Merger Creates Internet Company Serving Rural Areas in Texas, Arkansas, Oklahoma

Merger Creates Internet Company Serving Rural Areas in Texas, Arkansas, Oklahoma

Two Internet service providers are merging to cover a larger area of Texas, Arkansas and Oklahoma, but an expert in community broadband networks cautions that consolidation can often hurt customer service.

The two former companies – 360 Communications of Durant, Oklahoma, and 903 Broadband of Leonard, Texas – were roughly the same size, which means the combination is a doubling in size for both. Upon the merger in August that became 360 Broadband, the new company had nearly 16,000 subscribers and 88 employees across 10,000 square miles and 30 counties: 20 in Oklahoma, six in Texas, and four in Arkansas. The company’s services are provided via a hybrid network containing both fiber elements and almost 250 wireless towers.

Drew Beverage, chief strategy officer for 360 Broadband, said it seemed smart to combine the two companies for funding opportunities.

“At the federal level, at the state level, it makes sense for the two companies to come together to combine resources to be able to play in that arena,” he told the Daily Yonder. “And not only provide better customer service, give us better options to be able to go after some of that federal money to build out more resources to build out more rural space. And we’re talking about the most rural of towns.”

Christopher Mitchell, who runs the Community Broadband Networks program at the Institute for Local Self-Reliance, said in general, he is concerned about consolidation and the impact it has.

“We worry that local customer service will be harmed, and get worse,” he told the Daily Yonder. He added, however, that he knows there is a high cost of building and operating compared to many other businesses.

“And so, if you don’t have 5,000 to 10,000 subscribers, it can be hard to be able to grow the network in ways that you would like. And so it’s kind of expected, I feel like for some ISPs to grow through mergers,” he said. “As they get bigger and bigger, we really worry about their ability to meet all of the local needs.”

Beverage served on the Oklahoma Rural Broadband Expansion Council for one year. He said making sure people know about the Affordable Connectivity Program is important. The program provides a discount of up to $30 per month toward Internet service for eligible households and up to $75 per month for households on qualifying Tribal lands. 360 Broadband will now cover Choctaw and Chickasaw Nations, Beverage added.

“If nobody has ever been around someone that builds broadband, they might not know that that is offered to them,” he said. “But I think it will have a huge impact for the small communities, the more we build, to be able to get reasonable, reliable broadband service.”

Mitchell said that it’s important for a new company from a merger to try to remain rooted in the communities they are serving.

“We find that when an ISP is rooted in the community, with its technicians, and its ownership – all being within a community – that they tend to make more investments in higher quality services, and they provide better customer service,” he said. “As they spend less time in the community – as they become a larger, more regional ISP – they may not put as much attention into the community that they previously had.”

Beverage said they hired locally from the communities they serve,

“I think it’s a lot of buy-in from our staff, knowing that we’re bringing Internet to their family members, loved ones, the community that they grew up in,” Beverage said. “And so I think there’s a big difference there: the money is not in rural Internet, the money is where there’s a population that can give you a better ROI. But we have a passion to serve rural communities.”

Mitchell said it’s also important to keep in mind who is operating and running a combined company.

“If it’s still a company that is owned by a few people who are deeply committed to providing high-quality internet access, that may still be able to provide a high quality service,” he said. “If it’s owned by private equity, which is focused on a long-term, maximization of profits or even a short-term maximization of profits, then the experience is less likely to go well for the customers.

The post Merger Creates Internet Company Serving Rural Areas in Texas, Arkansas, Oklahoma appeared first on The Daily Yonder.

Broadband is Critical for Rural Education. $1 Billion Won’t Be Enough To Reach Everyone in Washington State

This story was originally published by the Spokesman-Review.

Last year, Brandi Jo Desautel installed a SpaceX-powered Starlink dish in front of her trailer outside Inchelium, Washington, on the Colville Reservation. At $700 for the equipment and $120 a month for service, it wasn’t cheap. But for her, it was the only option.

Some folks in town have basic internet through their cable provider, but the network doesn’t reach the 32-year-old’s address. A paraprofessional for Inchelium High School, Desautel is out of range of wireless towers, and cellphone coverage is spotty.

Satellite internet allows her to take online classes at night from Spokane Community College, where she is working on a special education degree. It also helps her twin daughters, grade six, do their schoolwork from home.

“Between my school and theirs, we don’t have a choice,” Desautel said.

Even though classes are back in person after the Covid-19 pandemic, access to reliable home internet remains critical both for a well-rounded education and for participation in modern life. Yet some 236,000 Washington households still don’t have broadband-level speeds or internet access at all – many of them in rural areas like where the Desautels live where it is not as profitable for internet providers, according to Federal Communications Commission data.

Over the past few years, Congress has invested hundreds of millions of dollars to expand broadband infrastructure in Washington. Another $1.2 billion will begin rolling out as soon as next year. All of this federal funding will do a lot to bridge the digital divide, but it probably won’t be enough to meet the state’s ambitious goal of universal high-speed internet for every address by 2028.

Accessible by ferry across the Columbia River on the east side of the Colville Reservation, Desautel’s hometown of Inchelium has some of the worst internet coverage in Eastern Washington.

