With many rural hospitals on the financial critical list, Congress created a Rural Emergency Hospital model in 2021 to help deliver critical care to struggling communities in Kansas and elsewhere.

Two years in, the Bipartisan Policy Center has issued a report which showed care is improving where the system has been implemented but more work is needed. Under the model, 32 Rural Emergency Hospitals in 14 states have been established.

Julia Harris, health program director at the center, said the plan is preserving health care options for rural residents.

"If you start seeing hospital closures go down, that's a success measure," Harris explained. "Because this should be what helps them meet the needs of the community and stay open rather than being forced to close."

Harris said under the model, a rural facility can offer emergency department, observation, outpatient care and skilled nursing facility services in a distinct unit. Mercy Hospital in Moundridge and South Central Kansas Medical Center in Arkansas City are the only two such facilities in Kansas.

Harris pointed the growth of Rural Emergency Hospitals is reducing the number of rural hospital closures. She acknowledged challenges remain in operational flexibility and the availability of financial assistance. They studied states across the Midwest, looking for hospitals and communities to potentially benefit from Rural Emergency Hospitals.

"The reason we chose Kansas and Nebraska is because there was some modeling done to see which states would have the most hospitals eligible for this model," Harris noted. "Those were two states that had a lot of potential REHs."

Other recommendations in the report included support for prescription drug discounts, more flexibility in converting to Rural Emergency Hospital status, timely payments to speed the process and more funding for providing technical and operational assistance through technical assistance centers.

"There is a federal TA center to help hospitals that are trying to consider their pros and cons," Harris explained. "We advocate for continued funding for that TA center to be able to continue to do this sort of advising and help states make these choices."

Several rural communities across North Dakota are strategizing how to slow the pace of local grocery stores shutting down.

Some are making use of state grant money to aid their efforts, but challenges remain.

In North Dakota's Walsh County, the Rural Access Distribution Cooperative has been on the leading edge of establishing local grocery store co-ops, where a handful of smaller shops buy items in bulk together.

The initiative was eventually awarded a state grant to buy a bigger truck and van, making supply deliveries more manageable.

Cooperative President Alexander Bata said they continue to see progress with increased sales, and better options for area residents.

"So, there's less waste, less cost," said Bata, "and we've significantly improved the quality of food."

However, other elements of the initiative still face hurdles.

That includes utilizing food lockers, where customers can buy their food online and pick it up when they choose. But Bata said they haven't been able to make the technology work.

In 2023, the Legislature approved $1 million for interested communities to sustain grocery service in smaller towns with limited access.

The town of Milnor, with a population of around 600, was one of the early grantees - and used its money for a feasibility study.

Milnor's Community Economic Development Coordinator Carol Peterson said those findings were clear - their lone grocery store needs more storage space to stay afloat.

"It makes it very hard," said Peterson, "to order in enough product to service the community."

That limits the store from keeping prices lower.

Peterson said she worries more customers will then look at far away options, taking their tax dollars with them. While local leaders did get a read on what's needed, they haven't been able to secure additional funding for the next phase.

A key legislative sponsor of the pilot grant program says there's interest in extending it next session, but she's still gathering feedback.


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The American Postal Workers Union is pushing back against proposed changes to the Postal Service they said would slow delivery.

Among other things, the proposal aims to cancel afternoon deliveries and pick-ups for areas more than 50 miles from a regional hub. Postmaster General Louis DeJoy said elimination of night pickups could save the post office more than $3 billion a year.

Daniel Cortez, director of industrial relations for the Oregon Postal Workers union, said reducing services does not make sense financially.

"To think that eliminating services, reducing standards, basically providing the American people with less reliable service is somehow going to make money, it's nonsense," Cortez contended.

The charges are the most recent in a series included in Dejoy's 10-year "Delivering for America" plan. The union said DeJoy, who was appointed under President Donald Trump, has already raised prices for stamps while closing post offices across the country, especially in rural communities.

Cortez noted although rural communities would be hit hardest by this latest proposal, urban centers will also be affected. He explained the Postal Service has been shutting down processing centers in the state, making Portland the sole distribution site for all of Oregon, which means more mail delays for everyone, including Portlanders.

"If the clerks and the employees in the main plant are processing mail for the rest of the region, that means they're not at that same time processing Portland's mail," Cortez emphasized.

The changes come as first class mail volume has fallen 30% in a decade, with fierce next-day delivery competition. Although the Postal Service said under the new proposal most first class mail will not be affected, Cortez argued management is already failing to meet its lowered delivery standards from 2021. He added mail never used to sit around.

"First class mail was always moving until it got to where it needed to go," Cortez recounted. "That's just what everybody understood about the service that we're required to provide to the American people."

North Dakota has 30 available workers for every 100 open jobs. To help confront workforce shortages, the state is now accepting grant applications to kick-start solutions at the local level.

The Department of Commerce's Regional Workforce Impact Program invites towns, cities and their business development groups to seek out the grants.

Arik Spencer, president and CEO of the Greater North Dakota Chamber of Commerce, said providing seed money to foster innovation in worker recruitment might boost rural areas at a competitive disadvantage.

"Whether it is starting manufacturing ventures or doing other creative things," Spencer outlined. "To the extent that this can help those, maybe, small communities or underserved communities get people to move there and bolster their workforce, we think that's a positive outcome."

Spencer pointed out the innovation might look like closing affordable housing gaps, which he said is a common roadblock around the state. He and other stakeholders monitoring the labor landscape still hope for broader support when the Legislature reconvenes early next year. North Dakota's labor shortage woes appear to be more pressing than its neighboring states.

Spencer noted no matter the size of the community, applicants appear to be in the driver's seat in coming up with fixes that work for their populations.

"While living in Fargo may be attractive to some people, maybe living in Watford City's attractive to others," Spencer acknowledged. "This grant program allows those regional communities to figure out their own solutions and tackle those with the support of the state."

The application period began this week and runs through Jan. 21. There are grant caps for certain categories. For example, a local coalition focused on recruiting talent can receive a grant of up to $250,000. The cap is higher for infrastructure needs related to worker recruitment, such as child care centers.


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