The National Rural Health Association supports expansion of insurance coverage, covering individuals with pre-existing conditions and all of the pro-patient provisions in the Affordable Care Act. We are fighting to protect each of those provisions.
However, Republicans and most Democrats alike agree that parts of the ACA are simply not working. Unfortunately, most of the provisions that aren’t working are impacting rural Americans. But rather than Congress joining together to address the troubling issues in rural America, we again see a politically-charged and lopsided debate. Enter the American Health Care Act (AHCA) which does nothing to address these compelling concerns either. The Congressional Budget Office analysis of the AHCA indicates that 24 million more Americans will be uninsured by 2026.
Even after the implementation of the ACA, a higher percentage of uninsured still reside in rural America and the rural population remains sicker. In fact, a January 2017 Centers for Disease Control report found that life expectancies in rural America have actually declined and the top five chronic diseases are worse in rural America.
The co-op insurance concept has collapsed, leaving thousands of rural citizens without coverage. Insurance premiums have increased higher in rural markets than anywhere else. Insurance companies are dropping out of rural markets. In fact, 70% of the counties where big insurance companies have dropped out have been rural counties - - leaving rural Americans with little or no choice of plans.
Many of the most rural and low income states in the nation have opted not to expand Medicaid, leaving millions of rural Americans unable to obtain coverage. Rural Americans still becoming sick and in need care. As a result, bad debt at rural hospitals is escalating, and is 50 percent higher than urban hospitals. At the same time, reimbursement for bad debt has been reduced. Because of this, rural hospital closures have escalated. One in three is in financial risk, and 25% of all rural hospitals could close in less than a decade if Congress doesn’t act.
Democrats and Republicans, it’s time to work together to fix the ACA on behalf of Rural America. However, the current legislation under consideration is simply not the right prescription for rural Americans.