Without federal intervention, a new report warns, rural hospitals across the United States, including many in Nebraska, could be forced to reduce services or even close their doors after pandemic relief funds expire.

Nemaha County Hospital chief executive Marty Fattig said ending across-the-board federal spending cuts, known as sequestration, would be a good start. Since lawmakers haven't used cuts to bring down the national debt as promised, Fattig said, he believes hospitals should receive full reimbursement from Medicare.

"So, it looks to me like the only people that are paying for this thing are those of us that take care of Medicare patients," he said. "And we get 2% off of what we would normally get paid. That's kind of a big deal."

Researchers at the Bipartisan Policy Center found that 30 rural hospitals in Nebraska suffered financial losses for patient services over a three-year average. More than 20 hospitals had negative earning margins. Current and long-term financial liabilities exceed current assets for 18 Nebraska hospitals. Nationally, the report says 441 rural hospitals face multiple financial risk factors.

In addition to putting a pause on sequestration, the report recommends making higher Medicare payments permanent, and maintaining flexibility in telehealth until at least two years after the federal public health emergency ends.

Report co-author Julia Harris, the think tank's senior policy analyst, said 116 hospitals closed between 2010 and 2019, but that pace slowed as COVID peaked.

"So, the CARES Act and the American Rescue Plan really did a lot to stave off more hospitals from closing," she said, "but that aid masked the fact that the underlying finances of rural hospitals continue to deteriorate, especially with new pressures brought on from the pandemic."

Fattig said lawmakers also should push back against efforts by drug companies to make it harder to get discounted medicines through a program known as '340-B.' He said those savings help pay for patient services that aren't financially viable otherwise.

"Right now 'Big Pharma,' the big pharmaceutical companies, are throwing all kinds of roadblocks down," he said, "so that they will not pay for the 340B program like they should."

More than 1 million people in North Carolina are diabetic and they have become increasingly worried about the national shortage of insulin.

The access problems in North Carolina are prompting some individuals to either ration their medication or switch to different brands, which can significantly complicate their diabetes management.

Jessica Lynn-Lato of Charlotte was diagnosed with Type 1 diabetes at age 28 during pregnancy. She said she has seen firsthand the challenges the insulin shortage has created.

"We typically are prescribed 10-milliliter vials," Lynn-Lato explained. "Some people were being prescribed three 3-milliliter vials. Other people were being prescribed insulin pens or altogether having the type of insulin they use changed to a different brand."

She emphasized the urgent need for transparency about the causes of the current insulin shortage and for proactive measures to ensure access to the lifesaving medication.

Lynn-Lato explained for decades, people have struggled with insulin access for a variety of reasons, primarily cost. She recounted the tragic loss of her nephew, who was forced to ration insulin when he could not afford it.

"When he was 21 years old, he went to the pharmacy to pick up his insulin and couldn't afford to pay for it," Lynn-Lato noted. "He started using less insulin, which is something many people attempt to do to make it last longer. And sadly, it caught up with him two months later."

She believes if the Affordable Care Act, and more recently, President Joe Biden's cap on insulin costs through the Inflation Reduction Act, had happened sooner, it could have saved her nephew's life.

According to Lynn-Lato, systemic reforms are needed to address the root causes of insulin shortages and improve affordability and accessibility for diabetes patients.

"I think it falls on the FDA to maybe set some standards here, when you're dealing with medications that people literally need to live," Lynn-Lato stressed.

She encouraged people to advocate for themselves by reaching out to their lawmakers and the Food and Drug Administration.

The number of avian flu cases in dairy cows is holding steady in New Mexico but experts say more testing is needed to prevent its spread and protect humans.

Technically known as H5N1, "bird flu" has been detected in eight Curry County herds, although no deaths were reported. In Texas, a man is known to have become ill with bird flu last month after contact with infected dairy cattle.

Andrew Pekosz, professor of molecular microbiology and immunology at Johns Hopkins University, said the transmission to humans is cause for concern.

"Given that dairy farms have a large number of people who come in contact with infected cows, there is an increased chance of the H5N1 virus also directly infecting humans and beginning that process of adapting to replication and spread within humans themselves," Pekosz explained.

He acknowledged the risk to the public is still very low, but argued the U.S. should improve its response to new and emerging infections in order to minimize the chance of another pandemic. The U.S. Department of Agriculture announced this week it will pay dairy farms with confirmed avian flu infections to help contain the virus' spread to people and more cows.

In Texas, the Centers for Disease Control and Prevention confirmed the virus killed a dozen cats who drank raw cow milk.

Meghan Davis, associate professor of environmental health and engineering at Johns Hopkins University, said due to extensive federal food checks prior to human consumption, she believes it is safe to eat poultry and drink milk, with one exception.

"Raw milk and raw milk products may not undergo the same processes to inactivate the virus," Davis pointed out. "I have very large concerns about the safety of raw milk."

In addition to New Mexico, last month's outbreak affected more than 33 dairy cow herds in seven other states. To date, federal officials only mandate testing for dairy cows moving between states.


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Newborns benefit the most from their mother's milk but may not always receive it.

An Indiana nonprofit group works to get breastmilk donations for premature babies. Similar to a blood bank, The Milk Bank accepts breastmilk donations from nursing mothers. Breastmilk is vital to a child's growth and development but what should be a natural occurrence between mother and child has sometimes historically been used as a tool of subordination.

Andrea Freeman, professor at Southwestern Law School, has conducted research on breastfeeding and found it has been a concern among Black families for more than 200 years.

"Black women breastfeed at lower rates than any other women, and always have done," Freeman explained. "This is a story that started during enslavement, and has continued ever since. And there are a lot of health consequences to Black families not having the same choice whether to breastfeed [or] use formula as other families."

Freeman asserted the baby formula industry is powerful in America, and the U.S. Department of Agriculture is its biggest purchaser. She stated the industry's perks and lobbying persuade medical professionals to promote using formula instead of encouraging new moms to breastfeed.

One study found infants who are not breastfed have higher chances of pneumonia, childhood obesity, diabetes, Sudden Infant Death Syndrome and more. But medications or a parent's financial need to return to work could mean opting for baby formula instead.

Jenna Streit, advancement director for The Milk Bank, said it sends 80% of breastmilk donations to the most medically fragile infants in neonatal intensive care units. She pointed out potential donors undergo thorough screening.

"They complete a prescreen online on our website and after that, they complete a more detailed health history," Streit outlined. "They get a blood test done at The Milk Bank's expense. And then, we also reach out to their health care provider to get their consent for donation as well."

She said the organization does experience shortages at certain times of the year. Streit acknowledged more donor milk was available during the pandemic because more moms were at home. According to the nonprofit Women4Change, one in four women returns to work within 14 days after childbirth.