, his family created a foundation honoring their son, placing caution signs at intersections statewide to alert drivers to the risks near farmland. Riley's father stressed to lawmakers while signs help, permanent visibility improvements require enforceable legislation.

"We need to move to the next level," Settergren urged. "We need help to pass this putting responsibility on the landowners and the lessees to make sure that they are maintaining their corners, and their crops, and their properties."

Rep. Jim Pressel, R-Rolling Prairie, said legislators intend to amend House Bill 183, shifting emphasis away from strict sightline triangles, toward maintaining existing road right-of-ways.


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The future of a big carbon capture project in the Midwest was thrown off balance after a new South Dakota law was adopted. Rural property owners made a big push for the policy and their organizing is getting noticed.

South Dakota's governor just signed a bill prohibiting eminent domain for carbon dioxide pipelines. It is in response to a proposed line where the company behind it has not secured all the voluntary land agreements it needs. Worried landowners found sympathetic ears in the Legislature.

Sarah Jaynes, executive director of the Rural Democracy Initiative, said outcomes like these reflect the mindset of smaller communities when big projects come their way, potentially affecting their way of life.

"Rural people are not in the habit of fighting things," Jaynes pointed out. "They're in the habit of taking a close look at what's proposed for their communities after decades of exploitation."

She is referring to corporations outsourcing jobs from rural areas, as well as agricultural firms wanting to add larger animal feedlot operations. Jaynes noted the decline of local news outlets is likely playing a role in how communities are responding. Without access to key information, residents are enhancing their coordination to have a bigger voice.

The multistate carbon pipeline is proposed by Summit Carbon Solutions, which wants to capture ethanol plant emissions and store them underground. It touts economic and environmental benefits but some skeptics see it as a power grab, especially if objecting landowners are forced to let it run along their property through eminent domain.

Jaynes explained in a broader sense, rural residents are not confined to narratives about what they care about.

"They want to make sure that they have clean air and water and access to nature," Jaynes emphasized. "They want to take care of their land."

Such sentiments have surfaced in polling from the Rural Democracy Initiative.

As for the Summit project, the new law might lead to a legal challenge. Summit has won permit approval in other states and is trying again in South Dakota. But the uncertainty, along with the land restrictions, could make it harder to begin construction. The governor insists the action will not kill the project, calling it an "opportunity for a needed reset."


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Later this month, on March 26, the U.S. Supreme Court will hear arguments in a case that challenges the constitutionality of a federal fund that aids rural broadband service.

South Dakota advocates say a negative outcome could be devastating for customers.

A conservative organization brought the case, hoping to end a Federal Communications Commission fee that flows into what's known as the Universal Service Fund.

It provides $8 billion a year for telecommunications programs geared toward underserved populations. That includes high-speed internet service in rural areas.

Kara Semmler, general counsel and executive director of the South Dakota Telecommunications Association, said she worries about the impact if the challenge is successful.

"Children will be missing out on educational opportunities," said Semmler, "businesses will lose their competitiveness."

Industry groups say rates for customers, benefiting from the fund, will double if it's struck down.

The plaintiffs contend the fee mechanism used to prop up the fund is more like a tax, meaning Congress should have the oversight.

Semmler said shifting that power would result in funding uncertainty for an industry that relies on long-term planning.

Cellphone service providers and other telecom companies pay the fee that's at the center of the legal argument. Those costs are passed along to consumers across the country through their monthly bills.

Semmler said it's a small price to pay to maintain critical broadband infrastructure in rural pockets.

"It's that ongoing operation, maintenance, and affordability of the product," said Semmler. "It does no good to have infrastructure in the ground if it becomes unaffordable for South Dakota consumers to use."

Semmler said they've had productive conversations with South Dakota's Congressional delegation about "Plan B" strategies.

But she acknowledged the budget-cutting tone in Washington D.C. right now, while adding it would be hard for state government to fill any sudden funding gaps.




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