Recess Tips & Rural Health Care Talking Points
Erin Mahn Zumbrun
Your Senators and Representatives are back in the district and many are holding town halls. Take advantage of the Congressional recess by reaching out to your elected official to discuss rural health issues that are important to you.
Talking points to tell your member of Congress:
- Health care reform has not worked in rural America. Lack of plan competition in rural markets, exorbitant premiums, deductibles and co-pays, the co-op collapses, devastating Medicare cuts, and the lack of Medicaid expansion have created a health care access and coverage crisis in rural America.
- 70% of the 650 counties with only one insurer on the exchange are rural for 2017, and based on what we already know this is going to be worse in 2018.
- Rural residents average per month cost exceeds urban ($569.34 for small town rural vs. $415.85 for metropolitan) and as market completion decreases these costs will rise further.
- 80 rural hospitals have closed since 2010. One in three rural hospitals is financially vulnerable. These closures would result in 11.7 million patients losing access to their local emergency room; 99,000 direct health care jobs will be lost in rural communities; and $277 billion in GDP to rural communities will be lost, exacerbating rural America's economic decline
1. Medicaid - Though most rural residents are in non-expansion states, a higher proportion of rural residents are covered by Medicaid (21% vs. 16%). For rural hospitals, it accounts for 15% of gross revenues.
- The 3 fixes that must be included in any modification to the Affordable Care Act are:
• Health care reform must protect the rural safety net by providing an option to a state to receive an enhanced reimbursement to account for the cost of providing care in a rural area. This will help maintain access to care for rural communities by limiting the loss to the hospital of providing care to the most vulnerable patients.
2. Market Reform – Forty-one percent of rural marketplace enrollees have only a single option of insurer, representing 70 percent of counties that have only one option. This lack of competition in the marketplace means higher premiums. Rural residents average per month cost exceeds urban ($569.34 for small town rural vs. $415.85 for metropolitan).
• Health care reform must address the fact that insurance providers are withdrawing from rural markets. This is especially concerning since rural Americans are more likely to need to purchase insurance on the individual market. Despite record profit levels, insurance companies are permitted to cherry pick profitable markets for participation and are currently not obliged to provide service to rural populations. In the same way that financial service institutions are required to provide services to underserved neighborhoods, profitable insurance companies should be required to provide services in underserved communities.
3. Stop Bad Debt Cuts to Rural Hospitals – Rural hospitals serve more Medicare patients (46% rural vs. 40.9% urban), thus across the board Medicare cuts do not have across the board impacts. The fact that according to MedPAC "Average Medicare margins are negative, and under current law they are expected to decline in 2016" has led to 7% gains in median profit margins for urban providers while rural providers have experienced a median loss of 6%.
• Congress must reverse the bad debt cuts they made to rural hospitals.
Here are some tips:
1) Contact the offices of your members of Congress and schedule a meeting to let them know the health care issues impacting their constituents. Share NRHA materials, but personalize it to tell them about your facility and the issues you and your community are facing.
2) Invite your member of Congress and staff to tour your facility.
3) Attend a town hall. Members of Congress list these on their webpage and often times on Facebook or Twitter as well. If not, call the office and ask.
4) And remember, to have an "ask." Members of Congress want to know how they can help you and your facility.