The Starlink Satellite dish at Brandi Jo Desautel’s home is in the front yard as her dog, Rocky, barks at visitors in Inchelium, Washington. (Photo by Kathy Plonka / The Spokesman-Review)

That should change soon, as the Confederated Tribes of the Colville Reservation are expanding their network with the help of a $48.4 million federal grant to bring fiber and wireless internet to 2,867 unserved Native American households and several hundred businesses and institutions in Inchelium and nearby Keller. The grant is part of the Tribal Broadband Connectivity Program, a $3 billion fund from the 2021 Bipartisan Infrastructure Law.

The Spokane Tribe was awarded $16 million for a similar project.

“In the modern world, internet access is critical,” Colville Business Council Chairman Jarred-Michael Erickson said. “It is especially vital for our youth and their education.”

Although she is not an enrolled member, Desautel is a direct descendant of the Colville Tribes. She lives near extended family several miles down a dirt road in an area northwest of town called Seylor Valley, or simply “The Valley” to locals.

Her satellite service cuts out sometimes. Other times, she loses internet because of power outages.

“The hardest part is convincing teachers to let me turn in late work,” Desautel said.

Starlink is becoming more popular among Desautel’s neighbors, but many cannot afford it. It could be a few more years before residents like Desautel get connected.

Growing Up in a Digital ‘Desert’

Nearly every public school building in Washington has broadband ethernet through the state’s K20 Education Network overseen by the Office of Financial Management. The network includes K-12 school districts, public libraries and colleges.

The challenge is to bring that same level of access to students’ homes.

During the pandemic, many school districts used Covid-19 relief money to provide hotspots for students, but much of that funding has run out.

School districts with less internet access tend to adjust homework requirements accordingly.

John Farley, superintendent of Republic School District in Ferry County, said his district accommodates students by not demanding work that would require internet at home.

“We want to make sure they are getting everything they need at school,” he said.

Farley noted the growing importance of technology in education and teaching online literacy and safety. The internet becomes more important as students apply for college or jobs, he said.

Rob Clark, superintendent of Washtucna School District in Adams County, said most of his students live in town, where they have internet access. Washtucna was awarded a Washington state Public Works Board grant in 2021 to build fiber to the homes in town.

“I can’t say it is a real big issue here,” Clark said. “It is a problem, but it is a minor problem.”

Washtucna is a tiny district with about 70 students where everyone can take home a Chromebook. The district is capable of going fully remote again in case of bad weather or another outbreak, Clark said.

Internet levels vary from district to district. Most incorporated towns in Eastern Washington have basic broadband options, and ongoing grant projects will make those options better. The larger challenge will be to reach those in unincorporated areas, especially those who don’t live near major highways.

Margaret Kidwell, supervisor of Spokane Community College’s center in Republic, said some students don’t have internet at all, and a few don’t even have electricity.

With mountainous terrain, many places in Ferry County don’t have cell service, so hotspots don’t work. Kidwell said she knows one person who uses a solar panel just to power their hotspot.

“We live a lot differently up here,” Kidwell said.

Students without internet will do their homework at the college office or the local library. Running start students – high schoolers who take classes for both high school and college credit – do their homework at the high school.

Teri Ford-Dwyer, a business instructor at Spokane Community College in Newport, Washington, teaches students across the state’s three northeastern counties.

She teaches “flex” classes, which are more flexible than hybrid classes by giving students a choice to attend each class in person, live on Zoom or to watch the recorded lectures later. This option is helpful for working parents, like Desautel, and those who live far away with spotty internet.

Bandwidth is a constant struggle for her live video classes. Many students turn off her video feed and just listen. Most students keep their cameras off. If they can’t even use audio, they will type in the chat. Students will often lose connection in the middle of class, then rejoin.

Students miss out when they don’t have fast enough internet to fully participate, Ford-Dwyer said.

They don’t get the same level of interaction with their fellow students during discussions. Peer relationships are an important part of the college experience because students learn from each other.

With the help of the internet and branch centers, SCC is able to reach rural students in a way it couldn’t before. Universal broadband would make it even easier.

“The course offerings are there, but the infrastructure hasn’t caught up,” Ford-Dwyer said.

Michael Gaffney, assistant director of Washington State University Extension, said internet access is not only important for college students, but for adult education and workforce development.

WSU Extension offers a 30-hour remote work certificate. As a prerequisite, some students have had to figure out how to get a high-speed internet connection, Gaffney said.

During the pandemic, WSU introduced 24-hour Wi-Fi at more than 30 extension offices. With the state broadband office, WSU Extension maintains a map of hundreds of free drive-up Wi-Fi locations across Washington.

For some, this remains the only way to access the internet.

Allen Pratt, executive director of the National Rural Education Association, said reliable internet is essential for K-12 students, too.

Although they might get by, growing up without the internet could leave these children behind their urban and suburban counterparts. Faster internet means more capabilities and educational opportunities.

And if a student has to ride a bus for an hour or more and they come home to slow internet, it will take them longer to get their work done.

“This is an equity issue,” Pratt said. “If we don’t have communities with the same access, it’s not equitable. We’ve got to do something as a country to make that equal for all.”

While many school districts lend devices and hot spots, one Whitman County school district has taken an extraordinary step of providing broadband infrastructure directly to its students.

