Tom Vilsack is finishing out his tenure as Secretary of Agriculture pretty much the way he began: Suit up, show up, and try to get some work done.
Last week, the secretary was promoting the open enrollment period for purchasing individual health insurance through exchanges established by the Affordable Care Act. Vilsack was a public face of a small campaign to make sure rural folks know they have through January 31, 2017, to renew, switch, or get new individual insurance.
Vilsack is accustomed to being the voice of rural America for the Obama administration. In this case, he stepped in to promote a signature program of the administration, but one that USDA has no direct authority for. Vilsack has been the administration’s designated “rural guy,” though he would never put it in such terms. He’s the only Cabinet member who has served the entirety of President Obama’s term, and he’s the head of the department with the largest rural portfolio, though there are many rural programs within other departments.
So when Washington needs someone to reach rural, it seems Vilsack is the designated driver. Besides leading the Department of Agriculture, his work has included heading the White House Rural Council, an interagency effort to coordinate several federal programs for greater impact in rural areas. He led an interagency project to address opioid addiction in rural communities. And in usual good order, he and his communication office stepped up to the plate to do a little drumming in rural for Obamacare last week.
Suit up, show up, with about two months remaining in his appointment.
The Daily Yonder spoke with Secretary Vilsack about the Affordable Care Act and, more broadly, about what rural advocates ought to be doing to get more “rural guys” in D.C. His response might surprise you.
(We also asked the secretary his thoughts on whether Democrats could do more to engage rural voters. He said he had but didn’t want to talk about party politics while on an “official” call about ACA. You can read some of rural voters Bloomberg News and The Des Moines Register.)
Daily Yonder: Rural communities have had a tougher time getting enrolled in the Marketplace. Do you know how rural areas are doing generally with their participation in the ACA?
Secretary Vilsack: What I can tell you is that 1.7 million rural Americans who didn’t have health care coverage before the Affordable Care Act have it today. They are part of the 20 million Americans that are now insured and have the peace of mind of having health insurance, which has allowed us, as a country, to have the lowest uninsured rate on record. That makes sense. If you no longer have preexisting conditions that exclude you from coverage, or you’re no longer facing a lifetime limit, or you’re a young person who has graduated from college, not yet fully employed or don’t have a job with health care insurance, your parents can provide coverage for you under their plan until you are 26. Obviously more people are going to have access to coverage. Certainly, the Marketplace is an important aspect of the Affordable Care Act. …
We are now in the sign-up and enrollment period for 2017 in the Marketplace. For the first two weeks of the [this year’s enrollment period, which started November 1], over a million people have selected a plan for coverage that begins January 1st. We’re trying to emphasize as well the necessity of not only signing up, but understanding that with tax credits and financial help, this can be very affordable for most people. We calculate that most people who will participate in the Marketplace will probably pay less than $75 a month for health insurance coverage [when subsidies based on income are included]. That is, I think, an important message.
Daily Yonder: About a third of the counties in rural America have only one insurer who is participating in the Marketplace, and there are many more that have only a couple of insurers. What is your take on whether there is enough competition in rural America for health insurance dollars? If there is not, what we can do to correct that.
Secretary Vilsack: Within the offerings, there are opportunities that in a sense, even if you only have one provider, there is competition, if you will, for your health care dollar by the provider providing multiple plans that you can choose from. In 2017, there are going to be 19 different plans that people can potentially choose from. There is that competition. I think that it is unfortunate that in some places that you have limited choices, but there’s also the chance that the state that you’re in, with limited choices, also has Medicaid expansion, so maybe it’s not as necessary to have as many companies, because Medicaid has been expanded.
Folks can, I think, find a little help and be able to get questions like this answered. There is a 1-800 number that I think is important for your folks to know. It’s 1-800-318-2596. There is also a website, localhelp.healthcare.gov, where people can find information on who might be able to help them navigate the plans that are available, and figure out what works best for their family.
One of the things I would urge you all to do is to keep pressing those of us in government for information about what government does from a positive perspective, so that we can begin reversing the 30 years of constant and consistent attacks on government generally.
Daily Yonder: You brought up Medicaid expansion. You know that the states that did not expand Medicaid generally skew more rural in their population. We have even seen states that have tried to do very moderate moves to expand their Medicaid fail. Have you felt discouraged by that?
Secretary Vilsack: You start with a proposition that 150 million Americans are covered under an employment-based system, an employer-based system. That is some comfort, and the fact that there are now 20 million more Americans covered and insured that were not being insured before the Affordable Care Act, that is obviously a good data point. We know that when you have access to health insurance, you have access to more health care. The reality is, rural folks are gaining access to physicians, to community health centers, and that lives have been saved as a result. We still have work to do, obviously. When you have 8.6% of America not being insured, there is still work to be done, but there have been a lot of benefits that have accrued from the Affordable Care Act that don’t get a lot of attention, and perhaps need to get more attention, such as, we have seen the slowest rate of growth in health care prices in over 50 years.
