Rural health attracts reform attention
July 31, 2009
OMAHA (DTN) – The Obama administration is putting more energy into the message that health-care reform matters to rural America, where there likely is more skepticism of a possible new government program, as well as some major health-care challenges.
With the administration’s hope to get a vote on health care now delayed at least until fall – which allows more time for critics to build public opposition – administration officials have started to fan out into the countryside to attack the status quo.
Rather than the Health and Human Services secretary speaking on health reform Thursday at a Nashville hospital, it was Secretary of Agriculture Tom Vilsack who talked about why rural Americans should care.
“It is an issue that affects farmers and ranchers in a very significant way,” Vilsack said in a phone interview. “There are just a whole series of issues here that affect rural communities, because if you don’t have health care, you don’t have good access to health care,” he said.
“You can’t afford health-care insurance. You have a hard time as a community attracting economic opportunity, manufacturing facilities and off-farm income opportunities, which in turn affects the number of farmers we have who can help keep their farms. So it’s sort of a cyclical dilemma,” said Vilsack.
Also, rural residents pay on average about $1,000 more annually on insurance premiums, despite earning about $7,400 less per household.
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Vilsack said 55 percent of farmers list other occupations as their primary jobs, because they work off-farm largely to buy health insurance. People in small towns of fewer than 2,500 people also have higher rates of uninsured people than urban centers.
“People want some action, they want some comprehensive response to these problems, because they realize the country will not be competitive economically if we don’t get our health-care costs under control and we don’t get people insured,” said Vilsack.
Vilsack’s Nashville visit on Thursday came a day after President Barack Obama held a forum in rural Virginia. The prior weekend, more than 2,700 people showed up at a roving free health clinic near Bristol, VA. Throughout August, Vilsack and others will integrate health-care talks more deeply into the administration’s rural tour stops in at least eight states.
Rural workers also are less likely to have health insurance, because a higher percentage of rural residents work for smaller businesses. A study by the Center for Rural Affairs said that about 50 percent of all rural residents work for companies with fewer than 20 employees, companies that usually have limited insurance options and get clobbered with higher premiums when one worker faces high medical expenses.
Another group, the Access Project, recently cited a study that 91 percent of farm households in seven states in the upper Midwest and Plains had insurance. The median amount spent on health care was $7,100 a year. But 39 percent of farmers who bought insurance outside a group plan paid a median cost of $11,500 a year. Nearly one-quarter of the farmers surveyed said that healthcare expenses contributed to personal financial problems. One reason farmers pay disproportionately higher premium costs is they also work to much older ages than the rest of the population.
John Hansen, president of the Nebraska Farmers Union, said one issue that faces farmers who are insured through a spouse’s off-farm job is that those farmers may not actually be covered. Sometimes fine print in the policy rejects coverage for jobs more hazardous than the job of the primary person covered.
“We have run across it, not a lot, but enough it’s on our radar screen,” Hansen said. “When you look at the amount of money ag pays for healthcare, it’s a lot, and we still have a whole bunch of folks who aren’t covered.”
Hansen said people believe they are covered, but aren’t because of all the riders and exclusions.
The American Farm Bureau Federation opposes a mandate that requires individual coverage, but supports continuing the tax deduction for self-employed people. In a column this week, Farm Bureau President Bob Stallman said a Farm Bureau task force examining the federal debt has issued a report to acknowledge “the toll that health care is taking on our budget is the biggest challenge identified by the task force.”
The Farm Bureau task force recommended incentives be created to centralize medical records and focus on preventive care. The Farm Bureau recommended federal vouchers for people to purchase a “bare-bone, private insurance policy.”
Sen. Tom Harkin, D-IA, who has spearheaded wellness issues on the Senate Health, Education, Labor and Pensions Committee, said Thursday he thinks the final bill would address several key challenges. First, the reform bill should prohibit insurers from discriminating for pre-existing conditions. Currently, insurers can refuse coverage because of medical history.
The bill would also limit “exorbitant” deductibles or co-pays, Harkin said. Further, the bill would eliminate caps on coverage either annually or lifetime. Insurers would also be required to renew plans for people. Harkin also said there would be no co-pays or deductibles for preventive-care visits such as mammograms or other such tests.
Sen. Kent Conrad, D-ND, told National Public Radio Thursday there are not enough votes in the Senate to create a plan that would allow people the option to sign up for a government program – the public option. Harkin disagrees with Conrad’s assertion.
“We will have, I believe, in the end, a public option,” Harkin said. “A national kind of a plan that if you don’t like what you got … you can switch.”
Harkin said the end result will be that people will be able to shop for different plans, just like members of Congress do now.
Besides trying to find insurance options, any health-care reform has to find a way to get more country doctors. The National Rural Health Association cites that rural America has just 10 percent of the country’s doctors, despite making up 25 percent of the nation’s population.
The Obama administration recently handed out $220 million in grants to draw more physicians and other health-care providers to rural areas across the country. The Senate bill provides student-loan forgiveness for people who want to become family practitioners.
“I can honestly say the way the bill is sort of shaped now, and the way I think it’s going to wind up, this is going to be a good deal for small businesses and independent farmers and people like that who are in the small pool and places like that,” Harkin said.