Pullman Public Schools’ technology director, Garren Shannon, spearheaded a $1 million grant from the state broadband office to build four wireless internet radio towers in Pullman, Albion and Tekoa.

The stark divide during the pandemic between students who had quality internet and those who didn’t inspired him to do something about it. The district will distribute 60 specialized Chromebooks in the coming months for students to connect to the closed network.

West Plains companies New J and Peak Industries designed the retractable telescoping towers, which range from 65 to 120 feet tall and can be relocated if needed.

Some questioned why Pullman, home of Washington State University, needs such a program.

“If you drive 2 miles out of town, it is a desert, digitally speaking,” Shannon said.

Albion, just northwest of Pullman, is a part of the school district with cheaper housing and many low-income residents. Town clerk Starr Cathey said students sit outside the library in the winter using the Wi-Fi to do their homework, since the small branch is only open a few hours a week.

Stories like that make Shannon want to expand the pilot program to more districts. That’s why the program also includes Tekoa, a small town with its own school district in the northeast corner of the county with a similar profile to others across the Palouse, whose rolling hills make long-range wireless difficult.

“If we can make it work there, we can make it work anywhere,” Shannon said.

What $1 Billion Can Do

Scott Hutsell, a hands-on Lincoln County commissioner, used a forklift on a recent Monday morning to unload 20,000-foot spools of fiber-optic cable from a delivery truck into a semi-cylindrical warehouse. The spools, along with dozens of pallets of related hardware, are temporarily stored at the fairgrounds in Davenport until contractors pick them up and string the fiber, mostly along telephone poles, across the county.

It’s part of a series of projects from more than $20 million of federal and state grants to connect the county’s eight incorporated communities with fiber. The projects, overseen by the county’s recently created broadband office, also will build redundancy into the network by creating more connections between towns.

Some internet providers are expanding their networks, but the free market falls short in low-density places like Lincoln County.

“No one else was going to come here,” Hutsell said. “They would have been here already if they could make money.”

The model is a little different from other counties, which mostly operate their broadband projects through a port or public utility district. Instead, Lincoln County owns and oversees the project directly. The goal is to run it as a self-sustaining business where internet service providers will be allowed to use the network for a fee, then the county will reinvest the profit to maintain and expand the network.

The Federal Communications Commission defines broadband speed as at least 25 megabits per second for downloading and 3 megabits per second for uploading. This is abbreviated as 25/3 Mbps.

Some say that is too slow.

A household’s bandwidth needs depend on the type of use and the number of people using different devices at the same time. Email and web browsing require minimal bandwidth, video streaming requires a little more, and video conferencing and gaming require a lot.

Washington’s stated goal is for all businesses and residences to have 25/3 Mbps by 2024 and 150/150 Mbps by 2028.

To date, the federal government has invested $705 million for broadband projects in Washington, while the state has invested $68 million. Another $1.23 billion will soon be coming from the Broadband Equity, Access, and Deployment (BEAD) Program, which was funded by the 2021 Bipartisan Infrastructure Law.

That will almost certainly fall short of the state’s goal.

The Washington State Broadband Office estimates it will cost at least another $2.02 billion to serve every remaining location with fiber. Even with BEAD’s 25% match requirement, there is still a gap of nearly $500 million.

Fiber is the preferable broadband technology because it is most reliable and has the most bandwidth. But fiber is harder to deploy over large, low-density areas.

Broken down per household, the average cost across the state for a fiber connection is estimated at $8,825. That average is much higher in rural counties, where it can exceed $20,000.

Hutsell said the state’s goal is ambitious, if not overly optimistic, at least for Lincoln County.

“Getting fiber to every home is going to be tough – not that it isn’t a long-term goal,” Hutsell said. “A certain amount of that is going to have to be fixed wireless.”

The broadband office has drafted a Five-Year Action Plan and Digital Equity Plan to help inform how the BEAD money will be allocated. The office is accepting public comments on these plans through October 15 and 31, respectively.

While the countryside takes much of the focus, urban areas aren’t completely connected either. Urban counties with some of the highest rates of subscription, including King and Spokane, also have the highest number of households without broadband, the Five-Year Action Plan points out. These households are often in lower-income or marginalized neighborhoods.

Spokane County last year formed a regional broadband public development authority called Broadlinc to improve access in rural and urban parts of the county.

There are other barriers for people adopting broadband besides infrastructure. It also needs to be affordable, users need devices, and users need to want to and know how to use the internet.

The federal Affordable Connectivity Program subsidizes $30 a month for low-income families and $75 for households on tribal lands. The program’s future is uncertain, as its funding is set to run out sometime next year, unless Congress renews it.

Some 307,000 Washington households are enrolled in the program, according to the Universal Service Administrative Co. ACP Enrollment and Claims Tracker.

Advocates say broadband should be a universal utility, comparing it to New Deal-era investments in the electric grid, telephone lines and the public road system. Some go so far as to call it a human right.

Michael Gaffney said broadband for everyone is a worthy a goal, even if it isn’t 100% achievable.

“As technology advances, we’ve got to recognize broadband is not a luxury, it is a necessity,” Gaffney said. “It’s like water or electricity.”

Reporting conducted for this article was completed with funding from a Center for Rural Strategies and Grist grant program.

