RICHMOND, Va. - A small-town mayor walking though Virginia will reach Washington, D.C., on Monday, carrying the message that rural hospitals need Medicaid expansion to survive.

Adam O'Neal, the Republican mayor of Belhaven, N.C., is walking from his hometown to the nation's capital - 540,000 steps, as he puts it - to drive home the impact of the closing of his town's rural hospital. He said the facility would have been financially stronger had the state expanded Medicaid, and added that he's found similar views along his route.

"We've had people invite us in their house for glasses of ice water," he said. "Most of the people, of course, have been in rural communities, and they're all afraid that they could be deprived of their health care in the future. This is not just a Belhaven issue, this is a national issue."

The state General Assembly has refused to expand Medicaid for Virginia. Lawmakers will take the issue back up in September.

Rural hospitals "live close to the red line," said Beth O'Connor, executive director of the Virginia Rural Health Association. Nationwide, she said, they average only 1 percent to 4 percent profit a year, but still have a huge burden in terms of treating patients who can't afford to pay.

As many as one in five of the patients at Virginia's rural hospitals gets uncompensated or charity care, O'Connor said, describing it as a serious burden for health-care facilities.

"If you are hungry and you go to a grocery store and you don't have money, you're not going to get food," she said. "But if you walk into the hospital and you need care, and don't have insurance and don't have any money, they're going to have to pay for you anyway."

Critics of Obamacare say they don't want to see government-funded health services expand, but unless more people get coverage somehow, O'Neal said, the rural hospitals won't be viable.

"Many of them struggle each year to break even," he said. "They depend on foundations and charitable gifts. So I don't think anybody can argue that Medicaid expansion wouldn't help rural hospitals. They struggle anyway."

When he arrives in Washington, O'Neal said, he hopes to meet with the president, the U.S. Attorney General or the head of the Department of Health and Human Services.

O'Neal can be reached on Twitter at @MayorONeal or on at saveourhospital.org/walk.


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People who are part of the Deferred Action for Childhood Arrivals program, known as DACA, will be dropped from their CoveredCA health plans at the end of August.

The move comes after the Trump administration changed a Biden-era definition of "lawfully present" to revoke health care eligibility for thousands of immigrants.

Christine Smith, policy and legislative advocate for the nonprofit Health Access California, said people only have a few weeks to get medical appointments in before their coverage ends.

"If you're enrolled in Covered California and you're a DACA recipient, the Trump administration just ended your coverage," Smith emphasized. "People should use as much of your health care as you can before the August 31st deadline."

The Centers for Medicare and Medicaid Services defended the move, saying it will save taxpayers money. CoveredCA estimated the change affects about 2,400 DACA recipients in the state who make too much to qualify for Medi-Cal and have jobs not providing health insurance. They can still buy private insurance but it is much more expensive. People who prepaid for their coverage can seek a refund.

Smith predicted it will be a blow not just to those who lose coverage but to the state's health care system as a whole.

"The lines in the ERs are going to be longer because people are not going to be able to get affordable preventive care," Smith projected. "They're just going to get sicker and then end up in the ERs. People will overall incur more medical debt. Hospitals will have more uncompensated care."

The change is nationwide. As of mid-July, about 538,000 people in the DACA program across the U.S. are ineligible to enroll in any state-based insurance marketplace and are unable to access premium subsidies or cost-sharing assistance.

Artificial intelligence is appearing more prominently in many aspects of life and research suggests older populations are curious, yet remain wary of using the technology in their everyday lives.

According to Stats Indiana, there are more than 1.5 million Hoosiers aged 65 and older, or 18% of the state's population. Experts said it is likely the demographic will use AI in some form in the next few years, either by choice or necessity.

Dr. Shaun Grannis, vice president of data and analytics for the Regenstrief Institute on Aging, said AI offers real benefits.

"It can reduce loneliness through conversation, provide reminders for medications and appointments," Grannis outlined. "It can support cognitive stimulation via games, storytelling, news updates."

The technology can also offer a low-pressure way to access information on public services, he added, which is valuable for those with mobility issues or those who feel intimidated by technology.

Grannis cautioned any tool which can be used for good can also lead to problems. He noted AI can create a false sense of companionship and mask social isolation. Overdependence is a legitimate concern, he argued, if the technology becomes a "crutch" for all forms of interaction.

"All cognitive activities or decision-making, it can actually lead to and create a negative feedback loop, lead to a decline in engagement and even basic self-management skills," Grannis explained. "This is risky."

Grannis believes one solution is designing AI systems to complement, not replace, human interaction. He stressed it can be done though building broader support ecosystems including family, friends, caregivers and community services. Grannis emphasized it would encourage real-world activity, prompting the user to go for a walk, call a grandchild or attend a local senior event.

If you have an extra five minutes, you can save a life because you can learn cardiopulmonary resuscitation at no cost from a new mobile, hands-only CPR kiosk.

The new kiosk is in the lobby of Saint John's Health Center in Santa Monica. The machine's touch screen gives a brief overview of hands-only CPR and you can practice right there, on a mannequin.

Dr. Rigved Tadwalkar, cardiologist at St. John's, said it is an easy way for people to get more comfortable giving chest compressions in an emergency.

"It's a lot like a video game but of course, a lot more important than a video game," Tadwalkar pointed out. "It gives real-time feedback about the depth and rate of compressions, proper hand placement, which are all factors that influence the effectiveness of CPR."

The American Heart Association operates the St. John's mobile kiosk and a stationary model at L-A-X with support from the hospital. Santiago Canyon College in Orange County also has a mobile hands-only C-P-R kiosk now through September, sponsored by Edwards Lifesciences.

Steven Munatones, an Orange County business owner, said he survived what's known as a "widowmaker" heart attack which led to cardiac arrest nine years ago, thanks to his 17-year-old son, who gave him immediate CPR with instructions from a 911 operator.

"You don't have to put your mouth to anybody's mouth," Munatones explained. "You just put your hand on their chest and pump. He saved me, and others can do the same, anywhere. So, it's absolutely a lifesaving, heroic act that anybody can do."

Statistics show 350,000 Americans suffer from cardiac arrest outside a hospital each year and about 90% die, in part because they do not receive CPR. About 70% of those cardiac arrests happen at home, so people often depend on family or friends to give CPR before an ambulance arrives.