Two-thirds of the Americans who are underserved by the nation's health care system are in rural America and would benefit from changes proposed in reform proposals now before Congress, Secretary Kathleen Sebelius of the Department of Health and Human Services said Tuesday.
In a telephone conference call with reporters from rural parts of the country in which she outlined a new report on the status of health care in rural America, Sebelius said that health insurance reform -- including the provision of a public option or other alternative to private insurance -- would provide individuals, farmers and small businesses with more choices and better coverage.
"The system we have really isn't working for the 50 million" Americans who live in rural areas, she said.
"A lot of them are self-employed or work for family businesses, including family farms," Sebelius said, and are disadvantaged by "not many choices and extremely high prices and rules that don't protect consumers."
Two-thirds of the nation's underserved health care consumers are in rural areas, she said, and are more likely than urban dwellers to face transportation issues and miss critical preventive care, such as pap smears and cancer screenings.
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Sen. Kay Hagan, D-N.C., who participated in the conference call, said that rural areas in her state and around the country face higher rates of chronic diseases, including diabetes, arthritis and heart disease.
"We need to be doing something about these statistics," she said.
Reform will provide grants and credits "to be sure we have more health care providers ... in these underserved areas" and "allow rural small businesses to have affordable insurance for their employees," the secretary said.
Public option
Asked about the controversial public option, which would establish a government-run insurance option to compete with private insurance, Hagan said she supports "a backstop option for people who don't have employer-sponsored insurance" and she "will be looking very closely" at that part of the reform bill.
Sebelius noted that Senate Majority Leader Harry Reid announced Monday that he will include a version of public option in the bill he brings to the floor and that four of the five congressional committees that tackled health insurance reform included an "alternative to the private insurance market to make sure choices" are available. In the fifth panel, the Senate Finance Committee, Sen. Kent Conrad, D-N.D., was among moderate Democrats who developed an alternative based on cooperatives.
"The biggest winners (if reform legislation includes a competitive alternative) are likely to be those in rural America," Sebelius said, noting that in her home state of Kansas, "one company controls two-thirds of the marketplace, including most of rural Kansas."
Sebelius did not address how reported changes to a public option feature in the Senate bill -- including a provision that would allow individual states to opt out of public option -- might affect its chances of gaining the needed 60 votes or how it might play in rural states.
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The new report states that "millions of rural Americans have limited access to a primary health care provider," and "with the recent economic downturn, there is potential for an increase in many of these health and access disparities that are already a problem in rural communities."
Rural Americans "pay for nearly half of their health care costs out of their own pocket," according to the report, and one farmer in five is in medical debt.
"There were only 55 primary care physicians per 100,000 residents in rural areas in 2005, compared with 72 per 100,000 in urban areas. The rate decreases to 36 per 100,000 in isolated, small rural areas. There are nursing shortages as well, with less than half as many nurses per capita in isolated rural sareas than in urban areas."
The full report is at www.healthreform.gov/reports/ruralamerica/index.html
Reach Haga at (701) 780-1102; (800) 477-6572, ext. 102; or send e-mail to chaga@gfherald.com .
