Rural communities struggling with health care despite Obamacare

Sept. 14--People in nearby rural communities are struggling with getting health care despite ongoing efforts to boost health insurance enrollment through the Affordable Care Act.

A national study covering the last three years ranks Grundy County as the most unhealthy county in Tennessee and several other counties in the region -- such as nearby Marion, Meigs and Sequatchie counties in Tennessee; Dade and Walker counties in Georgia; and Jackson County, Ala. -- remain ranked low in the study as health insurance participation continues to lag.

After last October's troubled launch of HealthCare.gov, the portal for national health-insurance exchanges, the push to cover more Americans resumes Nov. 15 with the beginning of the ACA open-enrollment period for 2015.

But are rural people heeding the call?

Caleb Rae, a physician's assistant at Grundy County Primary Care Center in Coalmont, Tenn., said the impact of the Affordable Care Act has been mixed, so far.

"There are certainly more people who have insurance," Rae said. Still, he noted that many low-wage workers fell into a gap in the system created when Tennessee decided not to use available federal funds to expand Medicaid.

The cheapest health plans on the ACA's national health-care exchanges come with high deductibles, Rae said, so "(people) might have insurance, but since they're paying such a large part of their costs, it hasn't encouraged them to come in any more regularly." And some of those cheaper plans aren't being accepted by some health-care providers in Grundy County, so patients there are often forced to drive to Chattanooga for services such as X-rays, Rae said.

The report, County Health Rankings & Roadmaps: Building a Culture of Health, County by County, by the Robert Wood Johnson Foundation, ranks counties in each state in terms of quality of life, length of life and factors that influence a community's overall health. Such factors include smoking rates, obesity, teen pregnancy, high-school graduation rates, access to healthy food and availability of health-care providers.

Area counties such as Bradley and Hamilton in Tennessee, Madison in Alabama (Huntsville) and Whitfield in Georgia (Dalton) rank in the top quarter in their respective states, but people in more rural counties such as Grundy and others in the Tennessee Valley still face many hurdles to quality health care, health industry officials say.

While the report looks at long-term trends in communities, the Affordable Care Act is intended to improve community health across the nation and its impact so far is impossible to measure, according to officials.

Rae said health care for rural people is still a financial hurdle because of limited access to physician networks, costly insurance premiums and high deductibles.

Similarly, North Georgia Health District spokeswoman Jennifer King said some hurdles to quality health care include "relatively lower numbers of health-care providers, transportation issues and financial challenges."

King said it will take time before health-care industry officials can judge the long-term impact of the Affordable Care Act.

Research by Kaiser Health News, a nonprofit organization that covers health-care policy and politics, points to many of the same barriers. Despite the fact that millions have signed up for private insurance or Medicaid in the first year of ACA, millions more have not, according to Kaiser.

Rural people face special barriers to quality health care, which has federal officials concerned, says Laurie Martin, a RAND Corporation senior policy researcher, and Brock Slabach, a senior vice president at the National Rural Health Association.

Distance to doctors and lack of Internet access played a role, but some experts say the most significant problem comes from states' decisions about whether or not to expand Medicaid eligibility. Tennessee is among 20 states that have not yet taken that step, including every state in the South except Arkansas, according to Families USA, a nonprofit organization dedicated to the achievement of high-quality affordable health care.

Tennessee is among four "states to watch" on this front, according to Families USA. Tennessee Gov. Bill Haslam said Aug. 28 that an expansion proposal would be submitted to the Centers of Medicare and Medicaid Services this fall. Other states working on proposals are Indiana, Utah and Wyoming.

Targeting outreach in rural areas remains difficult because enrollment data hasn't been released by the Centers for Medicare & Medicaid Services, Commonwealth Institute senior policy analyst Massey Whorley told Kaiser. The nonpartisan institute examines the impact of public policy on middle-class and low-income people.

"It's critically important we have this data well in advance of the next open enrollment," Whorley said.

Contact staff writer Ben Benton at bbenton@timesfreepress.com or twitter.com/BenBenton or www.facebook.com/ben.benton1 or 423-757-6569.

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