Speak Your Piece: ‘Obamacare’ and Rural

Figuring out which health insurance is right for you may be the biggest challenge people face in adapting to the Affordable Care Act. Other changes – like ending the practice of denying coverage to people with preexisting conditions – go into effect automatically.

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EDITOR’S NOTE: How will rural America fare under the Affordable Care Act? That’s one issue the National Rural Assembly will tackle next week in Bethesda, Maryland. Steph Larsen with the Center for Rural Affairs will help lead two sessions on “Obamacare” and rural America. Here she answers some of the questions she’s hearing about the health-care reform.

If you were to look in my email inbox, one thing is clear – rural Americans, like the rest of the country, are confused about the Affordable Care Act, also known as Obamacare or the ACA. I’m happy people are asking me about the health care law, frankly, because that means they aren’t just believing the latest rumor they heard from their mother’s hairdresser’s cousin.

So here’s a place to start – some answers to common questions about what the Affordable Care Act means for rural communities.

What parts of the Affordable Care Act are likely to be easiest (and most problematic) for rural communities?

The easiest provisions of the Affordable Care Act (ACA) for rural people will be the ones that happen automatically. For example, keeping a child on your health insurance until they turn 26 or free preventative services will happen without consumers doing anything. When the ACA passed, I received a letter from my insurance company detailing changes to my policy. They were all good things, and each one was mandated by the ACA. I didn’t have to do anything.

Buying insurance has never been easy, but there’s one piece that won’t be a problem for anyone – no one will get a rejection notice. No matter who you are, where you live or what your past health problems have been, if you want to buy health insurance, no one will be turned away. And you will pay exactly what everyone else of your same age, tobacco use, family size and location pays. In other words, you won’t pay more regardless of your health. Just like those sketchy commercials you see on daytime TV claiming “no health questions” – except this is real.

The hardest part of the ACA for rural people will probably be figuring out what insurance option is right for your family. For example:

  • If your employer offers a plan that meets the minimum standards for coverage and affordability, you can keep it.
  • If you’re already on Medicaid or Medicare by January 1, 2014, you’re covered.
  • If you don’t have insurance from your employer, you can buy it through your state’s Health Insurance Marketplace, also known as the “Exchange.” If you’re below 400% of the federal poverty level (see this chart), you’re guaranteed not to pay more than 9.5% of your income for your insurance. See this chart for the sliding scale subsidy levels.
  • If your state is expanding Medicaid (see this map) and you are below 133% of poverty, you only have to sign up. You can do this at your state’s Health Insurance Marketplace.

That’s a lot of “if” statements. That’s why the ACA also provides impartial guides, called “navigators.” These people will guide you through your choices and make sure you get the right plan for your budget and family.

The ACA relies quite a bit on access to the Internet, and this can also be a problem for rural people. Insurance plans and the assistance you might need in purchasing a plan will all be available online, but not everyone has high speed access. The ACA will also have phone helplines to call and physical locations to go for help, which will, it is hoped, make them more accessible to rural people.

There will also be distinct benefits for rural communities in states that choose to expand their Medicaid program. In part because small businesses in rural communities are less likely to offer health insurance, a greater percentage of rural people qualify for Medicaid compared to their urban counterparts. With more patients insured, rural hospitals will be more financially stable and less likely to accrue bad debt from uncompensated care. In addition, rural doctors receive more of their revenue from Medicaid than their urban colleagues, 20% compared to 17%.

FamiliesUSA
Twenty-three states have elected to expand Medicaid. Twenty-five have not. Three are undecided. Click the map for an expanded infographic on Medicaid expansion.

Are there going to be fewer choices for coverage for rural consumers?

Under the ACA, all insurance is provided by private insurance companies.  So it’s up to insurers whether they want to provide coverage to rural areas. It shouldn’t be worse than it is now, and it might even be better because the consumer pool is higher and the competition between companies will be better.

Will rural consumers be able to find providers who accept their insurance?

Again, that’s up to providers and the deals they make with insurers. It likely won’t be any harder, and it might even be easier.

When it comes to Medicaid, rural people may actually have more choices finding a provider. Right now, 84% of rural physicians accept new Medicaid patients, compared with 65% of urban physicians.

How is rural crucial to the success or failure of the Affordable Care Act?

Rural Americans have been hit hard by a campaign of fear and misinformation by the detractors of the Affordable Care Act. Because of the rampant misinformation, a lot of rural people are understandably confused. If rural folks can get beyond this misinformation and educate themselves with accurate information, it will result in more rural people having comprehensive, affordable health insurance and greater access to health care. This will result in stronger rural health care infrastructure and healthier rural Americans. And that’s good for all of us.

Steph Larsen lives in Montana and is assistant director of organizing for the Center for Rural Affairs.

The author requested that the Daily Yonder run the following disclaimer: This article is meant solely to answer questions the author receives and provide general information about the Patient Protection and Affordable Care Act. The Center for Rural Affairs does not offer or provide legal advice. CFRA is not an insurance agency, broker or consultant, does not recommend any health insurance product or policy or provide any advice on the purchasing of health insurance, and does not accept any compensation or consideration from an insurance company, insurance broker or insurance consultant.

 

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