St. Paul, MN - As elected leaders consider changes to the country's health care system, one researcher suggests expanding the role nurses and nurse practioners play in primary health care. The study finds people seeking primary care outside of major Minnesota cities are seeing a drop in the already-low number of doctors and other primary care providers.

Melissa Florell, a researcher for the <Center for Rural Affairs, says 20 percent of people live in rural areas where only nine percent of primary care providers practice. That ratio causes rural medicine to be a less-appealing career choice for doctors and other health professionals, and is an example of one of the projects health care reform needs to tackle, she says.

"When you combine the overhead costs of serving in a rural area along with the demands on their time from being one of a few, or the only health care provider in that area, it's too much for them to handle. There's no work-life balance."

The lack of accessible and affordable rural health care is troubling, says Florell, given the higher incidence of certain chronic illnesses, such as diabetes and heart disease, in rural areas.

"The fewer primary care providers available to patients, the more fragmented their care. That leads to some overlapping of testing, which increases cost. It also reduces the quality of care that patients are receiving because no one is looking at their whole health history."

Any reform of health care could include incentives, adds Florell, such as tuition reimbursements for recruiting and retaining medical professionals in sparsely populated areas. Reform could also include guidelines to help states allow nurse practioners to move into the role of primary care provider, she says. Advocates of the concept believe allowing nurses and nurse practitioners more freedom to prescribe medicines and other treatments could expand accessibility of care in rural Minnesota. Minnesota typically ranks high for its overall quality of health care, but rural areas don't share those overall rankings.

The study is posted online at www.cfra.org.


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The chair of the Federal Trade Commission will be in rural Iowa this weekend to hear from farmers and other residents about the proposed sale of Iowa Fertilizer to Koch Industries.

The sale is pending FTC approval. Iowa spent $500 million to build an Iowa Fertilizer factory in Weverly to create competition in an already consolidated industry.

Aaron Lehman, president of the Iowa Farmers Union, said he plans to tell FTC Chair Linda Khan a sale to Koch Industries would backtrack on any competitive progress the state has made.

"Our concern is that an industry that already lacks competition and has all sorts of monopoly problems would only get worse if this sale is allowed to go through," Lehman explained.

Koch and other corporate ag conglomerates have said consolidating allows them to provide better products to farmers more efficiently. The hearing is set for Saturday on Main Street in Nevada.

In addition to reducing competition for fertilizer, Lehman argued the sale would increase prices for farmers, and ultimately mean higher food prices for Iowans. He wants Khan to hear stories firsthand, from the people on the ground in Nevada.

"We know that we might not be able to have a dialogue with the people who are investigating this situation, because they need to be impartial," Lehman acknowledged. "But our farmers need to tell their story about how the industry is already in a monopoly state."

Some 18 other ag organizations have joined the Iowa Farmers Union calling on the FTC and the Justice Department to investigate the proposed sale.

A farm group is helping Iowa agriculture producers find ways to reduce the amount of nitrogen they use on their crops.

Excess nitrates can wind up in ground and surface water, and cause health problems.

Practical Farmers of Iowa is encouraging farmers to find just the right amount of nitrogen they need for their crops - while avoiding applying too much, which the group says is common.

PFI's Field Crops Viability Coordinator - Chelsea Ferrie - said thanks to federal grants and private funding, the group will pay farmers up to $35 for every acre that has a lower than normal yield if they didn't apply enough nitrogen.

"No cost to the farmer, either," said Ferrie. "We're trying to help incentivize them. This is something that farmers want to do - I mean, they want to be good stewards of the land - but also, that they need to have a profitable farm."

The application period for the program is open through the end of April.

To help them reach the right nitrogen balance, Ferrie said PFI will help farmers on the front end of the process, too - so they aren't left guessing how much to apply.

"Talk through what your typical fertilizer plan is, and what your reduction plan would be," said Ferrie. "Then you would implement this year, going into the spring and into the season."

Farmers have relied on nitrogen-based fertilizers for generations - but when applied in excess, nitrates run off into ground and surface water, posing health concerns for animals and people.




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Pesticides are still common in agriculture. Organic producers who avoid them have seen ups and downs in pushing for stronger regulations, and they point to a South Dakota example of the harm associated with widespread use among neighboring farms.

At the heart of the regulatory fight is the application of the weed-killing pesticide dicamba, and how it can drift from one farm to another. Last month, a federal court blocked "over the top" spraying of dicamba products, but the EPA followed with an order to allow the spraying of existing supplies.

Glenn Pulse, co-owner of an organic farm in Vermillion, said a 2017 drift incident had a big impact on his operation.

"Our entire farm was covered. We lost a lot of livestock, and thousands of bees were killed," he explained.

It also resulted in health concerns for his family, having to regain his organic farmer certification, and a legal battle over restitution. Groups such as the National Family Farm Coalition have been fighting what they call the deregulation of these chemicals, arguing the drift and runoff effect has damaged millions of crops.

Dicamba-manufacturing companies deny responsibility, instead blaming farmers who apply it for not following guidelines.

The EPA has said there were already millions of gallons of dicamba in circulation prior to the court's ruling, prompting the agency's order. Pulse feels there are farmers who are careful in spraying chemicals, but he wants stronger enforcement against those he describes as "loose cannons."

"The guys that are not following the labels and they're spraying in weather conditions that are not favorable, that is where, I would say, 90% of the problems are happening with drift incidents," Pulse said.

His calls for better responses to these incidents coincide with policy demands to heavily restrict dicamba products. Meanwhile, Rep. Dusty Johnson, D-South Dakota, is the main sponsor of a bill supporters say would assure uniformity in national pesticide labeling under federal law. But opponents argue it would limit longstanding state and local pesticide safety rules.