Sarah Jane Tribble, KFF Health News and Holly Ok. Hacker and Lydia Zuraw, KFF Health News
Data visualizations by Lydia Zuraw
BRANCHLAND, W.Va. — Ada Carol Adkins lives along with her two canine in a trailer tucked into the timbers off Upper Mud River Road.
“I’m comfortable here, but I’m having health issues,” mentioned the 68-year-old, who retired from her job as a faculty prepare dinner a number of years in the past after having a stroke. “Things are failing me.”
Her trailer sits midway up a ridge miles from city and the native well being clinic. Her telephone and web are “wacky sometimes,” she mentioned. Adkins — who’s fiercely impartial and calls herself a “Mountain Momma” — worries she gained’t be capable of name for assist if service goes out, which occurs usually.
To Frontier Communications, the telecommunications firm that owns the road to her residence, Adkins says: “Please come and hook me right.”
But she may be ready years for higher service, pissed off by her web supplier and left behind by troubled federal grant applications.
1 / 4 of West Virginia counties — together with Lincoln, the place the Mud River bends its method by way of hollows and previous cattle farms — face two boundaries to well being care: They lack high-speed web and have a scarcity of main care suppliers and behavioral well being specialists, in response to a KFF Health News evaluation.
Years of Republican and Democratic administrations have tried to repair the nation’s broadband woes, by way of flawed makes an attempt. Bad mapping, weak requirements, and flimsy oversight have left Adkins and almost 3 million different rural Americans in useless zones — with eroded well being care providers and the place telehealth doesn’t attain.
Blair Levin, a former government director of the Federal Communications Commission’s National Broadband Plan, referred to as one rural program rollout through the first Trump administration “a disaster.”
It was launched earlier than it was prepared, he mentioned, utilizing unreliable federal maps and a reverse-auction course of to pick out web carriers. Locations went to the bottom bidder, however the company failed to make sure winners had the information and assets to construct networks, mentioned Levin, who’s now an fairness analyst with New Street Research.
The fund initially introduced awards of $9.2 billion to construct infrastructure in 49 states. By 2025, $3.3 billion of these awards had been in default and, because of this, this system gained’t join 1.9 million houses and companies, according to a recent study.
A $42 billion Biden-era initiative nonetheless might not assist Adkins and plenty of others shortchanged by earlier federal broadband grants. The new wave of funding, the Broadband Equity, Access, and Deployment Program, or BEAD, has an anti-waste provision and gained’t present service in locations the place earlier grants had been awarded — even when firms haven’t delivered on their commitments.
The use of federal cash to get individuals related is “really essential” for rural areas, mentioned Ross DeVol, CEO and chairman of the board of Heartland Forward, a nonpartisan suppose tank based mostly in Bentonville, Arkansas, that focuses on state and native financial improvement.
“Internet service providers look at the economics of trying to go into some of these communities and there just isn’t enough purchasing power in their minds,” DeVol mentioned, including that broadband growth is analogous to rural electrification. Without high-speed web, “you’re simply at a distinct disadvantage,” he added. “I’ll call it economic discrimination.”
‘I Got Books Full’
Adkins retains spiral-bound notebooks and calendars crammed with handwritten data of telephone and web outages.
In January, whereas bean soup warmed on the range, she opened a pocket book: “I got books full. Hang on.”
Her finger traced the web page as she recounted outages that occurred about as soon as a month final 12 months. Adkins mentioned she misplaced connectivity twice in November, once more in October, and in July, May, and March. Each time she went for days with out service.
Adkins pays Frontier Communications $102.13 a month for a “bundle” that features a connection for her home telephone and wi-fi web entry on her cellphone. Frontier didn’t reply to requests for touch upon Adkins’ and different clients’ service.
Adkins, a widow, spends most of her time at residence and mentioned she would do video calls along with her medical doctors if she may. She mentioned she nonetheless has numbness on one facet of her physique after the stroke. She additionally has hypertension and arthritis and makes use of over-the-counter ache patches when wanted, reminiscent of after she carries 30-pound pet food baggage into the home.
She doesn’t personal a four-wheel-drive truck and, for 3 weeks in January, the snow and ice had been so extreme she couldn’t depart. “I’m stranded up here,” she mentioned, including that neighbors examine in: “‘Do you have electric? Have you got water? Are you OK?’”
The neighbors have all seen Adkins’ line. The pale-yellow twine was tied off with inexperienced plastic ties round a pole outdoors her trailer. As it ran down the hill, it was knotted round tree trunks and branches, frayed in locations, and, lastly, collapsed on the bottom beneath gravel, snow, and ice on the backside of the hill.
Adkins mentioned a deer stepping on the road has interrupted her telephone service.
David and Billi Belcher’s double-wide modular residence sits close to the highest of the ridge previous Adkins’ residence. Inside, an outdated looking canine sleeps on the ground. Belcher identified a window towards the place he mentioned Frontier’s cable has remained unrepaired for years: “It’s laying on the ground in the woods,” he mentioned.
