BISMARCK, N.D. – The number of Americans who have health coverage under the Affordable Care Act (ACA) continues to grow, but a new analysis finds that in rural states especially there are many who still can't access affordable insurance.

All states were given the option to expand their Medicaid programs, but many did not and Jon Bailey, director of the rural public policy program for the Center for Rural Affairs, says those were mostly states with large rural populations.

"Then the converse is true for states that have a higher portion of their population in urban areas,” he points out. “They're more likely to have expanded Medicaid.

“So if you live in a rural area, in a state that has a high rural population, it's less likely that you'll get the benefits of the Medicaid expansion."

In North Dakota, the Medicaid program is being expanded this year to cover households with incomes of about $16,000 a year for one person, or $32,000 for a family of four.

In rural states where there was no expansion, there's a significant coverage gap of low-income workers who earn too much to qualify for Medicaid, but not enough to receive tax credits under the new heath insurance marketplaces.

Bailey says that coverage gap, percentage-wise, is about as large as the group of people whose policies didn't comply with the ACA, where action was taken.

"Congress introduced bills,” he explains. “The president came up with a plan to solve the problem for a year.

“That group of people is almost equal to the people in this coverage gap who have no insurance options at all and really very few people are talking about how to reduce those people's problems."

Nationally, nearly 1.8 million rural and small city residents are in the coverage gap.





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On Tuesday, 20 Colorado officials sent a letter to the state's congressional delegation protesting six cuts to public lands management in the new tax and spending bill signed into law by President Donald Trump.

John Clark, mayor of Ridgway, said the elimination of river and climate data programs, which are essential to managing the Colorado River Basin and forecasting drought, will put additional burdens on food producers.

"If our farmers and ranchers don't have accurate data about exactly what the situation is with the snow pack and what's happening with the climate, how can they be prepared for each growing season?" Clark asked.

Five active wildfires have burned more than 22,000 acres on Colorado's Western Slope. The letter urged state representatives to reject any additional cuts to the U.S. Forest Service's Community Wildfire Defense Grant Program or other mitigation efforts. Republicans have argued cutting the size of government is necessary to eliminate waste, fraud and expenditures they claim are unsustainable.

Officials are also calling out a provision in the new law they believe undermines local decision-making by forcing oil and gas leasing on public lands. In addition, the law creates new barriers for clean energy leases on public lands, a move Clark worries will lead to the loss of good-paying jobs.

"If we discourage clean energy on public lands, that's going to severely impact our alternative energy workforce," Clark pointed out. "If we can't do wind and solar on public lands, it disincentivizes clean energy all across the state."

Officials are also asking members of Congress to fully fund the National Park Service to ensure proper staffing and maintenance. Clark argued standing up for lands owned by all Americans is essential to preserving Colorado's iconic natural landscapes and rural economies.

"Our economy is hugely dependent on people coming in to visit us and eat at our restaurants and experience these beautiful outdoor environments," Clark emphasized.


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A Wisconsin nonprofit is working with farmers in Southeast Wisconsin to educate communities about the importance of agroforestry, with plans to establish its first urban site in Milwaukee.

The Michael Fields Agricultural Institute has planted more than 400 trees across three sites this year, in partnership with the Savannah Institute. The sites include a community garden and two farms.

Iris Lee, owner of Lee Hemp Farms in Burlington, said agroforestry collaboration is breathing life back into her nearly 50-year-old organic family farm.

"You plant and design things that go together," Lee explained. "That will help not only humans but the animals and nature and bugs."

Agroforestry integrates trees, shrubs and perennial plants into crop and livestock systems. Lee noted one of the project's goals is to raise awareness of the practices and their larger connection to food systems, climate change and communities. The sites will also be used for educational demonstrations.

Community members and project participants helped Lee plant a trail of more than 100 trees in April, from hazelnut and elderberry, to Juneberry and pawpaw trees. They have already grown two to three feet, and she anticipates the berry trees will yield results first. Lee added she even loves talking to her trees and emphasized the physical and mental health benefits of agroforestry.

"Growing something is therapeutic," Lee observed. "To be one with nature -- meaning you know where things come from that you put in your body -- anybody that is concerned about the food and their health, to grow something is to build upon a better human being."

Nolan Burkard, research technician for the nonprofit Michael Fields Agricultural Institute, said diversifying food systems in this way is a growing area of interest for small farmers. Through agroforestry, they can also improve soil health and local climate resilience.

Burkard emphasized it requires long-term investment to get there.

"It takes quite a while for trees to grow up and start fruiting or provide their benefit," Burkard acknowledged. "That's why this project is so important because it is such an investment to plant trees."

Burkard added the institute is accepting applications until July 26 for an urban site in Milwaukee. The selected site will receive $15,000 and planning support to aid in designing it.

Despite the elimination of a handful of alternative energy tax incentives in the new federal budget, Iowa corn farmers will benefit from one that was extended.

Tax breaks and rebates encouraging investment in solar and wind power in Iowa were eliminated in the federal spending plan. However, the Trump administration extended an incentive enabling farmers in Iowa to produce more corn. The Hawkeye State is the nation's top corn producer, much of which is used to produce ethanol.

Chris Bliley, senior vice president of regulatory affairs for the biofuel trade organization Growth Energy, said grain-based fuels burn cleaner and are more environmentally friendly.

"The credit actually goes for production of lower carbon fuels that are used for transportation," Bliley explained. "It includes on-road fuels as well as sustainable aviation fuel. And so, the lower in carbon, the higher the credit."

The Trump administration has made efforts to extract more fossil fuels, which it said will move the U.S. toward energy independence.

Lawmakers in Iowa and neighboring Midwest states have introduced their own tax incentives for biodegradable jet fuel, which Bliley noted will create economic benefits for ag producers.

"To remain competitive, plants in Iowa and Nebraska and throughout the Midwest are investing in some of these key projects to lower their carbon intensity," Bliley observed.

The commercial airline industry is aiming for net-zero carbon emissions by 2050, according to the International Air Transport Association, which could continue to benefit Iowa farmers who provide corn for ethanol production.


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