As I continue visiting every county in the Fifth District throughout the August recess, I continue to get feedback and questions from constituents about health care reform. Specifically, our neighbors want to know how health insurance reform will help rural America. Our rural areas have almost five percent higher uninsured rate than urban areas, and the current recession means more people are losing access to their employer-based health coverage. Many of our rural hospitals are hemorrhaging money due to the rising pressure of uninsured and underinsured populations, and many are seeing long waits to get a primary care appointment.
Our rural communities could gain a lot from reform. I hear daily from doctors, nurses and other health care professionals around the district who explain how, under the current system, rural hospitals serve a higher number of Medicare patients and are reimbursed less for those services. Without change, these serious budget troubles could close the doors on key medical facilities in Southern Virginia.
The reform bill would direct the Institute of Medicine to study geographic disparities in Medicare reimbursement rates and revise payment rates accordingly. Also, the bill would provide billions in new funds to support community health centers, critical to serving our rural communities, and would maintain the current requirement that these rural areas receive special consideration for distribution of funds.
Additionally, prior to 2003, the Medicare reimbursement formula paid doctors practicing in rural areas relatively less for their work, even though they have the same training as doctors serving in urban areas. The bill before Congress helps rural physicians by extending an existing provision that addresses this payment inequity.
Another huge challenge to providing health care in our rural communities is the shortage of primary care doctors. It’s not uncommon for me to hear stories of constituents in Mecklenburg, Halifax, Franklin or Pittsylvania Counties who have to wait months to see a primary care doctor. Only nine percent of physicians practice in rural America even though 20 percent of the population lives in these areas. The bill before Congress would provide a 10 percent incentive payment for primary care doctors practicing in underserved areas, which combined with a current bonus for physicians in shortage areas, will help recruit and retain primary care physicians in our communities.
Additionally, to help address the shortage of doctors in rural areas, the bill significantly expands the National Health Service Corps and invests in advanced nurse training. A new medical student loan repayment program directs primary care physicians to areas of need, and also supports other specialties and professions to practice in high-need areas.
The bill also addresses rural health disparities by providing grants to deliver community preventive services to fight things like diabetes, obesity, and substance abuse. Half of these dollars must be spent on programs whose primary purpose is to reduce health disparities, including disparities between urban and rural chronic disease outcomes.
Our rural communities are feeling strained under the current health care system and any bill to gain my support must provide sufficient advantages for rural communities. As I evaluate the health care reform proposals, one of my most important litmus tests will be how the reforms will affect rural hospitals, doctors, and of course, patients with regard to access, quality and cost for rural health care.
The entire bill, along with fact sheets and analyses, is posted on my online healthcare forum: www.perriello.house.gov/healthcareforum where your comments are welcome. Please feel free to contact me to share your concerns and ideas. You may call 888.4.TOM4US (888.486.6487); write to 1520 Longworth House Office Building, Washington, D.C. 20515; or visit www.perriello.house.gov to sign up for my weekly e-newsletter.
Tom Perriello represents the Fifth District in the United States House of Representatives.
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