Even with some of the spikes that have occurred this year, if you look at the history of the Affordable Care Act, you are looking at a very slow growth rate in health care costs, because people who are insured are not now forced to go to an emergency room for care. When they are very, very sick, they get to go to a doctor, and they get preventative health services, and they avoid those expensive emergency room visits. I think if people really understood what has happened, that we have millions more insured, that we have greater access to health care, that people’s lives are being saved, and we’re actually seeing a reduction in the rate of increase in health care costs, they would feel a little bit more comfortable about all of this.
Daily Yonder: You have mentioned that rural does not necessarily get the attention it might deserve in Washington, and you’ve been an advocate for rural in a lot of different settings. Sometimes it might even seem like you’re the only rural guy they know. They’ve got you on speed dial. What can Daily Yonder readers do that might help expand the profile and interest and response to rural in the federal government?
Secretary Vilsack: I think it’s more what we can do in government through the Daily Yonder to educate people about the role that government actually plays, and the partnership that government has, with rural folks. I don’t think that we do a particularly good job, government-wide, in educating people about that partnership. I think people have a tendency to think that government is all about regulations and taxes, when in fact it is very much also about services, and assistance and help, that is making a big difference in rural areas. Home loans, business loans, clean water, conservation, farm loans, disaster assistance: all of that reflects a government helping, in partnership with people in rural communities.
One of the things I would urge you all to do is to keep pressing those of us in government for information about what government does from a positive perspective, so that we can begin reversing the 30 years of constant and consistent attacks on government generally. It’s not fraud, waste, and abuse. It’s about home-ownership. It’s about job growth. It’s about a cleaner environment. It’s about safer communities. I think if we did a better job of conveying that message, people might feel more inclined.
I think we also need to reach out to our friends and neighbors in cities and suburbs to make sure that they are fully aware of the role that rural Americans play in providing a quality of life second to none for those city and suburban dwellers. The access to food, the affordability to food, opens up a tremendous opportunity for people who live in cities and suburbs to pursue careers without having to worry about where the food is going to come from to feed their family, and to do so in a way that they spend less money on their paycheck than most people around the world spend on food as a percentage. That gives them the flexibility to have a lot of interesting things to do in their life.
I think it is a combination of us doing a better job of educating you, and you helping us educate our city and suburban neighbors.
I can only tell you that I have put together what is now a 24-page memo to my successor. Part of what I am recommending is a continuation of that Rural Council.
Daily Yonder: You have had a long tenure — the longest tenure in the current Cabinet. What would you like people to remember about your tenure as the Secretary of Agriculture?
Secretary Vilsack: That’s a really hard question for me to answer, because we do so much at USDA. Our portfolio is so broad. It’s sort of like having a family of many, many, many children, all of whom have been incredible, and somebody asking you, “Which of your kids are you proudest of?” Or, “Which kid has performed better?” The reality is, every mission area of USDA has done historic work and I think is in better shape and in better position than they were when we came into this office.
If I had to summarize it in a short response to your question, I would say that I am proud that we have created and celebrated diversity in the Department of Agriculture. Diversity in terms of our workforce; diversity in terms of the types of opportunities that are now being created in rural America; diversity in the ways in which we have used our resources in an innovative way to expand and leverage them to provide more assistance.
I would say that is one aspect. The second aspect is innovation, the fact that we have been innovators. We have been innovators in terms of how services are being delivered, how resources are being leveraged, and all that has resulted I think in helping rural America to see its unemployment rate almost cut in half, from over 10% [after the Great Recession] to a little over 5%. Where we saw job loss in rural America, we now see job gains. Where we saw lost population, we now see stable population. Where we saw a rise in poverty rate, we now see a decline in poverty rate. Where we saw increased food insecurity, especially among America’s children, we now see the lowest level of food insecurity among America’s children in the history of the country. I would say it’s a tough question to answer without spending an hour of your time highlighting every single mission area, but within every single mission area I can guarantee you there have been incredible successes, and lives have been changed, and for the better.
Daily Yonder: What is next for you?
Secretary Vilsack: I don’t know. Unfortunately, I don’t know, is the answer, and probably won’t know until later in the year, first part of next year.
Daily Yonder: What chance do you think the White House Rural Council has of continuing its work in the next administration?
Secretary Vilsack: That’s a good question. I can only tell you that I have put together what is now a 24-page memo to my successor. Part of what I am recommending is a continuation of that Rural Council. Obviously, new administrations have new priorities and different ways to address problems. I would hope it would continue because I think it has been incredibly successful. The job accelerator led to a significant number of jobs being created. The relationship between the Department of Energy and the Navy and USDA on biofuels — we just recently celebrated Alaska Airlines flying from Washington state to Washington, D.C., with a 20% blend that was made from woody biomass. That has been a part of the Rural Council’s agenda. The child-poverty stuff that we have done is innovative and creative. We have certainly embraced the local food effort to create new opportunities for distressed communities, but also to open up opportunities for young people to get into the farming business. There has been a lot of work done collaboratively between Health and Human Services and USDA to expand access to telemedicine and to have the expanded access to professional services in rural areas.
All in all, a lot of really good work, and we recently put out a report that outlined some of the benefits of the Rural Council. I would hope that the next administration would continue it.