The post Broadband is Critical for Rural Education. $1 Billion Won’t Be Enough To Reach Everyone in Washington State appeared first on The Daily Yonder.

In rural Mitchell County, telehealth thrives in one town, falters in another

Even though remote health care has not been widely adopted in Mitchell County, there are signs of success in one clinic that prioritized connecting with the rural culture in this mountain region.

In rural Mitchell County, telehealth thrives in one town, falters in another is a story from Carolina Public Press, an award-winning independent newsroom. Our breakthrough journalism shines a light on the critical overlooked and under-reported issues facing North Carolina’s 10.4 million residents. Please consider making a contribution to support our journalism.

Pandemic brings telehealth boom to rural Wisconsin, but barriers linger

Marshfield Medical Center family nurse practitioner Brianna Czaikowski smiles while sitting at her desk

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Story highlights
  • Telehealth is increasingly connecting Wisconsinites living in remote areas to health resources.
  • Helping fuel that growth was the federal government’s COVID-19 Public Health Emergency declaration, which eased regulatory barriers that previously blocked telehealth access.
  • The federal government ended its emergency declaration in May, leaving questions about how long some telehealth flexibilities will last.
  • Gaps in broadband access continue to limit services in many rural communities.

This story is part of our series Unhealthy Wisconsin, which examines areas where Wisconsin falls short in well-being.

Marshfield Medical Center family nurse practitioner Brianna Czaikowski says telehealth appointments are a game-changer for some patients. But in serving a mostly rural community, Czaikowski often fights spotty connections and miscommunication when providing virtual care.

“They feel a lot that I’m talking over them, which sometimes I probably am because (of) the delay,” said Czaikowski, a doctor of nursing practice and pediatric urology specialist who sees patients as far away as Michigan’s Upper Peninsula. “You’re not getting that full connection.”

Fresh off a COVID-19 pandemic boom, telehealth is increasingly connecting Wisconsinites living in remote areas to a web of health resources. Telehealth claims in 2020 swelled to a 6.3% share of total claims in Wisconsin — an increase of more than 2,400% from the previous year, according to a report from the Wisconsin Health Information Organization. Some northern counties reported high gains compared with the rest of the state.

Helping fuel that growth is the federal government’s COVID-19 Public Health Emergency declaration, which eased regulatory barriers that previously blocked telehealth access. That included relaxing rules for certain prescriptions and changing regulations pertaining to appointments and reimbursement for those on Medicare or Medicaid.

But lingering gaps in broadband access continue to limit services in many rural communities, where telehealth use lags behind better-connected urban communities.

A screenshot from a Wisconsin broadband mapping tool
A screenshot from the Public Service Commission of Wisconsin’s online broadband mapping tool. Lingering gaps in broadband access continue to limit services in many rural communities, where telehealth use lags behind better-connected urban communities.

Meanwhile, the federal government ended its emergency declaration in May, leaving questions about how long some telehealth flexibilities will last. Legislation made some changes permanent, but others are set to expire by the end of 2024 or before.

Without action, some of the state’s most vulnerable patients could lose telehealth options they gained during the pandemic.

Pandemic actions expanded telehealth services 

After the COVID-19 pandemic struck in March 2020, the Biden administration announced initial telehealth flexibilities that Congress further expanded temporarily — igniting a 63-fold increase in Medicare patients seeking telehealth services that year, according to a federal Department of Health and Human Services report.

Pandemic-era changes, for instance, allowed all eligible Medicare providers to deliver telehealth services that patients could access in their home and outside of previously designated rural areas. The changes waived geographic restrictions on telehealth services and increased options to receive them.

The changes cleared a “huge hurdle” that previously blocked telehealth growth, said Mary DeVany, associate director for the Great Plains Telehealth Resource and Assistance Center.

The pandemic ushered in significant growth for telehealth services for behavioral and mental health. And it has also increased options for certain types of primary care, DeVany said. Remote patient monitoring software, for instance, allows doctors to keep tabs on weight, blood pressure and other vital signs for patients with chronic health conditions, meaning patients with chronic conditions need less frequent hospital or clinic visits.

Telehealth has its limitations. “We can’t see certain things that we could see in the office,” Czaikowski said. That could include immediately spotting signs of child abuse or diagnosing ailments that might not be on a patient’s radar.

But expanded telehealth options have proved “really beneficial” for Czaikowski’s patients in many ways. Although most of her patients still use in-person visits, she said, telehealth visits allow families to check in more often or get simple diagnoses without having to pull their kids out of school and drive long distances for a short in-person visit.

“I see people from Michigan,” Czaikowski said. “They have to drive six hours just to see me. And then to have a 10-minute visit and tell them that their kid is just constipated? Or that they wet the bed — okay, here’s your medicine. That’s a lot for the families to have to give up.”

Health care by phone and Zoom 

But not all telehealth options are equal — or accessible to all.

Czaikowski conducts telehealth appointments over video or phone. She prefers video appointments when possible, allowing her to see patients and keep their attention. But she said the majority of telehealth patients she treats rely only on phone calls. That’s in line with national trends among rural patients.

“People will call you from work or when they’re driving and not really give you their full attention,” Czaikowski said. “You have to be really talented in what questions you ask as a provider.”

