Rural hospitals were at the center of various negotiations and compromises made yesterday in Congress. The big topic, of course, is health care reform. The Democratic Blue Dog Coalition has been demanding more for rural hospitals. The Post notes that Blue Dogs are "from largely rural districts" who have enough votes to stop health care legislation from passing through the House Energy and Commerce Committee. The Washington Post explains:
Rural health-care providers generally receive less in Medicare reimbursements than their urban counterparts, and delinking the public plan from Medicare was considered critical for conservative Democrats. "We have saved America's rural hospitals from closure," said Rep. Mike Ross (D-Ark.), a Blue Dog leader on the committee.
Meanwhile, Post business columnist Steve Pearlstein has a recommendation for the Dogs: "If they really want to solve the doctor shortage in their home states, for example, they could propose a small tax on all hospital services and use the money to provide free education to all medical students -- in exchange for a few years of service in underserved communities."
What should health care reform be about? Think health care, not health insurance. Oh, and access to good care would be nice, too, especially in rural communities.
Rep. Mike Ross (above), a Blue Dog Democrat from rural Arkansas, comes from a town where many of his constituents can't afford health care. "Yet Ross stands ready to try to block passage of a House bill that, its supporters say, would provide exactly what Arkansas needs: guaranteed insurance and a wider choice of coverage at competitive prices," write Eric Pianin and Ann Carrns with Kaiser Health News. The two writers go to Prescott, Arkansas, to explore what they say is a "conundrum": that even though many Blue Dog voters would benefit from the health care bill now in the House, Blue Dog representatives oppose it "because they say it’s too costly and doesn’t solve other health care problems in their mostly rural districts."
Ross has said that unless changes are made, they'll vote against the bill in the House Energy and Commerce Committee. "What we’re talking about is containing the cost, slowing the rate of growth of health care down where it can grow at the rate of inflation,” Ross said in an interview, “because if we don’t, it’s going to bankrupt this country.”
In Prescott, in southwest Arkansas, the reporters find that the "economy is taking a toll on health care...." Twenty percent of Prescott's residents don't have insurance, and premiums have risen by 80 percent since 2000. There's need and suspicion there. Hospitals have closed in rural Arkansas because of low reimbursement rates, which is one of Ross's concerns. “You know, it’s easy to provide everybody a shiny new insurance card,” he said. “But what’s important here is they actually have access to a doctor once they get the insurance card.”
Lynda Waddington at the Iowa Independent reports that there's been a 20% increase in calls to a hotline set up to serve farmers in seven Midwestern states. Not only are there more calls to the Sowing the Seeds of Hope hotline, Waddington reports, the "content of the calls is changing," said a hotline supervisor. "The callers are reporting much more severe economic turmoil, more mental health symptoms and significant increases in mental stress."
This isn't a good sign. During the farm crises of the 1980s, farm suicides spiked. Iowa and Nebraska developed their hotlines then to serve ag workers. Waddington's argument in her Independent story is that the hotline works. Suicides appear to be down in the state where the hotline. And that as farm troubles appear to be on the rise — particularly within the dairy sector — she says this would be the time for Congress to fully fund the Farm and Ranch Stress Assistance Network.
Congress approved the Network with the 2008 farm bill. "The network creates a national crisis hotline for rural workers and also mandates additional behavioral health services in geographically rural regions," Waddington writes. Ag Secretary Tom Vilsack, however, says he doesn't see much hope for additional funding.
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Nick Reding went to Oelwein, Iowa, to write a book about meth. What he produced, at its heart, is a story about how a small town can survive the worst.
President Barack Obama acknowledged at his Wednesday night press conference that rural hospitals were getting Medicaid reimbursements that may be too low. The President said:
"I think that a lot of Democrats have a lot of different ideas. Some of them had to do with regional disparities. For example, you've got some Democrats who are concerned that the Medicare reimbursement rates in their communities are too low, and so they'd like to see the bill incorporate higher rates for doctors and providers in rural communities to incentivize good care in those communities. That's a legitimate concern. But the minute you bring up that concern, then that adds money, which means that we then have to find additional dollars. So this is just part of the normal give-and-take of the legislative process."
A New York Times story noted afterward that rural hospitals and urban teaching hospitals share a concern that efforts to hold down increases in Medicare spending "could indeed cut services in some rural areas and from teaching hospitals, which receive extra payments because of higher costs."
Health care reform legislation is pitting city hospitals against rural hospitals, the Boston Globe's Susan Milligan reports. "Big hospitals affiliated with medical schools around the country receive heftier reimbursements for treating elderly patients covered by Medicare, part of a government policy that rewards them for maintaining things such as trauma centers and burn units, as well as for training future generations of doctors," Milligan writes. "Rural members of Congress, however, angry at what they see as an unfair advantage to glitzier facilities in cities, are demanding a bigger share of the pie for smaller hospitals, which serve remote populations and often struggle to survive."
"This is a very urban bill,’’ fumed Representative Earl Pomeroy, a North Dakota Democrat on the House Ways and Means Committee, which passed the healthcare overhaul bill Friday. “Could it be improved? Could it be more rational? Of course.’’ Rational to rural legislators (Republican and Democratic alike) is a system that changes the status quo on how hospitals are reimbursed by Medicare. For urban legislators, Milligan writes, "any attempt to strip a portion of Medicare money from teaching hospitals would be a deal-breaker for House members from cities."
This tussle between rural and urban hospitals "exposes the often deep regional differences in Congress, with lawmakers of like political ideology squaring off on discreet local issues," Milligan writes. "The hospital Medicare reimbursement dispute is just one of many such issues that could upset the coalition required to pass the healthcare overhaul bill before the August recess, as House Speaker Nancy Pelosi, Democrat of California, has promised to do."