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Forbes
22-07-2025
- Health
- Forbes
Closing The Distance: Fixing Access To Care In Rural America
Part 2 of the Rural Health Resilience Series GRUNDY, VIRGINIA - Optometry students administer vision tests to patients for a free pair of ... More eyeglasses at a Remote Area Medical (RAM) mobile dental and medical clinic on October 7, 2023 in Grundy, Virginia. More than a thousand people were expected to seek free dental, medical and vision care at the two-day event in western Virginia's rural and financially struggling area. RAM provides free medical care through mobile clinics in underserved, isolated, or impoverished communities around the country and world. (Photo by) Bridging the Gaps That Separate Care from Communities In the first essay of this series, I described the rural health crisis: how it affects nearly 60 million Americans and why its resolution should be a national priority. But if we want to fix it, we must first understand what 'access' really means in rural America. It's not simply a matter of miles. It's a complex web of economic, structural, cultural, and technological gaps that separate people from the care they deserve. As a physician, I've cared for transplant patients who came to me in Nashville from coal towns in Appalachia, from the Mississippi Delta, from isolated ranchlands in the West. I've treated veterans at VA hospitals and seniors from small towns served by Medicare. I've helped build companies like Aspire Health, Monogram Health, and Main Street Health that now deliver care to patients in their homes across rural America. And for years I had a front row seat on the explosion of telemedicine as a board member of Teladoc, which has served millions of rural residents. What I've seen, again and again, is this: geography is only the first barrier. The deeper challenge is designing care that rural Americans can reach, afford, and especially trust. Care that understands them. The Many Faces of 'Access' At its simplest, access to care means being able to engage a health provider when you need it. But in rural America, this ideal runs into five major roadblocks: According to national polling by KFF, 58% of Americans believe rural residents have a harder time accessing care than urban ones. And rural adults themselves overwhelmingly agree that their communities lack primary care, mental health providers, and specialists. This is not a perception problem; it's a systems problem. And this needs to be addressed as such. When the Nearest Hospital Is Hours Away Since 2010, over 130 rural hospitals have closed. In my own state of Tennessee, over this period 15 rural hospitals have either fully closed or ceased inpatient care, the second most of any state and the highest in the nation on a per capita basis. In many areas, emergency rooms, surgical units, and maternity wards have been eliminated, with nothing to replace them. Remaining facilities increasingly operate under severe financial strain. As Dr. Keith Mueller of the University of Iowa notes: 'In rural America, we haven't just lost hospitals. We've lost healthcare ecosystems.'¹ Doctors and nurses move away. Supporting clinics close. Pharmacies disappear. The closures don't just threaten lives. They impact the economy, jobs, and social cohesion. The loss of a hospital often signals the slow unraveling of the community around it. One analysis found that for every 100 rural hospital jobs lost, another 35 jobs disappear due to declining local spending. This is not an argument that all rural hospitals should necessarily stay open, because they may be too inefficient and may not be the best way to deliver care when resources are limited. But it is a call to explore newer models of care delivery to fill the gaps caused by the failure of traditional, legacy-type delivery of inpatient care. It is a call to explore more creative, rural-focused payment mechanisms that adequately support modern value-driven care. A Workforce Crisis—and an Opportunity More than 60% of federally designated Health Professional Shortage Areas are rural. Nearly 80% of rural counties lack a psychiatrist. Many have no dentist or OB-GYN. Some have no practicing physician at all. These are the hard facts we must work around. We know that the best predictor of whether someone will practice in a rural area is whether they grew up in one. This truth means we should more actively invest in rural high school health career programs, community college training, and rural-focused medical education. In Nashville, we're working to open a Nurses Middle College, a public charter high school where students receive a rigorous college-prep education infused with nursing content, including nurse mentorships and firsthand experiences in medical workplaces. Introducing medical career paths early in students' education, particularly in rural regions, is key to growing the workforce. A proven rural physician training model is East Tennessee State University's Quillen College of Medicine in Johnson City. With the clearly stated mission to prepare physicians for underserved and rural communities, Quillen consistently ranks #2 nationally for graduates practicing in underserved areas. Through programs like its Rural Primary Care Track, Quillen provides early and sustained clinical exposure in community settings. The results are compelling: over 63% of its graduates practice in medically underserved areas, and more than half enter primary care, many returning to serve in their home regions.