FLAGSTAFF, Ariz. – As the Senate prepares to vote today on whether to proceed with health-care reform, experts at a conference on rural health in Flagstaff that starts today are warning that the proposed cuts to Medicaid would be a disaster for small-town Arizona.

The Congressional Budget Office says 22-32 million Americans could lose health-insurance coverage over the next ten years - depending on which bill the Senate considers passing.

Siman Quaasim, director of Health Policy at the Children's Action Alliance, says 400,000 Arizonans could lose coverage - many of them in small towns.

"The policies being put forward in Washington are not the policies that work for our state," she says. "We need solutions that make the lives of rural Arizonans better, their families healthier, and more economically independent. Not proposals that shut them out of health care, cut rural jobs and expose families to bankruptcy."

A recent study showed that in non-metro areas, 54 percent of children are covered by Medicaid, which is called AHCCCS in Arizona. And 17 percent of older rural adults rely on Medicaid for long-term care and services that help them stay in their homes.

Dan Derksen, director of the Arizona Center for Rural Health at the U of A, says the state stands to lose $7-14 billion in federal funding over the next ten years - which could cost up to 25,000 jobs in the health care sector.

And, he notes the state would have a hard time plugging the massive hole blown in the budget.

"So the state general fund would have to come up with another half billion dollars just to maintain childless adult coverage that we had expanded more than a decade ago in Arizona," he says.

Derksen warns that the GOP health plans could put many rural hospitals out of business, and take local pharmacies and nursing homes down with them. He says he'd like to see Congress work on bipartisan fixes to the ACA to increase competition in the health-insurance market and bring down premiums.


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It's National Nurses Week, and educators and healthcare officials say there just aren't enough of them to go around. A combination of retiring baby boomers and nurses who chose to leave the field after the pandemic has left a projected shortfall of more than 5,400 nurses in Nebraska's hospitals, clinics and long-term care facilities.

Linda Hardy, Nebraska Nurses Association president, explained that the system is not training enough new nurses to fill the vacancies.

"I think across the country we have a nursing shortage," she intoned. "But the other thing we have a shortage of are nurse educators - and also, clinical sites for student nurses to be able to practice their clinical skills."

According to a Nebraska Health Care Workforce Collaborative report, 66 of the state's 93 counties have been declared medically underserved, and nine have no nurses. The report points to degraded "emotional health and well-being" as the main reason for staff shortages.

Hardy added healthcare providers and state officials are studying how to increase the investment in educational facilities and clinical sites to train new healthcare workers, and said one goal is to recruit them when they are young.

"There's a collaborative effort to try and get more healthcare workers, not just nurses but radiology techs, pharmacists, etcetera, into the pipeline from high school kids. So, that's a good thing," she insisted.

Carole Johnson, administrator of the Health Resources and Services Administration, said her mission during National Nurses Week is to highlight the vital role nurses play on the front lines, providing care, comfort and support to patients every day, but added the best way to honor them is to support them from training through retirement.

"You have to be investing in the nursing workforce. And so we're providing scholarships, loan repayment, stipends, upskilling - a whole host of training initiatives to really help ensure that we can recruit people into nursing and that when they're there, that they stay," she continued.


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Birth doulas assist new moms with the stress, uncertainty and anxiety of childbirth, while another type of doula offers similar support to those who are dying.

Death doulas, or end-of-life specialists, give spiritual and emotional support to people nearing death in a nonmedical setting. The word 'doula' comes from the Greek word 'doule,' meaning 'female helper.'

Kim Burgess, end-of-life doula and board certified adult geriatric nurse practitioner for Comforting Transitions, an elder care facility in O'Fallon, said fulfilling a dying person's wish to be in their desired setting is important.

"When I was in the home, primarily geriatric population, people wanted to stay in their home; the comfort of their home, their own surrounding, their own food, their own loved ones," Burgess explained. "I loved to being able to support people in that role."

Training to become an end-of-life doula happens in workshops, with required reading and work-study assignments. Since it is not a federally recognized field, insurance companies do not cover the services. The Illinois Department of Public Health said in 2022, Cook County alone saw nearly 46,000 deaths. Almost 20,000 were between ages 65 and 84.

Death, or what is sometimes called "the other side," can produce feelings of fear, or a sense of denial, especially if a terminal condition has been diagnosed. Burgess observed it is a 24-hour job for loved ones helping someone in their final days or weeks. She has encountered families who are unprepared for the caregiving needs.

"A lot of times, their family is saying, 'We're just overwhelmed, and we have hospice involved, but we still feel like we need some more support,'" Burgess recounted. "An end-of-life doula can be there, giving the family reassurance or making some slight suggestions on how to comfort their loved one."

Doulas can also help plan an advance directive, instructions a person can leave behind about their funeral service or cremation, what to do with a pet or help writing a loving message to family and friends.

A Des Moines-based farm co-op is taking high-tech sports-training into the country and has hired an athletic physician to do it.

The field of high-tech sports training is usually reserved for athletes and other high-level performers but the mindset is taking a dramatic turn, as the Landus Co-op in Des Moines has hired a physician.

Dr. Dehra Harris has spent much of her medical career training the Toronto Blue Jays minor-league baseball players and is bringing those skills to the Iowa countryside. Harris said she has always been drawn to helping people who have to perform physically to make a living.

"You don't have days off. You can't take it easy, right?" Harris pointed out. "It's that 'rub some dirt on it' kind of world. And to be able to take the things that we've been learning, in sports and in medicine, and apply it to this group is just an incredible opportunity."

Harris explained she will start by listening to farmers' physical needs, then developing proper nutrition and recovery programs even if it means responding to a farmer who's delivering a calf at three in the morning, and whatever else it takes to help with America's ag production backbone.

Harris noted her regimen will not stop with physical training. In fact, the Centers for Disease Control and Prevention reports suicide rates are nearly twice as high for farmers compared to the general public. The threat was most severe during the pandemic.

Harris will design wellness plans for farmers' mental health, although she noted getting the information might not be easy.

"I love it when I talk to farmers because I'm going to hear all about their family," Harris added. "I'll hear about everything to do with their farm but I'm also not going to hear a lot about what they need. So, we think that the strategies that are actually going to work best here are actually to approach this as a family, and see what the needs are for the whole unit."

Landus is among the first co-ops in the country to take the new approach.


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