Rural Health Care and Reform

This page provides links to assist in reporting on the massive legislative package, the Patient Protection and Affordable Care Act, passed March 24, 2010. Please click here to access older blog items that may be of interest to those reporting on rural health care and reform.

Please let the Institute know about links that do not work, or about sources we should add. If a resource here helped you in covering a story, please let us know by emailing al.cross@uky.edu.

Reform now includes improved benefits for stay-at-home care for the elderly

Included in the Patient Protection and Affordable Care Act, is the first-ever national long-term care insurance plan – called Community Living Assistance Services and Supports, or CLASS – a federally administered program financed through payroll deductions. If a significant number of people sign up for the voluntary program, individual long-term care benefits could defray a portion of states’ costs for providing long-term care.

Christine Vestal, of Stateline.org, reports that "the real gift the new law presents states is a detailed roadmap to the most successful ways to cut costs and improve services for the elderly. By offering incentive payments of 2 to 6 percent of costs, the federal government is encouraging states to adopt and expand successful programs pioneered by a handful of states that give elders more options for their care at much lower expense. (Read more)

Black lung victims and their survivors have improved health care due to reforms

Among the changes in the health care reform legislation, is improved coverage for miners. Greenwire and the Pittsburgh Tribune-Review report on two of the significant changes in the new law. Greenwire reports that Section 1556, drafted by Sen. Robert Byrd (D-W.Va.), expands on a section of the Federal Coal Mine Health and Safety Act of 1969, creating a "legal presumption" that miners with at least 15 years of experience working in mines and medical evidence of black lung disease can get benefits.  (Read more, subscription required)

The other significant change in the law reverses a Reagan administration policy, which in the 1980s forced spouses to re-apply for black lung benefits when their husbands died, United Mine Workers spokesman Phil Smith said to Joe Napsha of the Pittsburg Times-Tribune. It now ensures that widows do not have to reapply for benefits after their spouse dies from the disease. Jim DeMarce, director of the Division of Coal Mine Workers' Compensation at the Department of Labor, said that his department estimated there would be 311 pending cases for widows resolved under the new language, with another 250 widow cases dealt with each year. (Read more)

Health care reform legislation benefits Libby, Mont., and any other 'public health emergency' areas

Sen. Max Baucus (D-Mont.), added provisions in the health care reform legisation so that "residents of an area deemed a public health emergency by the Department of Health and Human Services would be eligible for Medicare coverage and medical screening services," reports Jason Plautz, for E&E. To date, only Libby, Mont., has been declared a public health emergency under federal law. Nearly 200 residents of the town have died and nearly 2,000 have gotten sick from asbestos-related diseases linked to vermiculite mining by W.R. Grace & Co. (Read more, subscription required)

Health reform offers much for rural America but some rural hospitals fear its impact on them

By Lu-Ann Farrar

Many of the rural Democrats who voted against the health-care reform bill this week cited its impact on rural hospitals, but some who voted for it said the law will help such hospitals. At least one expert in rural health policy believes the law will be a "net gain" for rural populations, but the effect on rural hospitals is still unclear. The impact might be greatest in the Southeast, where the "no" votes were concentrated. (Map by the Daily Yonder)

Rep. Ben Chandler of Kentucky, a Blue Dog Democrat, told the Lexington Herald-Leader, "This bill still does not address the concerns I had about its effect on our seniors, rural hospitals, and the overall cost to taxpayers. Rural hospitals might be hurt by a cut in payments they receive for providing indigent care, and senior citizens might suffer from Medicare reductions, both of which the bill requires to help pay for its staggering cost."

But the effect may be different in other regions, states or congressional districts. Dr. Keith J. Mueller of the Rural Policy Research Institute at the University of Nebraska, said in an interview that rural hospitals, primarily in the Southeast, will feel the bite when Disproportionate Share Hospital payments, known as DSH ("dish") payments, are gone. But in other parts of the country, not so much.

Mueller explained that phasing out DSH payments is designed to occur in tandem with the increase in other forms of insurance. For areas that will have mostly privately insured or Medicare patients, losing the DSH payments will be inconsequential or financially advantageous. But the Southeast — with high unemployment, poor health and poor access to health care — the newly insured (based on the new criteria for eligibility, 33 percent above the poverty line) will likely be covered by Medicaid. Some believe Medicaid payments won't fully replace DSH payments, leaving hospitals holding the financial bag. And even with increased numbers of insured, 23 million people will still likely be uninsured. Someone will have to continue to pay for their health care, and hospitals assume it will be them.

Mueller also points out that with the reform, those folks who are newly insured will be more likely to see a doctor than when they were uninsured. Presumably, they will have better health care, but the question remains: Will the Medicaid payment cover the cost of service?

One important factor in rural health remains unchanged: Critical access hospitals, which are all rural, will continue to be funded as they are now. Their payment structure is based on a different regulation and will continue to be the cost of service, plus 1 percent.

Ultimately, Mueller says, the health reform act is designed with individuals and small groups in mind and the rural population is typically made up of individuals and small groups. "The is one more giant step towards universal coverage," he said, adding that while rural folks will not be a disproportionate share of the newly insured population, rural residents now uninsured should benefit greatly.




The Institute for Rural Journalism and Community Issues helps non-metropolitan media define the public agenda in their communities, through strong reporting and commentary on local issues and on broader issues that have local impact. Its initial focus area is Central Appalachia, but as an arm of the University of Kentucky it has a statewide mission, and it has national scope. It has academic collaborators at Appalachian State University, East Tennessee State University, Eastern Kentucky University, Georgia College and State University, Indiana University of Pennsylvania, Marshall University, Middle Tennessee State University, Ohio University, Southeast Missouri State University, the University of North Carolina-Chapel Hill, the University of Tennessee-Knoxville, Washington and Lee University, West Virginia University and the Knight Community Journalism Fellows Program at the University of Alabama. It is funded by the John S. and James L. Knight Foundation and the University of Kentucky, with additional financial support from the Ford Foundation. To get notices of Rural Blog postings and other Institute news, click here.

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Al Cross, director al.cross@uky.edu