In Our Opinion: Health care cuts hit rural areas hard

Nearly 450,000 New Yorkers are expected to lose their health insurance through the state's Essential Plan when terms for the program change as eligibility and funding changes take effect on July 1. While the numbers are staggering statewide, the consequences will be felt particularly hard in rural communities like ours.

According to data from the state health insurance marketplace New York State of Health, nearly 15,000 residents of the 19th Congressional District, which includes Otsego, Delaware and Chenango counties, and almost 19,000 residents of the 21st Congressional District, which includes Schoharie County, stand to lose coverage. Those numbers are not abstract, but represent our family members and community members who may soon find themselves without access to affordable health care.

The Essential Plan, which debuted in 2015 and was designed for low- and moderate-income New Yorkers who struggle to pay for health insurance, offers low premiums, has no deductible and includes dental, vision, prescription and other provisions. Eligibility requirements include age and income thresholds, as well as ineligibility for other coverage such as Medicaid. It also covers non-citizens who came to the United States legally, provided they meet the specific immigration status requirements and income limits.

The loss of this longstanding program is troubling for anyone affected, but it is especially concerning in rural regions where access to care is already limited. Our four counties continue to face shortages of both primary care providers and specialists. When a person's health insurance disappears, finding appropriate medical care becomes even more difficult. Preventive appointments are delayed, chronic conditions go untreated and emergency rooms become last-resort providers.

We're lucky that our region has organizations working to fill the gaps. The Oneonta Community Health Center provides free health care to uninsured and underinsured patients, regardless of residency. Supported by private grants, foundations and donations, the nonprofit organization saw 175 patients last year, according to Executive Director Beatriz de la Torre.

Yet even organizations like the health center are already seeing the effects of the Essential Plan changes.

The center works with navigators to help patients determine whether they qualify for available health coverage programs. Recently, de la Torre said, patients who previously would have qualified for the Essential Plan have been returning because they now fall into a coverage gap. They earn too much for one program and not enough to afford private insurance, leaving them with few options.

Currently, the health center operates a weekly clinic every Tuesday evening and is expanding its reach through a rural outreach pilot program in Edmeston. Plans are underway to bring pop-up clinics to Sidney, Richfield Springs and Worcester next year, extending services to communities across Otsego County.

Those local efforts are commendable, but they are not a replacement for a statewide insurance program that serves hundreds of thousands of people. Community health centers, charitable organizations and volunteers play an important role, but they should not be expected to shoulder the burden.

As thousands of residents across our region prepare to lose coverage, policymakers must recognize that access to health care does not begin at the doctor's office. It begins with access to insurance. Without it, the barriers facing rural patients only grow higher, and the health of our communities suffers as a result.