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 Nebraska 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 asserted. "Because this should be what helps them meet the needs of the community and stay open rather than being forced to close."

Harris pointed out under the Rural Emergency Hospital model, a rural facility can offer emergency department, observation, outpatient care and skilled nursing facility services in a distinct unit. Warren Memorial Hospital in the town of Friend is currently the only such facility in Nebraska.

Harris noted the growth of the model is reducing the number of rural hospital closures but acknowledged challenges remain in operational flexibility and the availability of financial assistance. She emphasized they studied states across the Midwest, looking for hospitals and communities which could benefit from a Rural Emergency Hospital.

"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 explained. "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, with what are called technical assistance centers.

"There is a federal TA center to help hospitals that are trying to consider their pros and cons," Harris observed. "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."

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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Groups from across Michigan are sounding the alarm on the effect Republican-backed policies would have on people in rural parts of the state.

In a recent webinar by the group Progress Michigan, leaders say policies laid out in Project 2025 are in stark opposition to the needs facing rural Michiganders. Representatives from Indigenous tribes, public school teachers and family farmers gave their views on the potential changes if the GOP regains power.

Dakota Shananaquet, member of the Little Traverse Bay Bands of Odawa, said she fears for her people's basic rights.

"The Project 2025 Agenda is a right-wing power grab that would harm Indigenous communities, our sovereignty and the ability for us to exercise our vote," Shananaquet asserted. "It would make outcomes worse by defunding health care and education programs."

Project 2025 is a 900-page document outlining plans for a conservative takeover of the federal government. Republican presidential candidate Donald Trump has disavowed any part in developing the document. However, dozens of former Trump administration officials contributed to the proposals.

Bob Thompson, president of the Michigan Farmers Union, which represents hundreds of small and medium-family farms, said the GOP plans to eliminate programs helping independent farmers implement conservation and clean energy goals, and most of the federal farm program's current financial safety net features.

"Family farmers operate on narrow margins and need the protection of many of the very programs that Project 2025 seeks to eliminate," Thompson explained. "Most elements stand against what rural folks want for our families and our future here in Michigan."

Gary Wellnitz, Northern Michigan field representative for the American Federation of Teachers-Michigan, said Project 2025 would have negative and destructive effects on public schools across the state.

"It's going to make the safety in our public schools far worse," Wellnitz contended. "We're going to see small schools closing down, We're going to see teachers losing jobs by the thousands if this were to take hold."


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