⁵ Another example of a training institution addressing this challenge head-on is Meharry Medical College in my hometown Nashville. A historically Black medical school with a long-standing mission to serve the underserved and in particular rural areas, Meharry has produced generations of physicians who return to practice in rural and economically marginalized communities. Through rural-focused pipeline programs and partnerships designed specifically for rural health like its accelerated training track with Middle Tennessee State University for rural primary care, Meharry is helping build a future workforce rooted in the very communities most often left behind. In recent Senate testimony, Dr. James Hildreth, Meharry's President and CEO, stated: 'We have been training health care professionals who are really competent and skilled—connected to their communities—for decades.' He added, however, that 'our challenge is the infrastructure we have to do that.' Equally important is expanding the role of non-physician providers. Nurse practitioners, pharmacists, EMTs, and community health workers are the care infrastructure in many places. States should continue to examine how to best allow health personnel to practice 'at the top of their license' to maximize workforce reach. And the shortages are not just traditional health providers. In many rural areas, broadband technicians and community health workers are as critical to healthcare access as doctors and nurses. Telehealth: Promise and Pitfalls Telehealth surged during the pandemic and demonstrated real promise for rural care. Behavioral health visits, routine check-ins, and consults have all benefited. We've likely just touched the surface of its potential; to be fully realized will take newer alliances among providers and more modern flows of payment to reimburse where value is added. Farmer uses telemedicine to access remote care. Teladoc Health, on whose board I served for eight years, provides a good example. During the COVID pandemic, Teladoc Health emerged as a vital lifeline for rural Americans, illuminating how virtual care can break through geographic barriers. In early 2020, total visits soared. Teladoc nearly tripled its capacity, rising from handling around 100,000 virtual visits per week to nearly 2.8 million visits per month at mid‑year. While telehealth growth was nationwide, Teladoc's platforms proved especially valuable in rural, underserved regions with few nearby providers or limited public transportation options. As a board member, I saw firsthand how Teladoc's operations not only expanded reach into medically underserved counties but also reduced travel time, alleviated strain on fragile local health systems, and provided critical continuity of care where in-person follow-up was unfeasible. Telehealth has proved especially beneficial for mental health treatment, with some patients actually preferring a virtual visit due to persisting stigma around mental healthcare. And its value goes beyond connecting a rural patient to a provider in another zip code. It can be a lifeline for isolated rural providers who want to connect with specialists on cases and procedures they are less familiar with – becoming a medical force multiplier. But telemedicine engagement generally requires broadband, and millions of rural Americans don't have it. The FCC estimates at least 19 million Americans lack high-speed internet, the majority in rural areas. Even where broadband exists, it may be unaffordable or unreliable. Inconsistent access means rural residents are being left behind in a system increasingly reliant on digital care. Without broadband, rural communities can't participate in modern healthcare. Behavioral Health: The Sharpest Edge Behavioral health care is arguably where the rural access gap is most dangerous. Many counties have no licensed mental health provider at all. And yet, as pointed out in our first essay, rural communities face some of the nation's highest rates of suicide, overdose, and depression. States are in the best position to facilitate local solutions. In neighboring Kentucky, peer counselors, primary care teams, and churches have come together to form informal behavioral health safety nets, especially in rural areas where clinicians are scarce. One powerful initiative is Recovery Kentucky, which operates eight rural residential recovery homes offering peer-led support, life skills training, and transitional housing. An independent evaluation found it serves up to 2,200 people annually with measurable improvements in substance use, housing stability, employment, and health outcomes.