Wednesday, September 16, 2009

A Democratic Party that's serious about ending the Republican lock on rural votes will get serious about the healthcare crisis and they will pass reform that will proper cost controls and low-income premium support because Health Insurance is elusive in Rural America.

Rural Americans are disproportionately unable to afford health insurance coverage and often resort to none, Many rural residents are self-employed or work for small businesses and farms so spreading the risk is not possible, and individuals are left with increasing deductibles.

Doctor shortages, increased small businesses, the risks associated with farming and ranching, and a rural population that tends to be older and sicker severely limits coverage. "The two biggest determinants of un-insurance in this country are the owner of a small business or employee of a small business. And that's more common in rural areas."

Health insurance may be even more necessary in rural areas because lack of coverage and lack of access means preventive care is neglected. Rural residents then only seek medical care when a small health problem becomes severe. Health insurance is killing rural America … We can put people on the moon. We can go up and fix this Hubble satellite that we have up there. And we can't have health care for all these people. It's ridiculous." Ranchers, Farmers And Individual Insurance

Also common in rural areas are farmers and ranchers, who disproportionately depend on individual insurance plans. I would have to guess that one-third of farmers and ranchers depend on individual insurance. That's four times the rate for everyone else.

But the places where they depend on getting their insurance are becoming rarer and rarer, which means they'll have to depend on the individual market, which costs more and provides less coverage."

Some farmers and ranchers have off-farm jobs that provide insurance. But those jobs are harder to come by in this economy. So, many are forced to buy coverage with high premiums or high deductibles or both.

Here are some fast facts On Rural Health Insurance from the National Rural Health Association
Percentage of noncorporate farmers and ranchers with health insurance: 95

Percentage of all Americans with health insurance: 84.7

The likely rate of underinsurance in rural areas compared with cities and suburbs: double

Percentage of the rural poor covered by Medicaid: 45

Percentage of the urban poor covered by Medicaid: 49

Percentage of all Americans dependent on individual health insurance policies with reduced benefits and high deductibles: 8

Percentage of farmers and ranchers dependent on individual health insurance policies: 33

Percentage of farmers and ranchers carrying medical debt: 20

Percentage of all Americans carrying medical debt: 28

Percentage of rural workers who have jobs with small businesses: 50

Percentage of urban workers who have jobs with small business: 37

The likely rate of having no insurance for small-business workers compared with all workers: double

Percentage of non-elderly urban workers insured at work: 72
Percentage of non-elderly rural workers insured at work: 61

Percentage of U.S. physicians working in rural America: 10

Percentage of U.S. population defined as rural: 25

Number of dentists practicing in urban areas per 100,000 people: 60

Number of dentists practicing in rural areas per 100,000 people: 40
Rural America presents a unique set of challenges for health care reform. Rural people have less access to health networks and health care providers, greater rates of disability and chronic diseases and higher use rates of all public health care programs. And largely as a result of higher rates of self-employment and small business employment, rural Americans have lower rates of employer-provided benefits and are more likely to be underinsured or uninsured for longer periods of time. The 50 million people in rural America are most in need of health care system reform and have much to contribute to any reform debate.

Health care is also a major barrier to rural economic development that creates genuine opportunity and reduces poverty. Microenterprise and small business development is the most effective path in many communities for low and moderate income rural people to pull themselves out of poverty. But if small entrepreneurs cannot gain affordable access to health care for themselves or their employees, that path out of poverty is blocked. Any hope of building genuine economic opportunity for struggling rural Americans through entrepreneurship must be accompanied by reforming the health care system in a way that benefits both small business owners and their employees.

The demographics and socio-economic conditions of rural America are also fundamental challenges to health care issues. Consider this right here:

Rural Americans are older and have lower incomes compared to the rest of the nation. The median age of rural Americans is 40 compared to 36 for urban residents. Median household income of rural residents is only 77 percent of non-rural households. This demonstrates greater need in rural communities, and confirms why rural residents – particularly those in remote rural areas – are more dependent on public forms of health insurance and health care.
Rural children are the Americans most need in need of health care system reform. For the most recent year for which data is available, 32 percent of rural children are covered by State Children’s Health Insurance Programs (SCHIP), compared to 26 percent of non-rural children. Nearly half of children in rural areas live in low-income families (again, a higher rate than non-rural children), and 44 of the 50 counties with the highest percentage of uninsured children are rural counties.
For example, a 2007 study by the South Carolina Rural Health Research Center showed that nationally rural children aged 10 to 17 have obesity rates nearly 15 percent higher than urban children (like here in Macon County), and that nearly a third of rural children aged 10 to 17 are overweight or obese (again, a higher rate than urban children).
National studies have also found that adult obesity is more prevalent in rural adults and that rural adults are less physically active than urban adults.
The 2007 South Carolina study also found that nationally rural children are at higher risk or comparable risk to urban children in weight-related health behaviors found to be statistically significant determinants of being overweight and obese, namely electronic entertainment media usage (higher rates than urban children), after school activity participation and inactive mothers (with rural and urban children having nearly equal rates in the final two).
Some parts of rural America are characterized by “bookend” generations. In our research of the socio-economic conditions of the Midwest and Great Plains, we found that rural areas have higher percentages of their population in two age cohorts when compared to non-rural areas – children under 18 and adults over 65. These age cohorts are, in general, most in need of health care and more likely to be recipients of public health insurance and health care services.
The population sub-groups most at risk of being uninsured – thus, most at risk of bad health outcomes – are those most likely to live in rural areas. According to recent Nebraska-based research by the Nebraska Center for Rural Health Research, which I think is on the money when it comes to Rural Health Insurance the population sub-groups most at risk of being uninsured are Hispanics, low-income individuals and families, small business employers and employees and the self-employed. Each comprises a significant (and in the case of Hispanics, a growing) segment of the rural population.
Health care in rural communities has many aspects – access to physicians, dentists, nurses, and mental health services; the financial circumstances of rural hospitals; federal rules concerning Medicare reimbursement rates and the impact on rural hospitals and healthcare professionals; and the consequences of all of these on the health of rural people. Here are some principles that ought to be included in a Healthcare Reform Bill:
Affordable to individuals and families – the primary reason given by businesses, employers, and people for lacking health insurance benefits is cost; the affordability challenge is even greater for low- and moderate-income individuals and families.

Affordable and sustainable for society – any reform proposal must be cost-effective and efficient, both to the society as a whole and to individuals and families.
Enhance health and well-being – coverage should include those services that provide for long-term health.
Continuous – gaps or interruptions in coverage lead to inadequate care and worse health outcomes. This is particularly important for rural people since rural residents lack health insurance for longer periods; any solution must have a long-term focus to assist rural people.
Universal – because of the long-term health and societal consequences of being uninsured and underinsured, health care coverage should be available to everyone.
If you are living in some of the poorest counties here in the state of Georgia like Randolph, Macon, Hancock, Baker, Quitman, Glascock counties for example, Healthcare Insurance Reform is essential. I know here in Macon County, there are high number of folks that do not have health insurance, especially among young people.

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