Sign Up for Email Alerts Visit us on Twitter Visit us on Facebook Visit us on YouTube Subscribe to RSS Feeds

Home > Past Briefings > Briefing Detail Page

Briefing Detail Page

Change Text Size:   Smaller Text Size   Larger Text Size   Default Text Size    

Rural Reality: More Coverage, Enough Care?

Friday, July 26, 2013

 Sixty-two million Americans live in rural areas and they have higher rates of mortality, disability and chronic disease than their urban counterparts. With high poverty and unemployment rates, low rates of health insurance coverage and an undersupply of health care providers, the ills of the health care system are especially notable in rural communities. The Patient Protection and Affordable Care Act (ACA) contains provisions relating to access to care, coverage and delivery system reform. But the impact of these provisions is uncertain in rural America, with its unique challenges.

What provisions in the ACA address rural health care challenges? How key is Medicaid in access to care in rural areas? Will the health workforce be sufficient to meet demand when coverage expands? How can recruitment and retention challenges be met? What role will state practice acts and licensing play in the use of allied health professionals and in the delivery of telehealth services?

A distinguished panel of experts addressed these and related questions.

Keith Mueller, director of Rural Policy Research Institute (RUPRI's) Center for Rural Health Policy Analysis, provided an overview of rural health issues, what's in the ACA to address them and what challenges remain.

Tom Morris, director of HRSA's Office of Rural Health Policy, offered an update on federal rural initiatives that aim to strengthen the workforce and enhance access to health care.

Art Kaufman, vice chancellor for community health sciences at the University of New Mexico Health Sciences Center featured the center's community health focus through a program of academic extension hubs. He highlighted the role of community health workers and outcomes in Native American communities.

Lisa Miller, former member of the Maine House of Representatives, talked about challenges that state legislatures and executives face in serving rural populations, including scope of practice and licensure.

Ed Howard of the Alliance and Zane Yates of Centene moderated the discussion.

Contact: Marilyn Serafini 202/789-2300

The event was sponsored by the nonpartisan Alliance for Health Reform and The Centene Corporation.

Event Summary and/or Webcast and Podcast

Full Webcast/Podcast: Video recording from C-SPAN

Speaker Presentations

Miller Presentation (Adobe Acrobat PDF), 7/26/2013
Morris Presentation (Adobe Acrobat PDF), 7/26/2013
Kaufman Presentation (Adobe Acrobat PDF), 7/26/2013
Mueller Presentation (Adobe Acrobat PDF), 7/26/2013

(If you want to download one or more slides from these presentations, contact us at info@allhealth or click here for instructions.)

Source Materials

Agenda (Adobe Acrobat PDF), , 7/26/2013
Speaker Biographies (Adobe Acrobat PDF), , 7/26/2013
Selected Experts (Adobe Acrobat PDF), , 7/26/2013
Materials List (Adobe Acrobat PDF), , 7/26/2013

Offsite Materials (briefing documents saved on other websites)

The Uninsured: An Analysis by Income and Geography, Rural Policy Research Institute, 7/1/2013
Health Care Workforce Distribution and Shortage Issues in Rural America, National Rural Health Association, 1/1/2012
Is GME Snubbing Rural America?, HealthLeaders Media, 6/19/2013
Pennsylvania starting to close rural health centers, furlough nurses, Pittsburgh Post-Gazette, 5/29/2013
Campbell’s new medical school strives to fill rural health care needs, The Fayetteville Observer, 6/16/2013
Community Health Workers and Medicaid Managed Care in New Mexico, Journal of Community Health, 9/28/2011
Accountable Care Organizations in Rural America, Rural Policy Research Institute, 7/1/2013
Bill would help rural veterans access VA services, Navy Times, 6/21/2013
Tom Morris Testimony before the United States Senate, Committee on Homeland Security and Governmental Affairs, Subcommittee on the Efficiency and Effectiveness of Federal Programs and the Federal Workforce, 5/23/2012
The Current and Future Role and Impact of Medicaid in Rural Health, Rural Policy Research Institute, 9/1/2012
NHSC Clinician Retention: A Story of Dedication and Commitment, National Health Service Corps, 12/1/2012
Options for Rural Health Care System Reform and Redesign, National Advisory Committee on Rural Health and Human Services, 12/1/2012
Missouri law may boost health-care access in rural areas, Southeast Missourian, 6/25/2013
Rural America Will Benefit from Medicaid Expansion, Center on Budget and Policy Priorities, 6/7/2013
The 2011 Report to the Secretary: Rural Health and Human Services Issues, The National Advisory Committee on Rural Health and Human Services, 3/1/2011
The Redistribution Of Graduate Medical Education Positions In 2005 Failed To Boost Primary Care Or Rural Training, Health Affairs, 1/1/2013
The Patient Protection and Affordable Care Act of 2010: Impacts on Rural People, Places, and Providers: A First Look, Rural Policy Research Institute, 9/16/2010
Small, Nonteaching, And Rural Hospitals Continue To Be Slow In Adopting Electronic Health Record Systems, Health Affairs, 5/1/2012
Health Extension: Learning from Farmers How to Improve Community Health, TEDxABQ, 9/1/2011
Health Extension in New Mexico: An Academic Health Center and the Social Determinants of Disease, Annals of Family Medicine, 1/1/2010
Rural Health Issues: Implication for Rural Healthy People 2020, National Rural Health Association, 1/1/2010
Rural Healthy People 2020, The Texas A&M University System Health Science Center, School of Rural Public Health, Southwest Rural Health Research Center, 7/17/2013
The Adoption and Use of Health Information Technology in Rural Areas: Results of a National Survey, The Journal of Rural Health, 3/18/2011