⁵ Another innovation, the state's Crisis Co-Response Model, pairs trained mental health professionals with law enforcement in rural communities to provide in-the-moment intervention and post-crisis follow-up, bridging gaps where conventional crisis services are hours away. These grassroots models reflect the power of trust-driven, community-rooted care that meets people where they are, both geographically and socially. In rural America, the most effective health infrastructure is sometimes the church basement, the school gym, or the farm supply store bulletin board. Something common to all of these rural models: they are built on trust, often from the community level up and not from bureaucracy, top down. WISE, VA - Early-morning screening takes place in a barn during the Remote Area Medical (RAM) clinic ... More at the Wise County Fairground in Wise, Virginia. Rural families, most with little or no insurance, lined up for hours to receive free health care from hundreds of professional doctors, nurses, dentists, and other health workers. (Photo by, 2007) Culture, Trust, and Local Voice Many rural residents hold deep skepticism toward government-led systems, ironically even when they benefit from them. According to KFF polling, many residents on Medicaid or Medicare say they 'don't rely on the federal government' for health support.⁴ That belief is not hypocrisy; it's identity. Self-reliance, pride, and cultural values shape how rural residents interact with healthcare. For many rural Americans, healthcare is much more than a service; it's a cultural encounter. It intersects with deeply held values of personal independence, skepticism of bureaucracy, and strong community ties. Health programs that emphasize entitlements or top-down aid can clash with this ethos. But solutions that build trust, use local messengers, and frame care as earned or community-rooted are far more effective. That's why programs like culturally aware Main Street Health and peer-led behavioral health models work: they feel local, personal, and dignified. As one rural stakeholder said, 'What matters is whether this person knows us, not what their credentials say.' Reaching rural America means respecting not just the need, but the values that shape how care is received. Effective models don't dismiss that; they honor it. They empower trusted messengers. Main Street Health: A Working Solution At Main Street Health, a company on whose board I serve that delivers value-based care exclusively to rural populations, we're seeing what's possible. The company has placed 'health navigators,' trusted individuals drawn locally from their own communities, into hundreds of rural clinics across the country. These navigators, who are personally known locally, help seniors manage chronic conditions, access care, coordinate medications, and navigate the healthcare system. The program now operates in more than a thousand clinics across the country. Its rapid growth is not because of marketing. It's because it is built on community-centered relationships and trust, and it works. Access isn't a fixed obstacle. It's a challenge of systems design and one we are capable of solving. What's Next In the next essay, we will explore how technology can be a transformative vehicle for health in rural America, and why we need to make these investments now to bring aging systems into the 21st century to help eliminate the 'rural health penalty.' It just may be a model for the rest of America. Footnotes
Forbes
15-07-2025
- Health
- Forbes
Rural Health Resilience: A Four-Part Series On Healing The Other America
Preface: Why Rural Health Demands a National Conversation This essay is the first in a four-part series I'm calling Rural Health Resilience—a look at the state of rural health in America through the eyes of a surgeon, policymaker, and entrepreneur. Over the course of my life, I've cared for patients referred from rural hospitals and doctors as a surgical intern; I've treated them in VA hospitals and academic medical centers as a heart and lung specialist, and represented their interests in Washington as a senator from Tennessee. I've helped design companies—like Aspire Health, Main Street Health, and Monogram Health—that now serve hundreds of thousands of rural Americans in their homes and communities. And I've personally operated as a surgeon in remote clinics across sub-Saharan Africa, where geography often determines survival. I'm not an expert in rural care but I try to be a keen observer. What I've learned is that rural America is too often overlooked. But its health is inextricably tied to the health of the nation. No longer can we expect financial, organizational, and delivery models designed for urban areas to work in rural communities. They don't. We must meet the needs of rural populations with a new, more tailored approach. I'll share some ideas as potential solutions over the course of this series. This series will explore four pillars of the rural health landscape: 1. The Rural Health Crisis: How We Got Here—and Why It Affects Us All (this first essay) 2. Closing the Distance: Fixing Access to Care in Rural America 3. What Counts: How Technology Can Transform Rural Health 4. A Healthy Return: How Investing in Rural Care Is Good for America BROWNSVILLE, TN - The demise of Haywood Park Community Hospital added Brownsville, Tennessee to the ... More emergency services plight being endured in many rural communities across America. Photo