The future of healthcare isn’t possible without rural high-speed Interne

The Hitch in Kentucky’s Plan to Build High-Speed Internet for All 

Why the Internet Should Be Part of Trump’s Infrastructure Plan 

Community Broadband Media Roundup – August 27

Indiana Electric Coop “Concern for Community” Means Building a High-speed Fiber Network

The future of healthcare isn’t possible without rural high-speed Internet by Brandon S. Thompson, Western Slope Now  Aug 21, 2018

GRAND JUNCTION, Colo. – Chairman of the Federal Communication Commission Ajit Pai discussed the future of virtual and telemedicine health care with staff at St. Mary’s Medical Center Tuesday evening.

“Virtual health is a significant part of the future of health care.” said Dr. Brian Davidson, the President of St. Mary’s in Grand Junction, “These are the things we need to be doing.”

The up and coming way of health care treatment involves doctors and other health care provider speaking and analyzing patients via phone, internet, video chat or virtual imaging. All of which includes a telecommunication line, preferably high-speed internet.

“One of the biggest hurdles that is in the FCC’s purview is connectivity. The telemedicine application is only as strong as the digital connections between communities.” said Pai in a press conference.

St. Mary’s has been dabbling in remote and virtual care. Across their coverage areas of western Colorado and eastern Utah, high-speed internet comes at a premium, an often cost-prohibitive one.

Video chatting with patients can underline the importance of a stable connection, as an interruption of service when a health care professional may be delivering a life-altering diagnosis is unacceptable, according to Davidson.

“It needs to be reliable because, the last thing you want is that visit in a high acuity situation to be interrupted.”

The biggest hurdle for high-speed internet in rural areas of Colorado, almost literally, are the mountains. Getting infrastructure, such as fiber-optic cables, around, through or above mountain ranges can be expensive, and again, sometimes cost-prohibitively so.

Pai has a few plans to address the problem he discussed Tuesday, one being a plethora of low-orbiting satellites.

The other would increase funding for the Rural Health Care Program by over $500 million (43% increase, according to Pai) and increasing the Universal Service Subsidy to $10 Billion each year.

“We want to make sure that these scarce tax payer funds are dedicated to the parts of the country that are on the wrong side of the digital divide.” said Pai. “We want to make sure that these companies have a strong incentive to upgrade to fiber. Especially in these rural communities that need that high capacity internet access.”

Pai affirmed the minimum speed for internet to be considered broadband to be 25 mbps, versus 10 mbps that had been discussed.

Davidson says, remote healthcare is the future because, the price of a virtual visit is less than building the infrastructure needed for an in-person appointment.

“But, if the technology isn’t there, were back to having people drive to and from facilities.”

Orange County Electric Co-Op & High-Speed Fiber Network

There may be one famous Orange County already — the one in California is home to Laguna Beach, Disneyland, and The Real Housewives — but Orange County, Indiana, will soon be making a name for itself with world-class connectivity thanks to the local electric cooperative.

Orange County, Indiana, will soon be making a name for itself with world-class connectivity thanks to the local electric cooperative.  After a few years of planning, Orange County REMC is moving ahead with the construction of a Fiber-to-the-Home (FTTH) network that will bring premium Internet and telephone services to its members and other nearby residents. Construction on the main fiber ring begins this fall with services starting as early as next year.

The Seventh Cooperative Principle

In Orange County, the co-op’s main service territory, about half of the county’s 9,000 residents do not have access to 25 Megabit per second (Mbps) wired Internet access.

To address this, Orange County REMC began exploring ways to provide fast, reliable connectivity to its members in 2015. Two surveys and a feasibility study confirmed that a fiber project would be financially possible for the co-op and that it would garner sufficient interest from residents, while also improving management of the electric grid. “Based on the second survey, 85 percent of Orange County REMC members stated they would take our service if it were offered,” Matt Deaton, the co-op’s General Manager and CEO, told Hoosier Energy.

Because of the strong community support and the benefits for local businesses and residents, the Orange County REMC Board of Directors approved the FTTH project, Orange County Fiber, in May 2018.

In a recent edition of the Electric Consumer, published by Indiana electric co-ops, Deaton explained:

“All of these factors are found under the seventh cooperative principle ­— concern for community…This was a major decision to expand the services we provide to prepare us to meet the current and future needs of our members.”

Orange County Fiber

The finished fiber network will serve 14,000 people, primarily in Orange County, but also in parts of Crawford, Davies, Lawrence, and Washington Counties. Deaton estimates the cost of the entire network at more than $30 million. The co-op plans to finance this through private loans but is also applying for grants.

logo-orange-county-in-fiber.pngOrange County REMC will start construction of the fiber backbone in September. After the main ring is completed, which could take up to a year, they will begin connecting households, prioritizing communities with the most enthusiasm for receiving high-quality Internet access. Co-op members can ensure their neighborhood receives service first by signing up online to show their interest and by registering as a “champion” to promote the network to their neighbors.

