Creighton University's Mainstreet Economy index continues to find weakness across the Great Plains. Bankers surveyed by university economists say they expect a drop in holiday sales. It's hard to find good news in the report. Farm income declines continue to "weigh on the rural, agriculturally dependent economy with few signals that the economic downturn is coming to an end," said Creighton University Ernie Goss. 

Hiring is "frail," according to the report. Over the last 12 months, rural areas in the 11-state Great Plains region lost five percent of their jobs. Farm equipment sales have declined. Bank CEOs expect holiday retail sales to shrink 1.5 percent from last year — and last year's sales weren't so good. Brian Nicklason, president of Woodland Bank in Remer, Minn., said, “I have talked to several local retailers and hospitality businesses, and they are very concerned about business prospects over the upcoming winter months.”

The Mainstreet Economy index relies on reports from bankers in about 200 rural communities with an average population of 1,300.

Kaiser Health News reporters tell us that U.S. Senators continue to push for higher Medicare payments to rural hospitals in their states even as they decry budget deficits and an expensive health care reform bill. Eric Pianin and Mary Agnes Cary write that several senators want to help local hospitals become declared "critical access" facilities, a designation that allows these hospitals to collect higher payments from Medicare. Meanwhile, KHN reports, the "same senators are among those pushing hardest to hold the line on the cost of health care reform."

Senators Wyden (Oregon), Brownback (Kansas), Pryor (Arkansas) and Conrad (North Dakota) are among those seeking special designation of rural hospitals as "critical access" facilities. Congress created this designation in 1997 to help ensure care in isolated parts of the country. The original law said hospitals farther than 35 miles from other health facilities could be declared "critical access" and then collect 101% of their costs from Medicare rather than the usual 95% of allowable costs. The 35 mile limit was routinely waived, however, and the number of "critical access" hospitals grew to over 1,200 when Congress eliminated all waivers to the 35-mile rule in 2006.

"Now lawmakers from rural states want to ease the rules, partly by making it easier for hospitals to qualify for "critical access" status even if they are less than 35 miles from another facility," the reporters write. "Supporters note that the hospitals, besides providing emergency and limited inpatient treatment, are often the mainstays of small-town economies."

The big news late Friday afternoon was that the U.S. Environmental Protection Agency announced that it had moved to veto the Clean Water Act permit for the largest mountaintop removal mine in West Virginia history — and the largest MTR mine in Appalachia. As readers of the Yonder know, coal companies using this technique cut off the tops of mountains down to the coal and then push the leftover rock and soil down into the valleys below. As usual, our go-to guy for this coverage is Ken Ward Jr. of the Charleston Gazette.

Environmentalists and landowners in West Virginia have been protesting MTR mines for years, claiming they ruin streams and landscapes. They've been battling this mine since '98. Arch Coal's Spruce Mine would have buried more than seven miles of West Virginia streams, according to an EPA press release. It also would have employed hundreds of miners. That has set up a debate about the environment and employment among everyone involved: the federal government, West Virginia Gov. Joe Manchin, United Mine Workers President Cecil Roberts, the coal industry and the courts.

Arch Coal was "shocked that EPA would take such an action in light of the strong support for the Spruce permit voiced by the U.S. Army Corps of Engineers" and West Virginia. Gov. Manchin said, "To say that I am mad would be an understatement." Environmental groups have been pressing the Obama administration to be stronger in opposing MTR mines. They apparently have gotten their wish. Now we'll wait to see how this plays politically in a state that Obama lost by 13 percentage points in 2008. 

We see this over and again: An assertion that people in rural America have less insurance than those living in the cities. This statement of "fact" appears in reports and in speeches. Most recently, U.S. Secretary of Agriculture Tom Vilsack said that "there are significantly higher number of uninsured people as a percentage of population in rural communities." 

Is Vilsack right? Well, no, he isn't. The Yonder analyzed the most recent Census figures and found that the percentage of people under the age of 65 without health insurance is HIGHER in URBAN America than it is in rural.  For some reason the exact opposite is reported time and again. Most recently, the Center for Community Change issued a report finding (according to a summary) that "rural areas have the highest proportion of both uninsured and under-insured." Folks that just ain't so — at least the latest official data comes to the exact OPPOSITE conclusion. Surely too many people are without a way to pay for health care, but it's not a problem that's any worse in rural America than it is in the cities. 

Why would Secretary Vilsack be so far off base? All he has to do is go down the hall to his Economic Research Service which released a report on rural health care in the last month. The ERS found that rural people have health problems — higher rates of mortality, disability and chronic disease than in the cities. But the ERS also found, like the Yonder, that metro and non metro rates of health insurance coverage are the same.