by Michael S. Williamson. The Rural Health Crisis: How We Got Here—and Why It Affects Us All A Crisis in Plain Sight I first began thinking seriously about the vulnerabilities of rural health not from a policy paper, but from a patient. He was a 52-year-old farmer from western Tennessee—stoic, salt-of-the-earth, the kind of man who only came to the doctor when he could no longer walk up the stairs of his tractor. By the time he made it to me, a heart specialist, he was in advanced heart failure. His local hospital had closed. The nearest cardiologist was two counties away. And the many barriers to reach specialty care had cost him precious time. This man's story is not unique. In fact, it's painfully common. Rural America today is facing a slow-moving health crisis that affects nearly 60 million people—roughly one in five Americans. The definition of 'rural' varies slightly by government agency but broadly includes non-metropolitan counties characterized by lower population density, distance from urban centers, and limited commuting access. These communities span the country, from Appalachia to the Mississippi Delta to the high plains of Montana—and together they form the backbone of our country's food, energy, and cultural identity. And, yes, they include even populous coastal states like California, New York and Florida which contain significant rural regions—places where access, infrastructure, and outcomes mirror those of what are thought of more traditionally as rural states. These same communities are facing disproportionately high rates of chronic disease, mental illness, maternal mortality, and premature death. The phrase 'rural mortality penalty' is real. According to Dr. Shannon Monnat, a rural demographer at Syracuse University, 'The rural U.S. is sick, poor, and losing population. And the health and longevity gap between rural and urban America is growing wider every year.'¹ By the Numbers: Geography as Destiny The data are stark: These are more than numbers. They are lives cut short. Families left behind. Communities depleted. The Health Gaps We Don't See Rural health disparities aren't just about the availability of clinics or emergency rooms. They're deeply tied to social determinants of health, such as housing, transportation, education, food access, income inequality, and broadband connectivity. As Dr. Carrie Henning-Smith of the University of Minnesota notes, 'The biggest drivers of rural health inequities are not medical. They are structural.'² In rural America, patients are more likely to live in substandard housing, lack access to reliable transportation, and face chronic food insecurity. These social risks compound clinical ones. Lasting solutions must include attention to each of these. Put simply: many rural Americans aren't dying because they can't get to a doctor. They're dying because of what happens long before they need one. Loneliness and social isolation are significant public health concerns in the US, with rural areas ... More often facing unique challenges that exacerbate these issues. Rural residents may experience higher rates of loneliness due to factors like social isolation, poorer health, and socioeconomic disadvantages. These factors can contribute to increased risks of depression, suicide, and other health problems. Aging, Isolation, and Infrastructure Breakdown Rural America is aging rapidly. Nearly one in five rural Americans is over 65. Many are aging in place, even as younger generations move away. That means more and frequently older people with complex needs, and fewer providers or caregivers to meet them. These older adults are often managing multiple chronic illnesses without access to home-based care, nearby pharmacies, or geriatric specialists. As Dr. Tim Slack of Louisiana State University puts it: 'What we're seeing is a slow erosion of the systems that support health—economic, medical, and civic.'³ Meanwhile, in a post-COVID world, we've heralded telehealth as a powerful solution. And it can be, if patients have broadband. But millions still don't. Whether due to cost, geography, or digital literacy, virtual care remains inaccessible to many of the people who need it most. Real Stories, Real Stakes I've seen this reality firsthand. At Monogram Health, we care for patients with advanced kidney disease who can't safely reach dialysis centers. At Aspire Health, which focuses on palliative care, we treated rural seniors with complex, life-limiting illness, frequently homebound, often alone, disconnected from coordinated care. And through Main Street Health, we've built a primary care model that deploys trusted, local 'health navigators' in rural communities in 22 states to meet patients where they are, geographically and clinically. These aren't pilot projects. They each started as innovative ideas, each thoughtfully organized with rural needs in mind. Now they are proven and operating at scale. They demonstrate that rural care can work. But only if we design it intentionally and sustainably, listening to the local needs of the communities and aggressively engaging them in the solutions. Not a Monolith, But a Shared Challenge Rural America is diverse — racially, economically, and culturally. The needs of an Appalachian coal town differ from those of a tribal health center in South Dakota or a farming community in California's Central Valley. But core vulnerabilities are shared. As Monnat reminds us, 'We often treat rural as a category of deficiency. But the truth is that rural communities have enormous assets—tight-knit networks, cultural resilience, and deep place-based knowledge. They just need systems that work with them, not around them.'