Orange County Fiber plans to offer subscribers the following monthly Internet plans:

  • 50 Mbps symmetrical – $54.95
  • 100 Mbps symmetrical – $69.99
  • 250 Mbps symmetrical – $99.95
  • 1 Gbps symmetrical – $149.95

Households will also have the option to subscribe to voice services for $34.95 per month, or $24.95 per month if it’s paired with Internet service.

Locals are looking forward to another option. On the Facebook page for Orange County Fiber, one co-op member commented, “We pay Frontier $50 for 3 [Mbps] . . . I can’t fathom 50 [Mbps] for the same price. I’m pumped!!!”

Perhaps a sign of their commitment to providing better connectivity to the region, Orange County REMC recently acquired the local companies NetSurfUSA, a wireless Internet service provider, and CallUSA, a telephone service provider. Both are part of local company Helix Technologies.

Joining a Statewide Trend

Orange County REMC is not the first Indiana electric co-op to branch out into broadband. Jackson County REMC and South Central Indiana REMC have also decided to build fiber networks to better serve their members.

At the announcement of South Central Indiana REMC’s network, Indiana Senator Eric Koch noted that state law has made it easier for cooperatives to invest in fiber networks. For example, in 2017 Senate Enrolled Act 478, Facilitating Internet Broadband Rural Expansion (FIBRE) Act, made it possible for electric co-ops to use existing Right-of-Way easements for building out fiber infrastructure.

Learn more about the role that cooperatives play in bringing Internet access to rural communities; read our 2017 report Cooperatives Fiberize Rural America: A Trusted Model For the Internet Era.

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In Arkansas, “digital redlining” could leave thousands without healthcare by Sarah Holder, CityLab 

One of America’s poorest and least connected states says Medicaid recipients must find work and an internet connection to keep receiving benefits.

In June, Arkansas began rolling out a controversial change to its Medicaid program. Under a new state plan, all recipients who are able to work will have to log 80 working hours each month, or risk losing access to their health care. But finding a job might not be the biggest hurdle for many people.

In order to stay eligible for Medicaid, Arkansas’s recipients must report their working hours each month, and it must be done online—the state doesn’t offer a way to do it via mail, telephone, or in person.

This stings especially hard in Arkansas, which ranks 48th in the country for internet access. According to BroadbandNow, 30 percent of the state’s population has access to fewer than two internet providers. An estimated 20 percent have only a smart phone for internet access at home. And in a state where 17 percent of residents live below the poverty line—ranked 44th in the country—even those with access might not be able to afford it.

“Work requirements would be harmful to our clients in any situation, but the online-only reporting requirements make it incredibly difficult,” said Kevin De Liban, an attorney with Legal Aid of Arkansas. He is leading a federal lawsuit against the U.S. Department of Health and Human Services, arguing that the federal government doesn’t have the power to approve changes to state health care requirements at all, as the Trump administration did in March.

In some parts of Arkansas, “you don’t even have regular cell phone access,” he said. “If you have Verizon, and the sun is in the sky at a certain point, you might be able to get a bar or two of coverage.” Otherwise, he said, you’re often out of luck.

The new rules are being phased in in stages, and initial numbers suggest the first two cohorts are already in a precarious position. After the first month, about 7,000 people failed to report their working hours. That accounted for 72 percent of people in the first cohort, and 26 percent of all people on Medicaid in Arkansas. By the second month, 5,426 of the first cohort’s truants had failed again. In total, since June, more than 12,000 total have dropped off the reporting wagon. If recipients miss three months of reporting, they’re cut out of the system for the rest of the year.

It’s hard to parse where the reporting breaks down: whether it’s because people don’t have internet access, couldn’t work enough hours, or something else. Some people may not have been successfully notified of the new reporting plan at all. “If Arkansas sends out a letter and the address is wrong, they just kick them off,” Joan Alker, executive director of the Center for Children and Families at Georgetown University, told the Los Angeles Times. “Arkansas is shedding enrollment.”

Sixty percent of Arkansas’s Medicaid recipients already work full time, according to the Kaiser Foundation. Of those who don’t, most have disabilities, familial obligations, or are in school—and for them, the process won’t change much.
After the second month, more than 12,000 of Arkansas residents beholden to the new system failed to report working hours. 5,426 were in their second month of non-compliance. (Arkansas Department of Human Services)

It’s the rest of the recipients who are at risk from the latest changes, De Liban said, and with Legal Aid’s lawsuit he hopes to stop the changes before more cohorts are subjected to it. This lawsuit comes at the heels of another suit filed against Kentucky, which introduced its own work requirements this year. A federal judge struck the system down in June, calling it “arbitrary” and “capricious.”

After gaining federal approval to introduce work requirements in March, Arkansas told its first cohort about the new system in May, one month before the reporting mandates kicked in. Like Kentucky, officials there are claiming that working is good for your health.

Arkansas’s governor, Asa Hutchinson, insists that the work requirements are designed to help Arkansans, and strongly opposes the lawsuit. “This lawsuit has one goal, which is to undermine our efforts to bring Arkansans back into the workforce, increase worker training, and to offer improved economic prospects for those who desire to be less dependent on the government,” he said in a statement.