Frontier is West Virginia’s legacy service, controlling a lot of the state’s outdated landlines since buying them from Verizon Communications in 2010. Twelve years later, the corporate gained almost $248 million to put in high-speed web to West Virginia by way of the Rural Digital Opportunity Fund, an initiative launched throughout President Donald Trump’s first time period.
“Big Daddy,” as native transit driver Bruce Perry referred to as Trump, is widespread with the individuals of Lincoln County. About 80% of the county’s voters picked the Republican within the final election.
The Trump administration awarded Frontier cash to construct high-speed web to Upper Mud River Road residents, like Adkins, according to state mapping. Frontier has till Dec. 31, 2028, to construct.
But the Belchers wanted higher web entry for work and will afford to pay $700 for a Starlink satellite tv for pc web package and insurance coverage, they mentioned. Their month-to-month Starlink invoice is $120 — a worth many can not handle, particularly since Congress sundown an earlier program that helped offset the price of high-speed plans for customers.
Meanwhile, the newest broadband program to attach rural Americans is ensnared in Trump administration coverage shifts.
The National Telecommunications and Information Administration, which administers this system, in April announced a 90-day extension for states to finalize their plans throughout a “comprehensive review” of this system.
West Viriginia Gov. Patrick Morrisey, a Republican, announced his state would take an extension. The transfer, although, doesn’t make a whole lot of sense, mentioned Evan Feinman, who left the company in March after directing the broadband program for the previous three years.
Calling the work already performed in West Virginia an “incredible triumph,” Feinman mentioned the state had accomplished the planning, mapping, and the preliminary number of firms. The plan that was in place would have introduced high-speed fiber traces to houses forward of schedule and beneath price range, he mentioned.
“They could be building today, and it’s just deeply disappointing that they’re not,” Feinman mentioned.
When Feinman resigned in March, he sent a lengthy email stating that the brand new administration needs to take fiber away from houses and companies and substitute it with satellite tv for pc connections. The transfer, he mentioned, can be dearer for customers and harm rural and small-town America.
Morrisey, whose workplace declined to reply to requests for remark, mentioned in his announcement that he needs to make sure West Virginia spends the cash in a fashion “consistent with program changes being proposed by the Trump Administration” and “evaluate a broader range of technology options.”
Commissioners from Grant County responded with a letter supporting fiber-optic cables slightly than satellite-based connections like these supplied by Elon Musk’s Starlink. Nationwide, 115 lawmakers from 28 states sent a letter to federal leaders stating that modifications may “delay broadband deployment by a year or more.”
For Adkins and others, the wait has been lengthy sufficient.
While legislators in Washington and throughout the nation bickered over the broadband program, Adkins went with out telephone and web. By late March, she mentioned, her 42-year-old son was more and more anxious, noting “you’re getting up in age.” He informed her: “Mom, move out, get off of that hill.”
Worst-Case Scenario
A couple of miles from Upper Mud River Road, previous the McDonald’s and throughout the street from the native library, Brian Vance sat in his downtown Hamlin, West Virginia, workplace. He mentioned his firm has been attempting to “build up there for a while.”
Vance is a common supervisor for Armstrong Telephone and Cable, a regional telecommunications supplier that competes with Frontier. He grew up locally, and fogeys of a highschool pal dwell off Upper Mud River. But he mentioned “it’s very difficult” to construct fiber alongside the rocky terrain to houses the place “you are hoping that people will hook up, and if they don’t, well, you’ve lost a lot of money.”
A 2022 countywide broadband assessment discovered that stringing fiber-optic traces alongside phone poles would value greater than $5,000 per connection in some areas — work that would want large federal subsidies to be possible.
Yet Vance mentioned Armstrong can not apply for the newest BEAD funding to assist finance connections. And whereas he likes that the federal authorities is “being responsible” by not handing out two federal grants for a similar space, Vance mentioned, “we want to see people deliver on the grants they have.”
If Frontier hadn’t already gotten federal funds from the sooner Trump program, “we definitely would have applied to that area,” Vance mentioned.
The 2022 evaluation famous the group’s economic system wouldn’t be sustainable with out “ubiquitous broadband.”
High-speed web brings extra jobs and fewer poverty, mentioned Claudia Persico, an affiliate professor at American University. Persico, who can also be a analysis affiliate with the National Bureau of Economic Research, co-authored a recent paper that discovered elevated broadband web results in a discount within the variety of suicides in addition to enhancements in self-reported psychological and bodily well being.
More than 30% of Lincoln County’s inhabitants reviews circumstances of melancholy, in response to knowledge from the Centers for Disease Control and Prevention. The price of opioid prescriptions distributed in Lincoln County is down about 60% from 2014 to 2024 — however nonetheless larger than the state common, in response to the West Virginia Board of Pharmacy.
Twenty % of the county’s inhabitants lives beneath the poverty line, and residents are additionally extra seemingly than the nationwide common to expertise coronary heart illness, diabetes, and weight problems.
Lincoln Primary Care Center provides telehealth providers reminiscent of digital medical data on a affected person portal and a pharmacy app, mentioned Jill Adkins, chief high quality and danger officer at Southern West Virginia Health System, which operates the clinic.
But due to restricted entry, solely about 7% of sufferers use telehealth, she mentioned.