A family nurse practitioner at her computer
Brianna Czaikowski, a Marshfield Medical Center family nurse practitioner, is photographed at her computer on July 26, 2023, in Marshfield, Wis. (Drake White-Bergey / Wisconsin Watch)

While phone visits work well for those with less tech literacy or working parents with multiple kids at home, they reduce opportunities for children to communicate health information that parents might not think or want to mention, Czaikowski said.

“The kids tell the truth. When we’re on the (phone) visit, you don’t really hear the kids, it’s more the parent.”

Rural broadband access lags

Poor internet service ranks among the top reasons Czaikowski’s patients choose phone appointments over video, which generally should work at download speeds of 25 megabits per second and upload speeds of 3 Mbps — the federal standard for broadband access.

Nearly 22% of rural Wisconsinites lack adequate broadband services — a rate far above the rest of the state, according to a 2021 Federal Communications Commission report. And data from the U.S. Census Bureau’s American Community Survey show 38% of low-income households in Wisconsin lack an internet subscription.

State leaders are working on solutions.

In 2020 Democratic Gov. Tony Evers established the Governor’s Task Force on Broadband Access, which assists rural communities, many with older populations that want high-quality internet but don’t know where to start.

“They didn’t mind not having broadband, maybe they didn’t see the importance of it,” task force chair Chris Meyer said. “But as their communities age, telehealth suddenly becomes a reason.”

People watch a video showing Wisconsin Gov. Tony Evers speaking
A video showing Democratic Gov. Tony Evers speaking about broadband access plays during a Public Service Commission of Wisconsin Internet for All listening tour on May 23, 2023, at the Madison College Truax Campus in Madison, Wis. Evers created the Governor’s Task Force on Broadband Access in 2020 to help address the state’s internet needs. (Drake White-Bergey / Wisconsin Watch)

Telecommunications companies find it more lucrative to provide broadband to densely populated urban areas. For-profit businesses happily make the initial, and often heavy, infrastructure investment because they expect to have a large customer base.

But sparsely populated areas are less enticing for private companies. The cost of burying miles of fiber optic cables — one of the fastest and most reliable ways to deliver the internet — can be prohibitive. While a mile of internet service could serve hundreds of homes in a metropolitan area, it would cover only a few homes in northern Wisconsin, Meyer said.

Wisconsin has directed at least $340 million to broadband expansion and connected about 390,000 people to the internet since Evers launched the task force, Meyer said. The state had previously spent about $20 million.

Despite the task force’s increase in spending, Meyer said many people, especially those in northern Wisconsin, have yet to gain high-speed service.

Without broadband access, telehealth is “not a cure-all,” said Kirk Moore, Covering Wisconsin’s navigator who connects northern Wisconsinites to health insurance.

“Just to be able to take on the task of telehealth is a barrier.”

Meanwhile, low-income rural Wisconsinites may not make full use of the internet even after fiber optic cables arrive in their communities.

Rural households tend to earn less than urban households in Wisconsin, federal data show. And while a growing share of rural Wisconsinites own a computer, Moore said, “they have a computer but they don’t have the broadband access to be able to hook up to a physician or a behavioral health person through a video.”

Some telehealth flexibilities are temporary 

The federal government made some telehealth flexibilities permanent before the emergency declaration ended, particularly for those related to behavioral and mental health. Federally Qualified Health Centers and Rural Health Clinics, for instance, may continue providing such services to Medicare patients without previous geographic restrictions — including over audio-only platforms.

The government has extended similar flexibilities for issues unrelated to behavioral and mental health through only Dec. 31, 2024.

The Drug Enforcement Administration and the Substance Abuse and Mental Health Services Administration additionally extended flexibilities for remote prescriptions of controlled medications, such as treatments for opioid use disorder, through Nov. 11, 2023. The deadline will extend an additional year for new practitioner-patient telemedicine relationships.

Financial incentives affected

The pandemic also affected how hospitals were reimbursed — and financially incentivized — to offer telehealth services.

Under the federal emergency declaration, Medicare and Medicaid in Wisconsin and most other states began reimbursing hospitals for telehealth visits at the same rate as in-person visits.

“That means if you are seen … for something that you would have had covered in person, you are seen for that through telehealth,” DeVany said.

The Wisconsin Department of Health Services in March announced it would permanently reimburse hospitals for most video and audio telehealth services offered to the more than 1 million Wisconsinites on Medicaid — as long as the quality of virtual appointments matched in-person services.

The long-term future of reimbursements for telehealth services through Medicare remains less certain. Without further action, the equal treatment of telehealth and in-person services for billing will expire at the end of 2024.

At that point, Medicare could pay a lower rate for telehealth appointments — excluding the costs of items associated with in-person visits. That would require health care providers to absorb additional costs — or even eliminate services they can’t afford, DeVany said, adding that a similar result could happen with the private insurance market, which often follows Medicare’s lead.

Marshfield Medical Center
The Marshfield Medical Center is photographed on July 26, 2023, in Marshfield, Wis. The Wisconsin Department of Health Services says it will permanently reimburse hospitals for most video and audio telehealth services offered to Medicaid patients — as long as the quality of virtual appointments matched in-person services. (Drake White-Bergey / Wisconsin Watch)

“Once again, the patient would have to come and figure out how to come in,” DeVany said. “It’s a dual-edged sword, in that the patient gets the short end of that deal.”

