Rural health care access has challenges

Rural health care access has challenges

Cost-sharing and limiting out-of-pocket medical expenses will be crucial for many rural families under new Affordable Care Act.

RURAL Americans face unique barriers with regard to health care services. At the latest meeting of the White House Rural Council, Agriculture Secretary Tom Vilsack said there was a special focus on expanding rural access to health care.

New investments in medical facilities, expanded information technology (IT) and stronger veterans' health care services can help meet these challenges, Vilsack said. He anticipated that more announcements would be coming in the weeks and months ahead to strengthen rural health care capacity.

Last week, the U.S. Department of Health & Human Services awarded $4 million through its Rural Health Information Technology Program to recruit, educate, train and retain health IT specialists in rural America. These awards will allow 15 organizations across the nation to train more health care workers in the specialized technology needed to better manage records and deliver remote services in rural America.

"As these services are expanded, more folks in rural areas will see streamlined management of health care records," Vilsack said. "Service will be more efficient, and it will be easier for specialists to help provide remote consultations through innovative new technology."

Rural Council members also discussed ongoing efforts to expand health care services to veterans, in partnership with community organizations.

Right now, the Department of Veterans Affairs is accepting applications under its Rural Veterans Coordination Pilot. This effort seeks to partner with five organizations, for two years each, to help reach out to rural veterans and their families with information on programs that could help them.

 

Health care options

Beginning Oct. 1, Americans will face a new world of health insurance purchasing, Jon Bailey, director of rural research and analysis at the Center for Rural Affairs, wrote in a new report from the center.

The report examines how the Affordable Care Act will provide tax credits and subsidies through new health insurance marketplaces to make health coverage more affordable for many Americans. The report summarizes these provisions, how they will work and their importance to rural Americans.

"As individuals and families begin to make decisions on what to purchase in health insurance marketplaces, it is important for them to realize that cost-sharing assistance exists and what it means to their circumstances," Bailey said. "It is also incumbent on those making comparisons between current health plans and marketplace health plans to include cost-sharing assistance in comparisons and the positive role it can have for individuals and families."

According to Bailey, a major calculation for many as they begin to research and purchase insurance through the health insurance marketplaces will be the cost — the amount in premiums individuals and families must pay for their choice of coverage (Table).

However, the Affordable Care Act is making it difficult to make "apples to apples" comparisons because the health plans under the new law are different from what is available now.

"The affordability of insurance will determine the success of the primary goals of the Affordable Care Act — enrollment in health insurance exchanges to increase insurance coverage and reduce the nation's uninsured," Bailey said.

Bailey further explained that rural Americans are responsible for nearly 22% more of their total health care costs (premiums and out-of-pocket costs) than urban or suburban residents are.

Also, a greater proportion of rural residents struggle with chronic diseases and conditions — arthritis, asthma, heart disease, diabetes, hypertension and mental disorders — than urban residents do but receive fewer regular medical checkups and routine diagnostic tests than they medically and statistically should.

Cost-sharing will allow many rural Americans to obtain the tests and checkups they should at a lower cost, thus potentially enhancing their long-term health, the report suggests.

"As we have documented in a series of reports, many of the provisions of the Affordable Care Act are particularly applicable to rural people because of rural demographics as well as the unique health care challenges and economic circumstances of rural areas," Bailey explained.

"Likewise, cost-sharing and limiting out-of-pocket medical expenses will be crucial for many rural families," he continued. "With generally lower rural incomes combined with higher uninsured rates, more rural residents are likely to be eligible for cost-sharing assistance in the exchanges."

The result of cost-sharing assistance is that lower-income consumers can purchase insurance in the health insurance marketplace that has a much higher value, the report notes. Overall, the process will allow individuals and families to enroll in and purchase health care plans with lower deductibles, co-payments or total out-of-pocket costs.

"That is what makes the exchanges — the new health insurance marketplaces — so vitally important to rural Americans," Bailey concluded.

Find the report at http://files.cfra.org/pdf/ACA-subsidies.pdf.

 

Premium tax credits under the Affordable Care Act

-Income-

-Required premium contribution-

% of

Annual

% of

Monthly

poverty level

$ amount

income

$ amount

Family of four

 

 

 

100-133

23,550-31,322

2.0

39-52

133-150

31,322-35,325

3.0-4.0

78-118

150-200

35,325-47,100

4.0-6.3

118-247

200-250

47,100-58,875

6.3-8.1

247-395

250-300

58,875-70,650

8.1-9.5

395-559

300-350

70,650-82,425

9.5

559-652

350-400

82,425-94,200

9.5

652-745

Individual

 

 

 

100-133

11,490-15,282

2.0

19-25

133-150

15,282-17,325

3.0-4.0

38-57

150-200

17,325-22,980

4.0-6.3

57-121

200-250

22,980-28,725

6.3-8.1

121-193

250-300

28,725-34,470

8.1-9.5

193-272

300-350

34,470-40,215

9.5

272-318

350-400

40,215-45,960

9.5

318-364

Source: Center for Rural Affairs, using data from Center on Budget & Policy Priorities.

 

Volume:85 Issue:38

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