Access to treatment is primary concern for rural Americans

Even if every family in rural America currently owned health insurance, the crisis would be far from over because of the severe shortage of medical professionals outside urban centers. In fact, less than 10 percent of physicians serve 25 percent of the country’s population who live in rural regions of the country. Other medical professionals, including dentists, are also in short supply and their numbers continue to dwindle.

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I am often asked by my colleagues from larger urban populations why access is such a problem for many smaller communities. Having had the honor of representing rural counties in South-central Kansas, I know how difficult it can be to attract healthcare providers to our small towns. Unfortunately, the federal government is often an accomplice in a system that does not make it financially viable for providers to cover the costs of providing quality healthcare.

For years we have been calling for the elimination of barriers within the federal government that keep us from improving access to healthcare. The Medicare Modernization Act of 2003 was a good first step in providing many important provisions tailored to assist rural healthcare providers maintain  coverage; however, hospitals, clinics, nursing homes and other centers of care too often struggle to keep their doors open.

Healthcare costs, the root of all our healthcare problems, are largely driven by government interference or lack of attention. Many people do not realize that the federal government is currently the single largest insurer in the nation — controlling about 47 percent of the healthcare system between Medicare, Medicaid, veterans’ health insurance and TRICARE. What this means for those outside these programs is that Big Government often dictates the market through choices it makes for treatment coverage.

The cost of medicine is then driven up as more and more federal mandates have to be managed by providers, which takes additional time away from patient care. The Kansas Hospital Association estimates that for every hour of care, 1.1 hours is required to comply with paperwork requirements — mostly from the federal government.

Government reimbursement rates for providers pose an even greater barrier to quality rural healthcare. Across the spectrum — from doctors to hospitals to clinics — providers are only reimbursed between 20 and 80 cents for every dollar spent providing the healthcare, depending on the type of treatment or therapy. With the federal government monopolizing nearly half of the healthcare system to begin with, the remaining 53 percent who have private insurance end up footing bills for the inadequate reimbursements.

The reimbursement can be even less in rural areas where the average payment per discharge for rural hospitals is $7,432 compared with urban hospitals who receive $10,274 on average. Rural providers often do not have the private dollars needed to cost shift to make up for the shortfall in government reimbursements.

Still, many providers across the nation have had to make the difficult decision to refuse new Medicare and Medicaid patients in order to prevent bankruptcy. A recent sampling by the University of Kansas Medical School of family practitioners in Wichita found that of the respondents, 22 percent of family doctors are no longer taking new Medicare patients. This has left many seniors struggling to find a doctor.

The more we increase the role of the federal government in providing healthcare — such as what Speaker Nancy Pelosi (D-Calif.) and her allies did with the SCHIP expansion earlier this year — the harder it is for providers to stay in business.

Seniors are not alone — most rural communities face a shortage of providers. Families are not receiving the basic and preventative care needed to stay healthy and live a productive life. Dental care, vision care, and specialty care are rare. For example, often there is only one specialist in a rural state who can treat disorders such as juvenile arthritis. As a result, families are forced to drive long distances to seek specialized care. When there is a medical crisis, access becomes even more serious.

In order to improve access to quality medical care in rural America, we need to start with three basic reforms. First, the federal and state government should reimburse providers for the full cost of the care so medical professionals can do their job of curing and healing. Secondly, the nationwide dearth of general practitioners is felt even more acutely in rural areas. Investment in programs to help repay the enormous debt incurred through medical school will make it financially feasible to enter general practice and provide care in smaller towns.

Finally, the federal government should stop picking winners and losers with its coverage decisions. For instance, rural pharmacies are being driven out of business by Medicare and Medicaid’s focus on mail-order drugs. Pharmacists, rural clinics, and family doctors are the first responders, and we should be supporting them rather than making it harder for them to survive.

The reforms needed to help solve the healthcare crisis in rural America are also ones that will improve healthcare delivery to the rest of the nation.

Without a handle on exploding costs or a recognition that we need to focus on training new practitioners, the access problems plaguing rural America will only get worse.


Tiahrt is a member of the House Appropriations Committee and ranking member of the Labor, Health and Human Services, Education and Related Agencies Subcommittee.