FRANKFORT, Ky. -- Many rural health clinics primarily serving Medicaid recipients as well as the uninsured are navigating ways to help their patients manage chronic conditions such as diabetes and high blood pressure during the pandemic. One million Kentuckians see a health professional at more than ninety rural health clinics across the state.

David Bolt, chief executive of the Kentucky Primary Care Association, said rural clinics increasingly rely on telehealth phone and video appointments amid COVID-19, "and the concern there is that, in a lot of rural areas of the state, we still don't have appropriate connectivity in that last mile for people to take advantage of it."

Kentucky currently ranks 44th among states for broadband access, and statewide health organizations are calling for federal funding to expand reliable internet access in rural areas as part of continued coronavirus relief efforts.

With many patients continuing to avoid non-urgent care, clinic revenues are expected to decline as COVID-19 continues. But despite the challenging road ahead, Bolt said clinics are determined to continue providing primary care in communities hardest-hit by unemployment because of the pandemic.

"Some of these clinics have jumped in to continue to build primary-care operations in communities that have need," he said.

In April, Congress approved a $225 million grant program specifically aimed at helping federally certified rural health clinics cover coronavirus-related expenses, including testing.


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As the cost of food, medicine and rent continues to climb, new data shows the benefits miners receive are now 40% less than what they received in 1969, when adjusted for inflation.

Vonda Robinson, Vice President of the National Black Lung Association, said she is grateful for the benefits her husband receives, but points out the high cost of gas and grocery bills are a constant challenge.

"My husband worked in the coal mines for 30 years." Robinson said. "He had to come out of the coal mines when he was 47 years old due to complications with his breathing. We had no idea he had black lung."

According to a report from the Appalachian Citizens Law Center, the black lung benefit rate for a miner with no dependents is now $738 a month, while the current cost of living in Kentucky and other coal states is around three-and-a-half times that amount.

Chelsea Barnes, director of government affairs and strategy with Appalachian Voices, said the federal government could move to untangle miner benefits from the federal pay scale and instead tie them to inflation.

"This isn't a change that will break the bank," Barnes said. "Instead, it will ensure that coal miners and their families have the basic safety net they deserve to survive. "

According to the Department of Labor in 2018, the average yearly cost
for medical treatment was slightly under $10,000 per miner.


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Nurses are concerned about the closure of a Portland-area birth center set to go through today.

The Family Birth Center at Legacy Mount Hood Medical Center is closing because the hospital says "it maintains a low volume of births with an unusually high-cost care model."

Nurses in the facility were in the process of unionizing. Labor and Delivery Registered Nurse Alejandrina Felipe works in the center and said it provided a valuable 24-hour service to an underserved area east of Portland.

"Any emergencies, or if a patient has a headache, they're worried for high blood pressure, they don't feel the baby move," said Felipe, "the first thing their OB provider tells them is go to the nearest emergency department. And they come to Mount Hood because we're here."

Felipe said nurses were offered the chance for a job in another part of the hospital, but she is taking severance. The center delivered more than 750 babies a year.

The Oregon Health Authority hasn't yet approved the closure and said in a statement this week that the hospital could be subject to regulatory action if the center closes its doors.

Felipe said the birth center's closure leaves a gap for a diverse group of patients.

"More than 50% of our patients are Latinos, Russian, Middle Eastern or a lot of the Asian Pacific Islander, API," said Felipe.

Felipe said nurses wanted to unionize because they felt management at Legacy was making decisions without input from them.

"We're working towards becoming a union," said Felipe. "If we were union, we would not be going through this."


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President Joe Biden's proposal to increase taxes on Americans earning more than $400,000 a year from 3.8% to 5% in order to shore up Medicare is being welcomed by an unlikely constituency, the ultrarich.

Morris Pearl, chair of the group Patriotic Millionaires and a former managing director at BlackRock, said there is more than enough money to fund Medicare. He argued the wealthiest Americans, especially those living off of their investments, can and should be paying more.

"Our country can go two different directions," Pearl asserted. "We can ask the financially challenged people who need Medicare to sacrifice more by having less medical care, or we can ask the ultrarich to sacrifice more, by being a little bit less ultrarich."

Biden's proposal would keep Medicare solvent for at least the next 25 years, according to estimates by the Medicare Office of the Chief Actuary. Sen. Mitch McConnell, R-Ky., the Minority Leader, has dismissed the proposal and promised it will not advance in Congress. Critics said raising taxes would hurt the economy, which depends on consumer activity. They argued people would spend less if their earnings drop.

Pearl agreed the economy depends on consumer spending, and stressed working Americans who spend most of what they bring home should be allowed to keep more of their money.

"The very rich people are not going to spend more money; they'll just become a little bit richer," Pearl contended. "Somebody like me, if my tax rates are cut, I'm not going to live any differently. I'll just see the balances in my portfolio be a little bit higher than they would otherwise."

More than 65 million people in Colorado and across the U.S. depend on Medicare coverage, but the fund's trustees warn cuts to benefits will be necessary by 2028 without increased revenues. Pearl noted the nation's economy was strong under the Republican Eisenhower administration, when the wealthiest Americans paid tax rates up to 90% on their second, third and fourth millions.

"And there's no reason why people who make a lot of money now should be paying -- not the same tax rate as people who work for a living -- but actually lower tax rates than people that work," Pearl emphasized. "We need to change the system."


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