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."

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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