Why Rural America Needs Health Reform
Rural Problem: Rural Americans are uninsured and underinsured at higher rates than their urban counterparts.
• In the smallest and most remote rural areas, the uninsured rate is 23% compared to an urban rate of 19%.
• A greater proportion of self-employed workers living in rural, areas are uninsured (40%), compared to self-employed workers in urban (32%) areas.
Health Reform Solution: Health reform legislation will improve accessibility and affordability of health coverage for all rural Americans.
• Provisions for the guaranteed issue and renewability of coverage and the prohibition of pre-existing condition exclusions will ensure that insurance coverage is available to all Americans, even if they are already sick.
• Provisions to control insurance companies’ rating practices, prohibit annual or lifetime limits on benefits and place a cap on consumer cost sharing will keep health costs under control for rural Americans.
Rural Problem: Rural Americans are sicker, with higher rates of chronic disease.
• Conditions such as hypertension, high cholesterol, diabetes, chronic bronchitis, stroke and arthritis are more prevalent among rural populations than urban. Some of these conditions are also risk factors for other diseases.
Health Reform Solution: Health reform legislation improves primary care and preventive measures.
• Provisions to prohibit cost-sharing for preventive services will encourage individuals to seek care early for better treatment of their conditions.
Rural Problem: Rural America is already experiencing a health care workforce crisis.
• Less than 10% of physicians serve 25% of the country’s population.
• When more individuals have health insurance and are able to afford health care, the strain on the existing providers will be even greater.
Health Reform Solution: Health reform legislation will develop a robust rural health care workforce.
• A strong investment in the National Health Service Corps provides additional funding for scholarships and loan repayments for medical students who choose to practice in underserved areas.
• Changes to Medicare Graduate Medical Education funding can influence residents’ future career choices. Exposure to rural areas during residency is significant predictor for future rural practice.
• Increased support for Title VII and VIII workforce programs is an investment in the long term health of the rural provider pipeline.
Rural Problem: Rural hospitals and providers struggle financially because of inequitable Medicare reimbursement rates, low patient volumes and other reasons.
• The average payment per discharge for rural hospitals in FY 2009 was $7,432; for urban hospitals the average payment per discharge for the same time period was $10,274.
• Some categories of rural hospitals receive special Medicare reimbursement to protect them from financial losses as a result of serving Medicare patients and help them remain in business, serving the community.
Health Reform Solution: Health reform legislation is an opportunity to improve rural Medicare reimbursement rates and strengthen rural safety net providers.
• A number of changes are necessary to ensure that provisions that help rural providers continue to do so and that new provisions are created to better the system.
• For more information on specific rural Medicare provisions needed in health reform, please visit http://www.ruralhealthweb.org/go/left/policy-and-advocacy/health-reform or contact the NRHA Government Affairs Office at 202-639-0550.
Rural America needs health reform. These solutions or variations for rural America are included in a health reform bill currently in Congress. Congress must ensure that health reform works for rural America. For more information about why health reform is important for rural, please contact the NRHA Government Affairs Staff at 202-639-0550.