De Liban, however, says the state’s goal is to siphon people off state support without offering them a back-up plan. “Online-only reporting systems are administrative hoops, and when administrative hoops are there it’s easier for people to trip up,” he says. “And if they trip up they lose coverage, and if they lose coverage the state saves some money.”

While access poses one major hurdle for reporting, internet literacy poses another even for those who have access at home. This factor splits across rural and urban lines even within the state. “Generally in rural areas people go online less and have less familiarity,” said De Liban. “Then when you add in socioeconomics, the digital divide becomes even more pronounced.”

Part of this divide has been driven by “digital redlining,” says Deb Socia, executive director of Next Century Cities, an organization that helps cities improve their internet infrastructure and access.

“It’s not the government, but providers that have chosen to make additional investments in areas where it’s most lucrative, and to not improve infrastructure or provide better plans in low-income neighborhoods,” she said. That means urban, densely populated areas often have better broadband access than rural, predominantly low-income ones. And where access exists, users still have to pay for it. Those costs can be prohibitive, especially for those on government assistance.

Even those who have internet access at home or somewhere nearby, the Medicaid reporting system itself can be difficult to navigate, De Liban says: Users have to create an email address, link health records to the reporting website using a reference number sent months earlier by mail, and click through multiple busy screens. The website only accepts reports between 7 a.m. and 9 p.m.
“One, we’re asking people who are very poor to figure out how to find access to internet that’s not too expensive and can fulfill the need,” said Socia. “Two, we are presuming that they have the knowledge base to actually use it effectively. Those are two things we ought not assume or choose—and those two things should prevent us from implementing something like this requirement.”

To facilitate these transitions, states often hire case managers and set up programs to guide people into employment—albeit to varying rates of success—as well as compliance officers to keep people accountable.

But instead of hiring extra staff to train Medicaid recipients how to use the online system or to funnel them toward employment, the Arkansas Department of Health Services is allowing people to“designate a trusted individual to help them report their work activities or exemptions.” Two Arkansas insurance companies will provide these “registered reporters,” and the Arkansas Foundation for Medical Care is offering telephone assistance. The state’s health department says it will offer in-person help, too, at local county offices. But Arkansas is not getting federal aid to implement the new program, and state lawmakers say no additional money will be allocated to new hires this year.

If successful, Legal Aid’s lawsuit could mark the beginning of a string of challenges to these new work-requirement waivers. “Since Arkansas is the second state where this is being litigated, it’ll be a key indicator on the future of work requirements,” said De Liban. Utah, Kansas, Wisconsin, Ohio, Mississippi, and Maine have work requirements of their own pending; and waivers in Arizona, Indiana, and New Hampshire have already been approved.
And already, the Trump administration is attempting to challenge the Kentucky ruling by providing more evidence that work improves mental and physical health—a claim that has very little research to support it, and one the federal judge in the original case deemed“little more than sleight of hand.”

Even if lawsuits dismantle work requirements, internet access in Arkansas and other disconnected states remains a significant challenge. Arkansas may be the third worst-connected state in the country, but the problem exists across the country: A quarter of all Americans have no broadband at all. That’s something policymakers at all levels will have to contend with if they want to make the internet a central fixture of government operations.

Arkansas has received a little over $100 million in federal funds for broadband infrastructure projects since 2010, leading to slight gains in connectivity speeds over the last seven years. But in August, the U.S. Department of Agriculture committed to pouring $97 million into “rural broadband infrastructure” in 11 states. Arkansas isn’t one of them.

“Technology so empowers us to be able to communicate with one another,  but it’s not an equitable method of communication,” Socia said. “The outcome is only as good as the input, and in this case the input has serious flaws.”

Long Beach residents encouraged to participate in City’s digital-inclusion survey by the City of Long Beach, Signal Tribune
Preliminary Long Beach survey results show Latinos least likely to have home Internet access by Hayley Munguia, Press-Telegram


City, UF to launch wi-fi for Porters, Depot Park by Andrew Caplan, Gainesville Sun

Crouch announces new Director of Broadband Opportunities, Washington Times-Herald
State details pilot broadband grant program by Andy Ober, Inside Indiana Business
Rural broadband at center of new state position by Alex Brown, Inside Indiana Business

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Extreme heat is killing farm workers 

Nexus Media | Jeremy Deaton

In the Lake Apopka region of Florida, a typical August day might yield a high temperature of 92 degrees F, a heat made all the worse by the stifling humidity. The weather is bad enough for office workers who spend most of the day next to an air conditioner. For farm workers, who spend their August picking blueberries outdoors, the heat can be oppressive, even fatal. Heat can induce dehydration, nausea, exhaustion, stroke and death. Even among workers who endure little discomfort, heat can take a toll over time. Chronic dehydration, for example, can lead to kidney failure. Despite these risks, there is no federal standard protecting workers from extreme heat. “Hotter temperatures beget fewer full work days, exhaustion and fatigue,” said Jeannie Economos, the pesticide safety and environmental health project coordinator for the Farmworker Association of Florida. “It’s even worse when you have to pick fast because farm workers are paid by the piece, not the hour. This is a big deal when you’re trying to bring home wages that can support a family or pay a car bill–plus these folks don’t have health insurance.”