A bipartisan group of dozens of lawmakers in Congress are pushing to make a range of pandemic-era telehealth flexibilities permanent.

“While telehealth use has skyrocketed these last few years, our laws have not kept up,” U.S. Sen. Brian Schatz, D-Hawaii, said in a June statement. “Telehealth is helping people in every part of the country get the care they need, and it’s here to stay.”

Czaikowski hopes Medicare continues covering telehealth appointments for specialists, which she said are in short supply across Wisconsin. She is among just six nurse practitioners statewide certified in urology, she said.

“They can’t just go to the doctor an hour away. They are traveling six hours,” Czaikowski said about some of her rural patients in Upper Michigan. “I really hope Medicare doesn’t ever take that away because it’s really going to hurt us.”

The nonprofit Wisconsin Watch ( collaborates with WPR, PBS Wisconsin, other news media and the University of Wisconsin-Madison School of Journalism and Mass Communication. All works created, published, posted or disseminated by Wisconsin Watch do not necessarily reflect the views or opinions of UW-Madison or any of its affiliates.

Pandemic brings telehealth boom to rural Wisconsin, but barriers linger is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

‘Not a luxury.’ Fresno County residents call for major investments in broadband internet access

Dozens of rural Fresno County residents spoke out Wednesday, urging California leaders to address the “urgent need for investment” in local broadband internet access.

“We want, and we need broadband of the highest quality,” said Martha Sanchez, a resident of Selma. “It’s not a luxury anymore; it’s become a necessity.”

Sanchez and others gathered at Washington Union High School in Easton as part of a “digital access conference.” The event included Assemblymember Dr. Joaquin Arambula, the Children’s Movement of Fresno, and All Children Thrive.

Broadband internet access in communities like Easton remains slow and expensive.

Speakers at the events said connectivity issues hamper students, teachers, and business owners.

Broadband internet access in Fresno faces funding challenges

Funding remains one of the largest roadblocks to achieving digital equity.

Some fear the state’s forthcoming Digital Equity Plan won’t reflect the challenges in Fresno County.

In fact, Mike Espinoza, the executive director of The Children’s Movement of Fresno, said funding issues could get worse.

Espinoza said the California Department of Technology relies on maps from the Federal Communications Commission that are “flawed” and “incomplete.”

“We know that the State’s Digital Equity Plan will outline its planned investments by county,” Espinoza said. “Though we fear that the state’s overreliance on the incomplete FCC/CPUC data will motivate them to avoid investing in Fresno’s digital infrastructure.”

Additionally, Wednesday’s gathering came just a day before the Fresno City Council is expected to vote on a resolution to “foster equality for Fresno residents and bolster resources for upward mobility.”

Arambula promised to stand by the affected communities and push for a solution at the state capitol.

“For us to build a stronger future, we need to be listening to residents to address those digital divides and inequities head on,” Arambula. “We need to make sure that every one of our residents feels that ability to connect to internet that’s high speed and that works to address the issues that our economy demands.”

The post ‘Not a luxury.’ Fresno County residents call for major investments in broadband internet access appeared first on Fresnoland.

Building Publicly Owned Broadband Starts with a Low-Tech Approach: Community Buy-in

This story is part of a series.

On a Tuesday afternoon, standing in front of the Islesboro Sewing Circle on an island off Maine’s MidCoast, Jane Wherren holds up items recently completed by members for the annual fundraiser. The president of one of the nation’s oldest sewing circles, called simply “circle” by locals, Wherren begins every meeting with show and tell. As sewing machines hum and knitting needles click, a dozen women glance up from their work to watch. “Look at these potholders with blueberry pie.” A woman calls out, “Who knitted those cute mother and baby socks?”

Standing in a 120-year-old building with one of the oldest sewing groups in the nation, you’d almost think you had stepped back in time. Then a voice calls out, “Those are gorgeous, can you zoom in?” 

Sewing Circle president, Jane Wherren, displays completed items for annual sale to Zoom attendees. (Photo by Carolyn Campbell)

The voice isn’t coming from the women in the room; it’s coming from a computer held by the circle’s secretary. To zoom in the woman walks closer to Wherren, turning the screen to capture the purses. Later in the meeting, when women sing happy birthday to one of its members, women both online and in person sing along. 

“We’ve been having hybrid meetings since the pandemic,” Wherren said. “We still do. We want to include everyone from our community, whether they’re homebound, in another state, or just unable to attend. Soon we’ll be teaching online sewing classes.”

Ten years ago, long before today’s unprecedented amounts of federal funding in rural Internet infrastructure, Roger Heinen watched Islesboro’s population drop precipitously. “We were facing an existential crisis,” he said. “There’s nothing like young people moving away to threaten the survival of an island community.”

In 2014, Heinen formed a small volunteer coalition to come up with a solution for the island of under 600 year-round residents. 

“Our coalition spent two years talking to lobstermen, selectmen, the hunting club, the school, and power brokers like the sewing circle,” he said. 

In 2016, voters approved a $3.8 million bond to fund the construction of a fiber-to-the-premises infrastructure capable of speeds of 1 gigabit per second. By 2018, Islesboro Municipal Broadband construction was complete and service was installed for all home and business subscribers.

