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(This content was originally published in Cooperative Connections Newsletter)
Raise your hand if you are exhausted from the never ending news coverage, heated campaign promises, and scores of misinformation being broadcast pertaining to health care reform. (It’s okay…go ahead!) The complexities and confusion surrounding the recent Supreme Court decision aren’t lost on anyone and the confusion is compounded by election-year rhetoric and posturing that dismantles communication and banishes progress. Since we’re not running for office, we’ll give it to you direct—and with a sprinkling of enthusiasm for the role of rural health networks in the changing healthcare landscape.
The 5-4 Supreme Court ruling upholding the Affordable Care Act determined that the individual mandate, the most controversial part of the ACA, was a valid exercise in Congress’s power to tax (although it is not a valid exercise of the Commerce Clause, which was the clause that many opponents were expecting would deem the mandate unconstitutional). In addition to upholding the policies and provisions that are scheduled to take effect in the coming years, the ruling solidified that the money, payment modifications and workforce modifications that have already gone into effect will not be rescinded.
Okay, so that much you know, but what does all of this mean for rural? There are a variety of rural-specific provisions within the ACA that will move forward as scheduled because of the ruling. A compressive list of the rural-relevant provisions can be found on the website of the National Rural Health Association (NRHA). Because it’s a long list, we’ll walk through a few of them, and why they are critical to the success of rural health care facilities.
Approximately 25% of the country’s population resides in rural areas however, there are more rural Americans who are uninsured and underinsured than their urban counterparts.[1] The ACA contains provisions for the guaranteed issue and coverage renewability, along with the prohibition of exclusions based on pre-existing conditions. This will help to ensure that more citizens are covered. Increased coverage, however, does not equal access and workforce shortages will continue to be felt acutely in rural communities. Currently, less than 10% of physicians serve the country’s rural population and with increased insurance coverage, the strain felt by providers will be even greater. Included in the ACA are investments in the National Health Service Corps which will assist medical students with scholarships and loan repayment programs should they decide to practice in rural communities. The ACA also designates critical access hospitals, for the first time, eligible sites for Corps assisted physicians. The ACA also calls for increased funding for Area Health Education Center’s (AHEC) to improve the pipeline of potential future health care leaders, although the House of Representatives recently voted AHEC out of the running for funding for next year. (Hopefully the Senate will reinstate funding.) The improvement in the rural healthcare workforce will be vital to support the higher rates of chronic disease exhibited in rural communities[2]. With an increased focus on primary care and prevention, the ACA incentivizes patients to seek care before their condition becomes chronic or requires treatment from a specialist.
Networks will play a crucial role in all of the health reform models as rural providers and hospitals become valuable players in both accountable care organization (ACO) and Medical Home demonstration projects. The development and participation in ACO and the Medical Home concept all require collaboration, staff and resource sharing, collective innovation, and willingness to challenge the status quo. Increasingly, rural hospitals will have to prepare themselves for a challenging future, based on value, quality transparency, and physician-hospital partnerships while maintaining a successful business model in the current system. It’s is somewhat like navigating two canoes downstream with a leg in each canoe…it could end up being very painful!
[1] Lenardson, J., Ziller, E., Coburn, A. & Anderson, N. Profile of Rural Health Insurance Coverage: A Chartbook. Rural Health Research and Policy Centers. June 2009.
[2] Glasgow, N., Johnson, N., Morton, L. Critical Issues in Rural Health. Wiley-Blackwell. May 2004.
A special thank you to the National Rural Health Association for their breakdown of the rural-relevant provisions in the ACA.
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