By Angel Romero Kiester
(Editor's note: Angel is current our Rural Health Care Intern)

Last week, I was blessed to have spent a week in Alaska to celebrate a wedding. I know, Alaska in December. It was beautiful, and even though the temp read -37, it seemed much warmer. On my trip I sparked up conversation with the people I encountered. They would start with "Where are you from?" and "What is it that you do?" Of course, I explained what we at the Center do. Not surprisingly at all, I was taken in quite well. The heavily rural areas of Alaska are dealing with the same rural issues we do here in Nebraska.

It was easy to engage them because of all we had in common as rural residents, and really made me feel proud of what we are doing here at the Center. We are not alone in our struggles, and our work stretches beyond the boarders of Nebraska.

Alaska's rural population has it pretty tough due to the geography and climate, which makes access to several things difficult. Similar to us in Nebraska, access to health care is a big problem. Alaska has territory barriers that determine where you can go for medical care. If you are on one side of the line, you go to Fairbanks, and the other you go to Anchorage. In a state that is quite large this can be a major issue.

For instance, one of the couples I met told me how they were sight-seeing thirty minutes from their town, but crossed the line for care territory. She fell and needed medical attention, and had to wait two hours for a transport to the hospital. When her husband needed hip surgery later, they will have to go back to his state of Kentucky because of the long wait in the two hospitals equipped to preform it in Alaska. "Even though we have insurance, the access to medical care is a problem we all struggle with here." said Sharon Wilson of North Pole Alaska. "In the more rural areas, I can't even imagine what they have to go though."

Like Sharon and her husband Bobby, most of the people I talked to were unaware of the good that rural Americans can get out of health care reform. But once they learn of the benefits, they are quick to accept reform.

In a year, after all the rumors that have been debunked, the benefits of health care reform will be more well known. So, in light of all the negative media that continues to bombard us, we all must continue to use the power of our collective voices. I tried to do my part to spread the good word and inform those I met in Alaska. Hopefully they will do the same, and you will too.

When My co-worker sent around this article about the elderly in rural America, I couldn't help but nod my head in agreement. Although the article highlights the difficult points of growing old in rural areas, I still get tremendous amounts of hope and inspiration from talking with older people from small towns. 

When I hear about the busy main streets and late nights on the town of days past, of families making a living on smaller acreages, and good jobs in small towns, I am hopeful that we can rebuild rural areas to something that resembles what my grandparents describe.

Today, living outside of Craig, Nebraska, a town of 220 about 60 miles northwest of Omaha, is hard even for this 23 year old. Craig, now home to two bars, a post office and an elevator, once had a gas co-op and service station, a grocery store, a hardware store, a doctor's office, several cafes, a roller rank and dance hall, and a lumber yard.

In the early 1900's an initiative called the "Craig Improvement Association" worked to bring new businesses to town. They successfully brought an electric shop to Main street along with a few other businesses.

It's been decades since a new business opened on Main Street. Yet, I love this town. Maybe it's the old water tower, the husker-game pot lucks at the bar or the pretty rolling hills East of town. While I don't think Craig will ever have a roller rank and dance hall again, I'd love to see a good breakfast place where you can get a good cup of coffee and read the paper.

Normally, I don't like to draw attention to articles that aren't true or are misleading. However, there's a rumor that's already gained a lot of traction, saying that the Congressional Budget Office (CBO) found that "health care premiums costs would be 10 to 13 percent higher for those who purchase insurance directly from insurance companies."

Actually, what the CBO report says is that health care premiums "will go down for the vast majority of Americans, and that the same insurance policy will cost less under reform."

This is an important distinction, because the population they're specifically talking about are people who buy insurance on the individual market. Many of them are farmers, ranchers, entrepreneurs and small business owners in rural communities.

So it matters to us that our readers have accurate information.

How is it possible that these two messages can exist simultaneously? It's a case of comparing apples to apples, instead of apples to kiwi.

Ezra Klein explains:

The upcoming vote on health care reform is of historic proportions. The issue has vexed American leaders since Teddy Roosevelt called for universal health insurance in 1912, followed by Presidents Truman, Nixon, Clinton and now Obama. Even the hard-nosed Truman, who stared down the murderous dictator Joseph Stalin, met his match in the opposition to health reform.