⁴ Truck on gravel road in northern Minnesota. A Call to See—and Then to Act The rural health crisis is more than a sidebar to the national conversation. It is the national conversation. If we ignore the progressive decline in rural health, we risk losing entire communities. Economically, we lose labor. Socially, we lose trust. Politically, we deepen divides. But I believe rural health is also one of the greatest opportunities we have to make meaningful progress in American healthcare. That's what this series is all about. The data are in. The models exist. And the roadmaps are clear. Smart rural health solutions can accelerate care for all America; we will explore this more in essay three where we focus on technology. What's Next In the next essay, we will look at the specific barriers keeping rural Americans from accessing care and the innovations helping bridge the divide. From workforce shortages and transportation challenges to mobile health units and broadband expansion, we'll examine what's broken—and what's working. And a final thought: if we can't get healthcare right for 60 million Americans who feed us, fuel us, and form the fabric of this country—who are we getting it right for?Footnotes
Boston Globe
16-06-2025
- Business
- Boston Globe
Mass. lawmaker probes possible conflicts of interest for top RFK advisers
Get Starting Point A guide through the most important stories of the morning, delivered Monday through Friday. Enter Email Sign Up Auchincloss cited their special status in his letters, requesting internal communications and descriptions of what ethical guidelines were put in place to prevent possible conflicts while they served. It's the latest escalation of his scrutiny of Kennedy's management and deputies at HHS. Advertisement 'RFK Jr. and his henchmen accuse scientists at the [Food and Drug Administration] of corruption when in fact they're the ones who have conflicts of interest, they're the ones who are plundering public health,' Auchincloss said in a brief interview. 'The goal here is to focus the spotlight, collect the receipts, and prepare the investigation, because ... what we know of the facts are damning.' Neither Means and his company Truemed, nor Smith's company Main Street Health, responded immediately to a request for comment. Advertisement Auchincloss has been an outspoken critic of the Kennedy's and has zeroed in on Smith and Means in particular, repeatedly alleging potential ethical violations in their tenure. At an April policy forum that featured Means Auchincloss cites specific areas of concern in the letters, including policies and actions by the administration that he alleged benefitted Means's and Smith's businesses. Truemed, Means's company, gives Americans letters of medical necessity that enable them to spend their tax-free health savings account dollars on fitness and wellness products, which Truemed also sells. Auchincloss questioned Means's potential influence on the House-passed Republican tax legislation and the White House's executive order establishing the MAHA commission, which both encourage the expansion of such spending. Auchincloss requested Means and Truemed turn over any communications between him and the company during his time in government and what involvement, if any, he had in the development of those policies. In the letter to Smith's company, Main Street Health, Auchincloss focused more on Medicare policy. Though Smith left HHS at the end of last month, Advertisement Auchincloss alleged that the Trump administration during Smith's tenure edited a regulation initially proposed under Joe Biden in ways that decreased oversight on and increased payments for Medicare Advantage Organizations like Main Street Health's investors. He also took issue with In a brief interview related to his work for DOGE with Fox News in March, Smith said his work was focused on the administration's two main goals. 'Number one, making sure we continue to have the best biomedical research in the world, and number two making sure—which President Trump has said over and over again—that we 100% protect Medicare and Medicaid,' Smith said. As a Democrat in the House minority, Auchincloss lacks the power to compel answers to his letters, though private companies may still comply. But he noted in his interview with The Globe that Kennedy is expected to testify in the near future before the Energy and Commerce Committee on which Auchincloss sits, where he may follow up. And, he noted, if Democrats were to flip the House in the next election, his committee could issue subpoenas. Tal Kopan can be reached at
Boston Globe
27-02-2025
- Business
- Boston Globe
Who is Amy Gleason, the person named DOGE's acting administrator by the White House?