30 percent of the people in New Mexico who are currently eligible for Medicaid are not on Medicaid, Art Kaufman, vice chancellor for community health sciences at the University of New Mexico Health Sciences Center, stated at a July 26 Alliance for Health Reform briefing, Rural Reality: More Coverage Enough Care?


Uwe Reinhardt Questions Bundled Payment Savings Prospects

Video (2:58)

A new Alliance for Health Reform video features Princeton’s Uwe Reinhardt questioning whether bundling payments for medical services might actually lead to higher – not lower – costs.

"The ACO's, the accountable care organizations, could create local monopolies that could dictate to you what that bundled price would be, and some of us fear that bundled prices might be even more than what the fee-for-service for that bundle would be today. … You really should align all the payers and say, 'Let us jointly negotiate with the ACOs what those bundles should be so that they cannot divide and rule and sort of make us on the buy side weak.'"


Read More 

Sister Carol Keehan on Health Law Enrollment Challenges this Year

Video 3:00

A new Alliance for Health Reform video features Sister Carol Keehan of the Catholic Health Association of the United States addressing the challenges of quickly enrolling millions of Americans for health insurance this fall. Open season begins October 1 of this year, yet she says that up to 85 percent of those who will be newly eligible for Medicaid or for subsidies to buy private insurance in state-based exchanges don't know it.  FULL TRANSCRIPT

Read More 

Jonathan Blum on CMS Efforts to Keep Medicare Spending Growth Down

Video (2:54)

Jonathan Blum, acting principal deputy administrator and director of the Center for Medicare at the Centers for Medicare and Medicaid Services (CMS), addresses the slower growth of Medicare spending over the last few years, and what his agency is doing to try and continue the trend. “There are promising signs that this strategy to change the payment system, to change the payment models, to focus on waste and abuse, is paying off," he said. "We are taking a whole new approach to addressing fraud in the program. Much more data resources, much more on the ground reaction. We have seen dramatic spending declines in areas of spending, such as home health and durable medical supplies that historically fueled lots of the fraud.”  FULL TRANSCRIPT

Read More 

Two Former Medicare Administrators Discuss How to Save the Program

A new Alliance for Health Reform video features two former Medicare administrators -- Gail Wilensky and Bruce Vladeck -- on their ideas about how to save the program.

Ms. Wilensky, who ran Medicare in a Republican administration, argued for increasing the eligibility age of Medicare for future retirees, while still making the program available at age 65 for those who are disabled.

Watch at

Read More 

Douglas Holtz-Eakin: Health Care Spending Lull Only Temporary

Video (3:11)

A new Alliance for Health Reform video features Douglas Holtz-Eakin of the American Action Forum, and a former director of the Congressional Budget Office, arguing that recent slower spending growth in health care won’t continue.

"We also saw a slowdown in the mid-90s, and we all declared victory and it came right back. I think next year we’ll see a noticeable uptick. There will be lots of new people entering the insurance markets because of the exchanges and the subsidies that come along with them, and those subsidies are very generous. … These are an invitation for people to get coverage and to buy more health care. I think that’ll place a lot of pressure on spending."


Read More 

Marketplace Enrollment Helpers Toolkit

Beginning October 1, insurance marketplaces open for enrollment, and millions of people will be eligible to purchase plans. To guide them in the application process, the federal government has invested in programs to train community organizations and hired staff.

Read More 

The Employer Mandate of the Patient Protection and Affordable Care Act

The Toolkit, available here, details the ACA’s employer requirements and penalty. It also includes information about the delay in the mandate to 2015, and analysis about its impact on employer-based coverage.

Read More 

Toolkit: Training the Workforce for a Changing Health System

A new Alliance for Health Reform toolkit addresses concerns about whether newly-trained physicians are adequately prepared for today's evolving health care delivery system. Does training adequately emphasize care coordination, team-based care, costs of care, health information technology, cultural competence and quality improvement? Does it encourage students to practice in a primary care setting?

Read More 

Toolkit: Emergency Preparedness in the U.S.: The Ebola Threat

Is the U.S. prepared for a potential virulent pandemic? This new Alliance toolkit examines public health infrastructure, funding and policy levers that deal with these kinds of health crises in America.

Read More 

Copyright 1997-2014 Alliance for Health Reform
1444 Eye Street, NW, Suite 910 Washington, DC 20005-6573      202-789-2300      202-789-2233 fax      Sitemap