“Getting the network off the ground was the hardest work I ever did,” Heinen said. “We (the town) knew that at the end of the day when the last ferry left, there was no government to save us. We were on our own.”

It’s been nearly five years since Islesboro’s Municipal Broadband connected those first subscribers. Today, as unprecedented federal and state funding is funneled into high-speed broadband access, increasing numbers of coalitions are attempting to build publicly owned networks. In the last two years, numerous attempts in rural Maine have failed. Lack of financial resources is often cited as a factor. Some say campaigns by large telecommunications companies to undermine broadband utilities are another reason.

Heinen says another issue is the most important barrier to getting municipal broadband off the ground. 

“When I talk to towns, I tell them money is not the primary issue,” he said. “What’s most critical is the ability to create strong social capital. There is money out there. There are technical and financial consultants out there. Social capital building, though, that must come from the inside.”

Peggy Schaffer, Maine’s first director for broadband funding, now a strategic consultant and board member on the American Association for Public Broadband, echoed Heinen’s advice. 

“Though there is no clear path to success, strong community engagement is at the heart of most successful publicly owned utilities,” Schaffer said.

In June, one of Maine’s newest town-owned fiber optic networks, Leeds Broadband, will start marketing their service after nearly four years of navigating the murky challenges of garnering support and overcoming incumbent provider opposition. Joe McLean, the organizer of the network, building community understanding and support was important at every stage of the process.

PowerPoint presentation at Eastport City Council meeting. (Photo by Carolyn Campbell)

“It’s been a long haul of hard work,” he said. “We’ve done a lot of coalition building as we’ve worked alongside our selectmen. Each stage has another level of community buy-in, from basic education to the benefits of high-speed internet, to why we can offer it cheaper and better.”

Both Heinen and McLean said the political disagreement between local elected officials and publicly owned broadband committees can be another impediment to implementation. “I’ve watched broadband committees who are on a completely different page with their selectmen and other people in town, arguing about the two different ideas rather than just getting to one good idea and trying to push it,” McLean said.

Having worked with dozens of coalitions promoting publicly owned broadband, Schaffer said one of the biggest mistakes coalitions make is presenting fiber-optic broadband as very technical.

“In reality, it’s a very human infrastructure,” she said. “When asking for money for publicly owned networks, committees need to realize that just because they’ve picked the right technology for their community, that doesn’t mean the community is going to buy into it.”

There’s no substitute for spending time to build local support, she said. 

“There’s so much work to do, committees often forget the importance of public outreach. If committees don’t (get buy-in), when the cable companies and the Spectrums come with their flyers, mailers, newspaper ads, and online attacks, run by people who make their living running these reaching people on a seemingly personal level, it’s too late to start to build support.”

Relieved to have weathered some of these incumbent campaigns, McLean’s team is excited to begin marketing. “We’ll be putting up displays in the town office, at the farmers’ market, and other events around town,” he said. “We want everyone to understand that with this nonprofit model, the more people sign up the cheaper it can be. We are going to focus on being a local provider for our local community. We want people to know that in comparison to the incumbent provider, we can provide far better service for far less.”

Schaffer said the benefits of building strong social capital as part of municipal broadband projects are worth the effort. “We see it across the country,” she said. “Community-owned networks … put revenues back into the community. They increase speed and service while reducing prices. For communities who can bring these networks to fruition, the profits always exceed the costs. The challenge is getting the community on board.”

To do that, Heinen has some practical advice. 

“Make sure to include your sewing circle.”

The post Building Publicly Owned Broadband Starts with a Low-Tech Approach: Community Buy-in appeared first on The Daily Yonder.

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New migration data shows an uptick of people moving into some rural areas

Localities in green had more people move in than move out between 2020 and 2021. Localites in red had more people move out than move in. Note: This is not the same as overalll population growth or decline. Some localities gaining people through migration may still be losing population overall if deaths outnumber births -- and the number of new residents. Data courtesy of the IRS.

Want more news on Virginia’s population trends? We’ve collected all our coverage here.

Danville, I have good news for you.

Don’t get too excited because I have some key caveats to wrap this good news in. But it is good news. 

First, though, I have to put things in context. We’ll start here: Every year the Internal Revenue Service releases figures on where people are filing their income taxes from, and how those figures differed from the year before. Put another way, we can look at those IRS stats to see migration trends — where people are moving in, where people are moving out.

In some ways, this data might be better data than the Census Bureau headcount. Not everyone files an income tax form, of course, so the data’s not perfect, but guess what: No data is. This is still a good hard number on migration trends that, when combined with other population data, helps us get a better picture of what’s happening. So that’s the first caveat: Don’t rely completely on this, but this is important stuff.

The states in green saw more people move in than move out between 2020 and 2021. The states in red saw more people move out than move in. Source: IRS.
The states in green saw more people move in than move out between 2020 and 2021. The states in red saw more people move out than move in. Source: IRS.

Last week, I reported the big headline for Virginia: For the ninth year in a row, these IRS stats show more people moving out of Virginia than moving in. That doesn’t mean the state is losing population. Census Bureau data shows that births outnumber deaths, and this net out-migration, so Virginia’s population is still growing, just more slowly than before. I’ll look at birth rates another day; for now we’ll just focus on people who are moving into or out of the state.