Today, no ordinary American can be confident of continued quality coverage in the face of 15 to 20 percent annual premium hikes. Something must be done.

The issue is most critical in rural America, where more of us are uninsured or underinsured because we depend on self employment and small business employment. With each premium increase, fewer rural Americans can risk giving up their employer-provided insurance to start a business or farm. And as rural entrepreneurship declines, so goes the rural economy.

We’re also at risk of losing access to care as providers reach retirement age and no one takes their place. The Senate bills would improve rural access to care by expanding college loan forgiveness for health professionals who practice in rural areas and enticing more rural students to study for health professions.

All of the major bills would make insurance more affordable by providing refundable tax credits to offset insurance premiums to families making up to $80,000, with the greatest assistance going to those with the greatest need. The bills establish an insurance exchange to increase competition among insurers and lower prices for individuals and small businesses. Some bills establish a Medicare-like public insurance option to keep private insurers honest by making them compete on equal terms. We could all still choose to keep the insurance we have.

Each of the plans promotes healthy behavior to reduce health care costs. And each would discourage providers from using ineffective, but profitable treatments. Under the current fee-for-service system, providers make more by using more expensive treatments – even those that don’t work.

All of the plans would expand research to identify which health treatments work best and guide health care providers toward effective treatments. Each includes a pilot project to reward providers for using cost effective, successful treatments. The pilot projects would pay a fixed rate for effectively treating a particular health problem. Providers would earn the most by curing patients – so they don’t need ongoing treatment – in the most cost effective manner.

The current insurance system is broken. And the economic imperative for reform is equaled by the moral imperative. From 18,000 to 45,000 Americans die each year because they lack insurance and don’t get adequate care in time. We must reform health care to make America a more prosperous nation and, in the words of Abraham Lincoln, a more perfect union. We have been talking about it for 100 years. It is time to act.

Agree or disagree? Contact Chuck Hassebrook, chuckh@cfra.org or call 402.687.2103 x 1018.

On Nov. 3, farmer and Center for Rural Affairs board member Jim Knopik arrived in Washington, D.C. to tell Senator Ben Nelson (D-NE) of his support for health care reform in person. Knopik joined over 100 other small business owners and self-employed people who traveled to Washington to make their support known to their members of Congress.

Jim Knopik and Rick Poore after a press conference at the Capitol. Next they went to the White House, where Rick shared his health care story with Secretary of Health and Human Services Kathleen Sebelius. (Photo by Angel Romero Keister)

The small business owners focused on elements of health care reform crucial to small business and the self-employed, such as affordability measures, insurance reforms, and a public health insurance option as well as a national health insurance exchange to increase consumer choices and competition in the health insurance industry.

The fly-in featured several events, including a press conference at the Capitol with various legislators and a meeting at the White House with Secretary of Health and Human Services Kathleen Sebelius. Small business owners from Nebraska and North Dakota also met with Rep. Jeff Fortenberry (NE), Rep. Earl Pomeroy (ND), Sen. Kent Conrad (ND), and staff from the office of Sen. Nelson.

“For more than 50 years I have watched the population of my county decline. Where there were once 49 families within two miles of our farm, there are now only five. The remaining family farmers and Main Street businesses, the economic engine of our community, are struggling to survive. Access to affordable health care is one of the primary causes of their struggle. Without affordable health care, farmers, ranchers and small business owners cannot survive,” said Knopik.

Shortly after returning to Nebraska, the Center for Rural Affairs released a letter to Speaker of the House Nancy Pelosi endorsing the House health care reform legislation (Affordable Health Care for America Act, H.R. 3962) and encouraging representatives to vote for passage of that legislation.

Contact: Steph Larsen, StephL@cfra.org or 402.687.2103 x 1014 for more information on this event.