The identity of who was technically running DOGE had been a mystery, even though an executive order signed by Trump last month called for the appointment of an administrator to report to the White House. A government lawyer on Monday told a judge that he didn't know who that person was, and White House press secretary Karoline Leavitt had declined to identify the person earlier Tuesday in a press briefing. Get Starting Point A guide through the most important stories of the morning, delivered Monday through Friday. Enter Email Sign Up 'There are career officials and there are political appointees who are helping run DOGE on a day-to-day basis,' she said. Advertisement Gleason, 53, worked from 2018 through 2021 in the United States Digital Service, an agency that has been renamed the US DOGE Service, according to her LinkedIn profile. In that role, she worked with the White House on the federal response to the coronavirus pandemic. She returned to the agency in January after Trump took office. DOGE and Gleason did not respond to an email seeking comment on Tuesday. More than 20 members of the former digital service resigned Tuesday with a letter criticizing Musk for working to 'dismantle critical public services.' In the interim, she had been working as 'chief product officer' at two small Nashville-based health care startups, Russell Street Ventures and Main Street Health, according to her LinkedIn profile. Both companies were founded by health care entrepreneur Brad Smith, who worked in the first Trump administration in several key health care roles and has also been working on the DOGE initiative. Russell Street Ventures' website has recently been deleted, but the company has called itself 'an innovative healthcare firm focused on launching and scaling companies that serve some of the nation's most vulnerable and underserved patient populations.' Advertisement Main Street Health says it works with primary care physicians in rural areas to provide clinics 'with the data and opportunities they need to succeed in value-based care.' The company's website deleted Gleason's biography. But an archived version shows that it said she 'spearheaded technology efforts for the federal COVID-19 response' and worked on projects with the Centers for Disease Control and Prevention and Centers for Medicare and Medicaid Services. Gleason also has a consulting firm, Gleason Strategies, according to her LinkedIn profile. Gleason has long been an advocate to cure a condition called juvenile myositis, a rare autoimmune disease that can cause muscle weakness and a skin rash in children. It affects her now-adult daughter. Gleason shared her frustrations with how the health care system handles such diseases in a 2020 TED talk and called for technology and data changes that could help patients and doctors. She worked as vice president for research at the Cure JM Foundation from 2014 to 2018, according to her LinkedIn profile. She was also a co-founder and executive at Care Sync, a telehealth company based in Florida. Foley reported from Iowa City, Iowa.
Yahoo
25-02-2025
- Business
- Yahoo
Who is Amy Gleason, the person named DOGE's acting leader by the White House?
The acting administrator of the Department of Government Efficiency is a low-profile executive who has expertise in health care technology and worked in the first Trump administration. The White House on Tuesday afternoon identified Amy Gleason as the acting leader of DOGE, which has been pushing agencies to fire employees, cancel contracts and make other budget cuts. Although DOGE's cuts have been championed by billionaire Elon Musk and his associates, the White House has insisted that Musk is overseeing the effort as a senior adviser to President Donald Trump, not a DOGE employee. See for yourself — The Yodel is the go-to source for daily news, entertainment and feel-good stories. By signing up, you agree to our Terms and Privacy Policy. The identity of who was technically running DOGE had been a mystery, even though an executive order signed by Trump last month called for the appointment of an administrator to report to the White House. A government lawyer on Monday told a judge that he didn't know who that person was, and White House press secretary Karoline Leavitt had declined to identify the person earlier Tuesday in a press briefing. 'There are career officials and there are political appointees who are helping run DOGE on a day-to-day basis,' she said. Gleason, 53, worked from 2018 through 2021 in the United States Digital Service, an agency that has been renamed the US DOGE Service, according to her LinkedIn profile. In that role, she worked with the White House on the federal response to the coronavirus pandemic. She returned to the agency in January after Trump took office. DOGE and Gleason did not respond to an email seeking comment on Tuesday. More than 20 members of the former digital service resigned Tuesday with a letter criticizing Musk for working to 'dismantle critical public services.' In the interim, she had been working as 'chief product officer' at two small Nashville-based health care startups, Russell Street Ventures and Main Street Health, according to her LinkedIn profile. Both companies were founded by health care entrepreneur Brad Smith, who worked in the first Trump administration in several key health care roles and has also been working on the DOGE initiative. Russell Street Ventures' website has recently been deleted, but the company has called itself 'an innovative healthcare firm focused on launching and scaling companies that serve some of the nation's most vulnerable and underserved patient populations.' Main Street Health says it works with primary care physicians in rural areas to provide clinics 'with the data and opportunities they need to succeed in value-based care.' The company's website deleted Gleason's biography. But an archived version shows that it said she 'spearheaded technology efforts for the federal COVID-19 response' and worked on projects with the Centers for Disease Control and Prevention and Centers for Medicare and Medicaid Services. Gleason also has a consulting firm, Gleason Strategies, according to her LinkedIn profile. Gleason has long been an advocate to cure a condition called juvenile myositis, a rare autoimmune disease that can cause muscle weakness and a skin rash in children. It affects her now-adult daughter. Gleason shared her frustrations with how the health care system handles such diseases in a 2020 TED talk and called for technology and data changes that could help patients and doctors. She worked as vice president for research at the Cure JM Foundation from 2014 to 2018, according to her LinkedIn profile. She was also a co-founder and executive at Care Sync, a telehealth company based in Florida. ___ Foley reported from Iowa City, Iowa.