The figures last week also showed that Virginia’s net out-migration is driven by Northern Virginia. From 2020 to 2021, Virginia had a deficit of 7,224 people from more people moving out than moving in. In Fairfax County alone, the net out-migration was 14,588 people.

I promised then I’d dig deeper into this data, so here we go.

Here’s something else important to know: These are the first figures we have since the pandemic began so we get our first real look at what effect that might have had. If there’s a Zoom-era migration, here’s where we might expect to see it. 

Also: We shouldn’t hang too much on the data for any one year in these migration trends. A lot of population data is like the stock market. Sometimes it goes up, sometimes it goes down. The important thing is to look at trends, not every wiggle and jiggle.

Yes, I realize those two things seem contradictory: Hey, this information is a big deal! Hey, don’t take it that seriously! I also realize you’ve read all this way and you’re thinking like the woman in that 1980s Wendy’s commercial: Where’s the beef? You’ve seen prescriptions with fewer warnings than all this. 

Just hang on, OK? We’re almost there. We have just one more warning: Don’t pay attention to places with universities. The pandemic may have played havoc with those places’ stats, with colleges emptying out to go virtual. Montgomery County shows up as suffering from net out-migration, but nobody who has been there really believes that Montgomery County is shriveling up. 

All right, it’s finally showtime. Here’s the big picture:

1. Most of Virginia is seeing more people move in than move out.

It’s mostly just Northern Virginia, parts of Hampton Roads and parts of the Richmond area that are the problem. That means …

2. Most of rural Virginia is seeing more people move in than move out.

That runs counter to a lot of what we think but it’s true. And get this:

3. This trend of net in-migration in rural Virginia isn’t all that new.

Many rural localities have been seeing more people move in than move out for several years now, so we can’t specifically attribute these figures to that Zoom migration. However:

4. In some rural localities, we’re seeing in-migration accelerate. 

We might be able to attribute that acceleration to the pandemic (and rural broadband). We should probably hold off declaring that, though, until we’ve seen several years of data, not just one — remember, we’re looking for trends, not what might turn out to be one-year blips. Finally:

5. Many of these rural localities will continue to lose population even if there’s an influx of newcomers.

That’s because rural localities tend to be older, and old people tend to die, and those large numbers of deaths outnumber both births and the net number of people moving in. 

Now let’s look at some of the specific numbers, some of which might qualify as trends.

  • Lee County saw seven straight years of net out-migration before things turned around in 2020. That year, Lee County saw a net gain of 128 people from migration. Was that a fluke or the start of a new trend? We won’t know for a few years but in 2021, Lee County saw another net gain from migration, this time of 194 people. Those seem pretty hopeful figures.
  • Henry County has seen more people move out for 11 of the past 16 years, and when it has seen net in-migration, it’s always been under 100. But then in 2020 Henry County saw net in-migration of 224 and in 2021 that net in-migration went up to 376. Something seems to be going on there, and it’s not the only place.
  • Grayson County has been pretty even through the years — half the time it’s had net in-migration, half the time it’s had net out-migration, but those numbers have all been about the same. The last four years, though, Grayson has consistently seen net in-migration. In 2018, it showed a net gain of 54 people. In 2019, a net gain of 49. In 2020, a net gain of 74. But in 2021, Grayson’s net in-migration jumped to 125, the biggest ever that I can find (the searchable database goes back 16 years).
  • Patrick County next door has long had a history of net in-migration but has still lost population for the past two decades because deaths have outnumbered both births and all those newcomers. Those newcomers have also been pretty consistent, year by year. In 2018, the county saw a net gain of 64 people through migration. In 2019, a net gain of 36 people. In 2020, a net gain of 59 people. In 2021, that net in-migration accelerated to 295. 
  • Pittsylvania County, like Grayson County, has seen its migration trends toggle back and forth between people moving in and people moving out over the years, with 2020 being one of those moving-out years. But in 2021, Pittsylvania County saw net in-migration of 302 people — again, the biggest I can find in the records.
  • That brings us to Danville, which lost people through net out-migration for every year in that IRS database — until 2021, when it showed a net gain of 25 people through migration. That’s not many but it’s better than losing people, and it runs counter to all those other years that preceded it. Once again, maybe this is just a one-year aberration, but in the context of all these other localities, maybe it’s the first data point in a trend. If so that would a) be a big deal and b) not surprise me. Danville hit rock bottom two decades ago when textiles collapsed and has been reinventing itself ever since. Danville now calls itself “the comeback city” and that’s not just hyperbole. If this is, indeed, a trend, this would be some statistical support for that slogan.

While the numbers vary from place to place, the big story is that even before the pandemic, many rural localities were seeing more people move in than move out — and now the pandemic seems to have amped up those trends. We are going to have to adjust our mindset: Rural Virginia isn’t seeing people move away. As reported previously, it’s not even seeing a disproportionate number of young adults move away. Rural Virginia might like to see more people move in (or not, in some cases) and more young adults stay home, but the basic trend lines there are in its favor. What hurts rural Virginia is an aging population that is dying faster than it can be replaced. What hurts Virginia overall is the hemorrhaging from Northern Virginia. We are in the odd position that our state’s economic engine is also right now the main drag on the state’s economy. 

So, good news for Danville, but not necessarily the Old Dominion.

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