Without federal intervention, a new report warns, rural hospitals across the United States, including many in Nebraska, could be forced to reduce services or even close their doors after pandemic relief funds expire.

Nemaha County Hospital chief executive Marty Fattig said ending across-the-board federal spending cuts, known as sequestration, would be a good start. Since lawmakers haven't used cuts to bring down the national debt as promised, Fattig said, he believes hospitals should receive full reimbursement from Medicare.

"So, it looks to me like the only people that are paying for this thing are those of us that take care of Medicare patients," he said. "And we get 2% off of what we would normally get paid. That's kind of a big deal."

Researchers at the Bipartisan Policy Center found that 30 rural hospitals in Nebraska suffered financial losses for patient services over a three-year average. More than 20 hospitals had negative earning margins. Current and long-term financial liabilities exceed current assets for 18 Nebraska hospitals. Nationally, the report says 441 rural hospitals face multiple financial risk factors.

In addition to putting a pause on sequestration, the report recommends making higher Medicare payments permanent, and maintaining flexibility in telehealth until at least two years after the federal public health emergency ends.

Report co-author Julia Harris, the think tank's senior policy analyst, said 116 hospitals closed between 2010 and 2019, but that pace slowed as COVID peaked.

"So, the CARES Act and the American Rescue Plan really did a lot to stave off more hospitals from closing," she said, "but that aid masked the fact that the underlying finances of rural hospitals continue to deteriorate, especially with new pressures brought on from the pandemic."

Fattig said lawmakers also should push back against efforts by drug companies to make it harder to get discounted medicines through a program known as '340-B.' He said those savings help pay for patient services that aren't financially viable otherwise.

"Right now 'Big Pharma,' the big pharmaceutical companies, are throwing all kinds of roadblocks down," he said, "so that they will not pay for the 340B program like they should."

It's almost time for kids in Washington state to head back to school, and some might gravitate toward soda and other drinks with lots of sugar. Health professionals say consuming these drinks on a regular basis has a number of ill health effects.

Dr. Ruchi Kapoor is a cardiologist at the University of Washington and American Heart Association Puget Sound chapter president. She said sugary drinks have more calories and don't make for good lunchbox items.

"They're not as satisfying as calories that you get from actual food, actual meals that you end up consuming at dinner or lunchtime," said Kapoor. "But because of that, you don't get full as quickly and you end up consuming a lot more of this added sugar than you would otherwise."

Kapoor said these drinks can lead to weight gain, diabetes, and high blood pressure and cholesterol. Eventually, she said they can lead to higher risks of stroke and heart attack.

Kapoor added that people consume nearly 20 teaspoons of sugar per day, which is well over twice the recommended amount.

Sugary drinks also increase the risk of cavities.

Dr. Kyle Dosch is dental director of Delta Dental of Washington. He said the risk is greater for children, who have thinner enamel on their teeth.

The beginning of school also means the start of school sports, where people could be drinking sports drinks. Dosch said people typically bathe their teeth in these sugary liquids.

"Say during a basketball game or a baseball game, something where the game is a couple hours in length and you're kind of sipping on this," said Dosch. "There used to be a slogan in the dental-health care world of 'Sip all day, get decay.'"

Kapoor said water is the best alternative for people's health. She said there are natural ways to make water taste like their less healthy counterparts.

"Fruits, like a little bit of berries or some orange slices or lemon slices," said Kapoor. "Or even cucumbers, mint, rosemary. There's a lot of natural flavor out there that you can add to your water without having that downside of the added sugar that companies give you."

A relatively new virus known as monkeypox has made its way to the state of Washington. About 280 cases have been reported, with 240 occurring in King County, according to the state Department of Health.

Dr. Mark Cook, medical director of gender health for Kaiser Permanente in Seattle, said monkeypox has been known to medical professionals since the 1970s, but the virus has now begun a troubling trend of spreading from person to person.

"The symptoms are fever, body aches, swollen glands, fatigue and a characteristic rash; little round vesicles that can appear on your skin and many different parts of your body," Cook explained.

Cook emphasized monkeypox is spread through skin-to-skin contact, and so the best way to prevent getting the disease is not to touch people who are infected. He pointed out it is related to smallpox but is much less severe. A vaccine is available, but it is in short supply. There are close to 12,000 cases nationwide.

Cook noted fortunately, there have not been any reported deaths from the virus. But he added monkeypox is uncomfortable and people who are infected have to be isolated for a few weeks. There can also be scarring from the blisters.

"We should be concerned simply because it is a pretty significant illness, and it's miserable to have it for some people," Cook stressed. "That alone, I think, speaks to why we should do our very best to try to control it."

Changes in how to prevent COVID-19 at the start of the pandemic as medical professionals were learning about the disease may have sown distrust in the wisdom of authorities on the issue. Cook acknowledged doctors are more cognizant of it now.

"We've all learned how to try to deliver those messages in a more clear way to help people understand that the message isn't necessarily changing, but the information that we have does evolve over time," Cook stated.

Coloradans struggling economically put their health at risk when they decide not to turn on cooling systems, frequently out of fear of not being able to pay their utility bill and taking a hit on their credit score, or having services cut off.

Luke Ilderton, deputy director of Energy Outreach Colorado, said as homes get hotter, heat stress can come on very quickly. Prolonged exposure can lead to heart attacks, and can cause the body to shut down. Ilderton encouraged all Coloradans to make health priority number one.

"If people are suffering, they should turn on their cooling systems and look for resources -- like Energy Outreach Colorado, the Energy Office's weatherization program -- to be able to afford their cooling bill, but not at the sacrifice of their own personal health," Ilderton advised.

Help is available for those who cannot afford to pay their utility bills or repair or replace broken cooling systems, and for those at risk of being disconnected. To be connected with the right program, call Energy Outreach Colorado's helpline toll-free at 866-432-8435.

Ilderton pointed out there are ways to make your summer utility bill more affordable, especially for households participating in Xcel Energy's time-of-use rates.

"Try to precool your house in the early morning hours when electricity rates are at its lowest," Ilderton suggested. "You will be paying more in the afternoon, and you certainly will pay more from 3-7 p.m."

Climate change is bringing even more summer days above 90 degrees, and the Biden administration is encouraging states to add cooling assistance to programs initially created to help the nation's most vulnerable residents stay warm in winter.

Ilderton added the Inflation Reduction Act recently passed by Congress could help more people find long-term price relief by switching to lower-cost heat pump technology, which can be used to heat and cool homes, and does not require the use of fossil fuels.

"There's a significant amount of rebates and incentives, specifically targeting low- to moderate-income households, that will help with this transition," Ilderton noted.