Sebelius, U.S. senator: Health reform vital for rural America

U.S. Health and Human Services Secretary Kathleen Sebelius teamed with U.S. Sen. Kay Hagan (D-N.C.) on Tuesday to pitch health care reform as one of the few remaining ways to level the playing field for many Americans who reside in rural areas.

“While Kansas and North Carolina have a few little rivalries going on, [Hagan and I] have had a great time working together on health care issues, and particularly for rural citizens in this country because both of us come from states with a significant rural population,” Sebelius said.

The conference call with reporters was held in conjunction with the release of a new report by Sebelius’ office. The report, titled “More Choices, Better Coverage: Health Insurance Reform and Rural America,” documents many of the challenges faced by the estimated 15 million rural residents who seek health care insurance in the current system.

“A lot of rural Americans are self-employed or work for small businesses, including family farms,” Sebelius said. “A lot of them have to buy insurance on the individual market where they don’t have many choices and they have extremely high prices and rules that don’t protect consumers. Even when they do secure insurance, many folks in rural America then have difficulty finding a doctor. Two-thirds of the under-served community in America are in rural areas.”

According to Sebelius and Hagan, reform would begin to solve many of the access and insurance problems currently faced by rural residents.

“North Carolina does have a very large sector [of population] in rural areas,” said Hagan, who serves on the U.S. Senate Health, Education, Labor and Pensions Committee that is led by U.S. Sen. Tom Harkin of Iowa. “I think one of the critical aspects of the health care reform effort in Congress right now is that it is going to improve the quality, accessibility and affordability in our rural area.”

Forty percent of self-employed workers living in rural areas are uninsured, compared to 32 percent of self-employed workers living in urban areas, Hagan noted.

“[In North Carolina], 65 percent of of the uninsured population who are full-time workers, work for small businesses — compared to about 46 percent in urban areas,” she said. “And whereas there are nine doctors for every 10,000 North Carolinians in the larger cities, there are only about six-and-a-half for every 10,000 in rural areas. People in rural North Carolina are four times as likely to live in a county with lower access to health care professionals.”

Residents who live in these rural areas, according to the report, not only have more difficulty affording and accessing care, but typically have higher rates of poverty and chronic disease such as diabetes and heart disease. Because many of these same residents work for small businesses, or work part-time or seasonal jobs, it is much less likely that they will have private, employer-sponsored health care benefits. Nationally, a third of all rural residents work for small businesses, yet less than half have health insurance — a figure expected to climb as more small business owners drop health insurance coverage in order to keep their businesses afloat.

Farmers and agricultural workers are especially challenged in today’s insurance market. A multi-state survey of farm and ranch operators found that, while 90 percent of farmers have insurance coverage, one-third purchased it directly through an insurance agent (compared to a national average of 8 percent). The other two-third likely have a spouse that is forced to work off-farm so that the family can be provided with consistent health insurance coverage through an employer.

Sebelius and Hagan also acknowledged that simply providing rural Americans a way to pay for health care doesn’t always translate into access to health care. There were only 55 primary care physicians per 100,000 residents in rural areas in 2005, compared with 72 per 100,000 in urban areas. In the nation’s most isolated and small rural areas, that figure drops to 36 per 100,000. Hagan asserted that although the earlier stimulus had already addressed an expansion of the federal program for loan repayment of medical professionals who agree to practice in under-served areas, the current reform measure provides an extensive and necessary boost to further those efforts.

“There will be scholarships and loan-repayment programs for primary care providers who actually practice in these under-served areas,” she said. “The National Health Service Corps will provide grants and scholarships and loan-repayment programs to providers that’s going to include nurses, nurse practitioners, physician assistants, dentists and mental health providers who actually work in these under-served areas.

“The idea is to increase this dramatically from where it is right now, to be sure that we can get people who hopefully have lived in rural areas to actually go to these medical schools and into these medical professions and then return to their homes, or to agree to living in a rural area for a period of time.”

The current proposals would also provide payment bonuses to primary care providers practicing in under-served areas. Those who have studied ‘doctor drain’ acknowledge that the problem focuses on getting doctors and other health care professionals to begin a practice in an under-served.

“One of the things that we’ve found around the country is that once a person begins a practice, such as a practice in a rural area, [he/she] tends to voluntarily stay,” Sebelius said. “So it really hasn’t been necessarily the challenge of keeping folks there, it has been the challenge of getting them there and getting them back.”

Both women also expressed their optimism that the confirmation of Dr. Regina Benjamin as U.S. surgeon general would be forth-coming, as well as their belief that her personal experience will be a positive influence for young medical students to take advantage of incentive programs to not only serve in rural areas, but to build practices that add to the fabric of those communities.