Researchers from the Harvard Medical School have found that about 45,000 deaths of working age adults per year in the U.S. are associated with a lack of health insurance. For the study’s base year, the number of deaths associated with being uninsured were higher than those for HIV/AIDS, breast cancer, prostate cancer, leukemia, Parkinson’s disease, hypertension heart disease, liver diseases, kidney disease, and homicide, and nearly the same as motor vehicle accidents.

The report found that given the link between death and lack of health insurance, better ways to provide insurance to more people and provide medical care for the uninsured must be found. Alternatives now employed such as community health centers and clinics – while valuable – still do not provide the protection of health insurance.

These findings are especially important for rural people, who have higher rates of uninsurance and in many places lack even the alternatives the study found deficient. Health reform legislation that provides more individuals and families greater options for affordable, comprehensive health insurance will help address these issues.

The Harvard report theorized that the situation may be partially due to many of the chronically ill being less likely to have a usual and continual source of medical care, something health insurance is more likely to provide. In a second report, the same researchers took a deeper look at the connection between chronic health issues and insurance.

They found that half the working age adult uninsured with diabetes or high cholesterol were unaware of their condition (only a quarter of the insured with the same conditions were unaware). Once diagnosed, hypertension and high cholesterol were more poorly controlled in the uninsured. By some measures, diabetes control was also poorer for the uninsured.

This research generated two important conclusions. One, the diagnosis and control of chronic diseases in the U.S. is substandard regardless of insurance status, but it is much worse for the uninsured. Second, these chronic conditions are common, easily treated, but lethal if not diagnosed and controlled by a prescribed treatment regime that may be unavailable to the uninsured.

Again, these findings are critical to rural people. Rural people have higher rates of these and other chronic diseases and obtain fewer preventive tests and procedures. When combined with lower rates of insurance, rural people are more likely to suffer the consequences of a lack of diagnosis, treatment, and control of chronic diseases.

Both studies highlight the bottom line of health reform that Congress has for the most part ignored. This country is beset by an epidemic of preventable and treatable chronic diseases, but prevention is too often disregarded, and diagnosis and treatment is out of reach for too many. Without change, too many people will continue to be sick and ultimately die needlessly.

For more information: contact Jon Bailey, jonb@cfra.org or 402.687.2103 x 1013.

Access is the opposite side of the health insurance coverage coverage coin. The importance of access cannot be ignored, particularly in rural communities. The greatest health insurance in the world is less valuable without access to medical services. An Oklahoma State University report puts a different spin on rural access. It looks at the economic effect of primary care physicians and primary care services in rural communities, making the need for more rural health care providers an economic development cause.

The findings are intriguing.

One full-time primary care physician generates, on average, about $1.5 million in revenue, nearly $1 million in payroll, and creates or helps create 23 jobs. The physician’s economic contributions are direct and indirect. People come to or stay in town for medical services and obtaining other services or shop rather than travel to an urban area.

As health reform legislation takes its path through Congress we must be clear that both sides of the coin are equally valuable to rural people. In the words of our friends at the National Rural Health Association: Health Insurance does not equal Health Care Access.

Contact: Jon Bailey, jonb@cfra.org or 402.687.2103 x 1013 for more information.

Consider the following.

Federal incentives to boost renewable energy development will help shape a new energy economy. Depending on the nature of the incentives, the economic benefits of renewable energy may accrue to only those wealthy enough to invest in very large development projects. Or incentives can be designed to foster widespread ownership and community benefit of renewable energy development. Now is the time to advocate for policy that will create real opportunity for family farmers and ranchers and rural people of modest means.

Federal initiatives to address climate change are also critical to the future of our communities. The atmospheric level of CO2 has already reached a level above which climate scientists predict continued instability in weather patterns with negative consequence for farmers and ranchers who depend on predictable weather patterns. With effective action, the trend can still be reversed.

Initiatives to address climate change can offer direct benefits for both rural communities and farmers and ranchers. Programs to increase energy efficiency create jobs in rural communities while lowering the monthly utility bill of rural residents. Farmers and ranchers could also benefit from carefully crafted agriculture practices that reduce carbon usage or capture carbon in a measurable and verifiable way.

To get involved: contact Brian Depew at briand@cfra.org or 402.687.2100.