Della Vance was a affected person on the clinic however mentioned she has by no means used a affected person portal. If she may, Vance mentioned, she would examine data on the child she is anticipating.
“You can’t really get on if you don’t have good service and no internet,” she mentioned. “It makes me angry, honestly.”
Vance and her husband, Isaiah, dwell off a gravel street that veers from Upper Mud River. There is a tall pole with black wires dangling throughout the street from their small residence. Pointing to the cables, Isaiah Vance mentioned he couldn’t get telephone service anymore.
Verizon introduced plans final 12 months to purchase Frontier for an estimated $20 billion. The deal, which have to be accepted by federal and state regulators, is anticipated to be accomplished in early 2026, in response to an investor’s press release.
In its federal merger application, Frontier acknowledged that it had taken on an excessive amount of debt after rising from chapter and that debt would make it troublesome to complete the work of putting in fiber to clients in 25 states.
In West Virginia, Frontier’s Allison Ellis wrote in March 3 testimony, in search of approval for the merger from state regulators, that Verizon will honor the agricultural program commitments. The earlier month, in February, Frontier filed a motion with the state public service fee to maintain the variety of clients utilizing copper traces and the sooner fiber-optic traces confidential.
Kelly Workman, West Virginia’s broadband director, mentioned throughout a November interview that her workplace has requested federal regulators for “greater visibility” into Frontier’s rural program building, significantly as a result of these places can not win the Biden-era infrastructure cash when it is accessible.
“The worst-case scenario would be for any of these locations to be left behind,” Workman mentioned.
‘Money Cow’
Frontier’s progress putting in fiber-optic traces and its unreliable service have pissed off West Virginians for years. In a 2020 letter to the FCC, U.S. Sen. Shelley Capito (R-W.Va.) cited “the failure of Frontier to deliver on promises to federal partners” and its “mismanagement” of federal {dollars}, which compelled the state to pay again $4.7 million due to improper use and missed deadlines.
Michael Holstine, a longtime member of the West Virginia Broadband Enhancement Council, mentioned the corporate has “just used West Virginia as a money cow.” Holstine has been combating for the development of fiber-optic traces in Pocahontas County for years. “I really just hope I get it before I die.”
Across the state, individuals like Holstine and Adkins are looking forward to up to date networks, in response to interviews in addition to letters launched beneath a public data request.
Chrissy Murray, vice chairman of Frontier’s exterior communications, acknowledged that the corporate was “building back our community efforts” in West Virginia after a chapter submitting and reorganization. She mentioned there was a “notable decline” in shopper complaints, although she didn’t present particular numbers.
Murray mentioned Frontier constructed fiber-optic cables to twenty% of its designated rural funds places as of the top of 2024. It has additionally invested in different infrastructure tasks throughout the state, she mentioned in a January e-mail, including that the corporate donated high-speed fiber internet to West Virginia University’s rural Jackson’s Mill campus.
According to data tracked by a federal agency, Frontier has related 6,100 — or fewer than 10% — of the greater than 79,000 places it was awarded within the Rural Digital Opportunity Fund program.
The FCC oversees the agricultural fund. The company didn’t reply to a request for remark. Frontier expects to obtain $37 million yearly from the company by way of 2032, according to a federal filing.
In April, a new batch of letters from West Virginia residents filed as “support” for Frontier’s merger with Verizon appeared within the state regulatory docket:
“My support for this case depends on whether Verizon plans to upgrade or replace the existing Frontier infrastructure,” wrote one buyer in Summers County, within the far southern nook of the state, including, “West Virginians in my neck of the woods have been held hostage by Frontier for a generation now because no other providers exist.”
A buyer from Hardy County, within the state’s northeastern nook, wrote: “This is [a] move by frontier to to [sic] escape its responsibility to continue services.”
‘Deep-Rooted’
Adkins moved to Upper Mud River along with her husband, Bobby, many years in the past.
For years, Bobby and Ada Carol Adkins ran a “carry-out” on Upper Mud River Road. The outdated constructing remains to be on the rock quarry simply down the hill and across the curve from the place her trailer sits.
It was the kind of retailer the place locals stored a tab — which Bobby handled an excessive amount of like a “charity,” Adkins mentioned. They bought cigarettes, beer, bread, baggage of chips, and a few meals objects like potatoes and rice. “Whatever the community would want,” she mentioned.
Then, Bobby Adkins’ “health started deteriorating and money got tighter,” Adkins mentioned. He died at 62 years outdated.
Now, Adkins mentioned, “I’m having kidney problems. I got arthritis, they’re treating me for high blood pressure.”
Her physician has begun sending notes over the web to refill her blood strain drugs and, Adkins mentioned, “I love that!”
But Adkins’ web was out once more in early April, and she will’t afford Starlink like her neighbors. Even as Adkins mentioned she is “deep-rooted,” her son’s request is on her thoughts.
“I’m having health problems,” Adkins mentioned. “He makes a lot of sense.”
KFF Health News is a nationwide newsroom that produces in-depth journalism about well being points and is likely one of the core working applications at KFF—an impartial supply of well being coverage analysis, polling, and journalism. Learn extra about KFF.
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