Rural, Small Town Health Care: In Need of a Shot in the Arm

Article excerpt

Health care access in small town and rural America is frequently a matter of life and death, not just to the people who live there. It's an issue that cuts to the very survival of many such communities.

Access to good medical care is an imperative for economic development and community growth. Some small towns have even begun to offer bounties to citizens who successfully recruit health professionals to set up practices in small towns particularly those communities that are geographically isolated

What is included in the Clinton Administration Health Care proposal that is particularly applicable to smaller communities in America?

The Clinton Administration plan contains provisions intended to attract medical professionals to small town America and to provide payment to health providers from all who receive care. The administration plan also contains special limits on health care costs for small employers, although these caps are not currently proposed for small town and city governments as employers (see related stories in this issue of NCW). While not currently applicable to cities that are small employers, this provision may be particularly important because the job base of smaller communities is predominantly composed of small employers.

A series of public health initiatives proposed in the plan as well as the coverage under all health plans of preventative services may be of particular value in many rural communities, providing income streams for currently uncompensated or unprovided care and outreach.

The plan also includes a number of sections suggesting ways in which special programs developed by the new regional health alliances can incentivize the provision of health care in rural and underserved areas. Small communities will have to be particularly vigilant as states draw up regional alliance boundaries or decide on a state single-payer plan to make sure that the boundaries will provide appropriate care. In thinly settled states where much health care is obtained across state lines such structural issues will also be very important.

While the plan contains a number of reforms to unprove access and availability there are graphic characteristics that are beyond the ability of the plan to change. It is likely that the choice of health plan options in rural areas will continue to be less diverse than in urban areas even after reform.

Small Cities as Employers: No Special Treatment

Small cities will be required to pay at least 80 percent of the regional alliance health premiums just as with all other cities. As with all other cities they will not be eligible for the 7.9 percent of payroll cap or the special small employers caps which are discussed below. As with all other cities small communities will be required to pay for full family unit coverage and pay premiums for part-time workers on a pro-rata basis. …