What is in the Health Care Reform Law for Rural America?

Provides Coverage for Uninsured Rural Individuals: In rural areas, the uninsured rate reaches 23 percent, almost five percentage points higher than in urban areas, and the current recession means that more people may lose access to their employer‐based health coverage. The legislation guarantees that individuals currently without access to affordable health insurance would have options for obtaining affordable, quality health care coverage.

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More Affordable Choices and Competition. In many rural states, one insurance company dominates more than 80 percent of the market, meaning that there are often only one or two insurance companies offering health plans in the individual and small group markets. Health insurance reform will result in an additional 32 million people accessing health insurance creating greater participation and competition by health insurers.

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Protects Rural Consumers from Discriminatory Practices that Make Coverage Unaffordable: Health reform includes insurance market reforms that prohibit insurance companies from denying coverage based on pre‐existing conditions, prohibit charging higher premiums based on gender or health status, and require insurers to include an essential set of health benefits in their plan. These provisions will all help make quality health insurance more accessible and affordable for rural residents.

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Provides Bonuses to Reward Primary Care Doctors that Practice in Shortage Areas: Only 9 percent of physicians practice in rural America even though 20 percent of the population lives in these areas. The legislation provides a 10 percent incentive payment for primary care doctors practicing in underserved areas, which, combined with a current bonus for physicians in shortage areas, will help recruit and retain primary care physicians where they are needed the most.

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Ensures that Rural Doctors Are Paid the Same Rate for Their Work as Urban Doctors: Prior to 2003, the Medicare reimbursement formula paid doctors practicing in rural areas relatively less for their work, even though they have the same training as their urban counterparts. The legislation helps rural physicians by extending an existing provision that addresses this payment inequity.

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Helps Rural Doctors Cover Costs Related to Operating their Practice: Physicians practicing in rural areas are paid relatively less by Medicare than their urban counterparts for expenses such as rent and hiring office staff. The legislation will encourage doctors to practice in rural America by increasing Medicare reimbursement rates in many areas for these types of overhead costs.

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Supports Community Health Centers in Rural Areas: Community health centers are an important source of care in rural areas. The legislation provides $11 billion in new funds to support community health centers over the next five years, and maintains the current requirement that these rural areas receive special consideration for distribution of funds.

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Trains Primary Care Providers for Rural Areas: There is a shortage of health providers in rural America, particularly primary care. The legislation emphasizes training for primary care providers by supporting training on rural health, investing in advanced nurse training, and providing $1.5 billion to expand the National Health Service Corps to address work shortages in high‐need areas. The legislation also redistributes unused Medicare‐funded graduate medical education positions to hospitals in rural and other communities and health professional shortage areas that commit to train primary care or general surgery residents.

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Rewards Hospitals in Low Cost Areas: The legislation provides $400 million to reward hospitals located in areas of the country with the lowest per capita level of Medicare spending.

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Protects Payments for Rural Outpatient Hospitals: When Medicare moved to a new payment system for outpatient hospitals in 2000, rural hospitals were protected from potential losses. The legislation extends this current “hold harmless” policy for rural outpatient hospitals to ensure that rural residents will continue to have access to care.

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Helps Certain Rural Hospitals Cover Their Lab Costs: Rural hospitals have lower patient volume than their urban counterparts, making it more difficult to sustain much needed services such as laboratory tests. The legislation helps to maintain access to routine lab tests for patients living in rural areas by paying small rural hospitals their reasonable costs for performing clinical laboratory tests.

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Boosts Payments for Rural Home Health Agencies: Home health providers in rural communities often must drive long distances to see their patients, incurring additional transportation costs. The legislation reinstates a 5 percent add‐on payment for rural home health agencies that had previously expired.

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Protects Ambulance Services in Rural America: The bill protects seniors’ access to ambulance services in rural areas by continuing an existing increase to Medicare reimbursement rates for rural ambulance services. These adjustments help compensate for the additional costs incurred for providing these services over great distances.

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Ensures Access to Preventive Services in Rural Areas: The bill eliminates cost‐sharing for preventive care (including well baby and well child care) in new health plans to underscore the importance of preventive health services in making America healthier and lowering the growth of health care costs over time. And the legislation caps annual out‐of‐pocket spending for individuals and families so that no one faces bankruptcy from health costs ever again.

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Assistance for Rural Hospitals: The Medicare Modernization Act enabled certain hospitals, commonly referred to as “Section 508 Hospitals,” to be more appropriately reimbursed by Medicare for the services they provide to rural communities. The bill continues these critical payment improvements, enhancing the ability of these rural hospitals to recruit and retain essential staff to care for Medicare beneficiaries in their communities. Additional provisions assist hospitals with a low‐volume of discharges and extend payment protections for Medicare Dependent Hospitals.

PREPARED BY THE HOUSE COMMITTEES ON WAYS AND MEANS, ENERGY AND COMMERCE, AND EDUCATION AND LABOR MARCH 20, 2010

Ralph Hall brings the Republican Lie Machine to a "Town Meeting"

On May 27th I witnessed one of the slickest displays of marketing I have ever seen. Marketing is that skill the Bush white house used so skillfully to first confuse voters and then later to fill their heads with propaganda. And for most of the past eight years it worked to further a Reaganistic vision of big bid'ness first and the hell with the rest of society. War was the answer to all international conflicts whether they were real or not. Wall Street was allowed to run hog wild and every other regulatory agency was turned into a frat house for Bush's incompetent buddies. Anyway, back to the meeting. It was titled "Americanize US Health Care Not Socialize". Ignoring the lack of proper grammar, we got the point. It turned out to have been sponsored by the Dallas Association of Health Underwriters-basically insurance sales people who sell plans to employers.

I had never seen Congressman Hall speak and I was impressed. His entire biography was read out loud as his introduction and from most of the folks attending he received a greeting appropriate for a hero. Then he feted Bush who he felt was a "great" President and trashed Obama. That got the crowd aroused with feelings of righteous indignation and anger. Then he turned folksy and went into what I can only describe as a Will Rogers mode telling funny jokes on himself and others just to show he wasn't really a mean person. When he finally spoke at all to the issue at hand, Health-Care Reform he began to paint it as essentially a back door approach to introducing a communist style of socialism to America. A woman behind me stood up to shout that "this isn't a communist country!".

It was at the point that I spoke out loud to interrupt the flow of jingoism and misinformation that was emanating from the stage. I shouted that I objected to the whole premise of calling it a community forum to share information about the details of the coming Health-Care Reform legislation with only representatives of the insurance industry allowed to present. In turn I was shouted back at by the audience and I must say that the congressman was polite. When I asked why other stakeholders in the process of reform weren't invited he just didn't respond to my question. Then several more democratic activists stood up to speak with more direct criticisms, like the perception that the insurance brokers were just afraid of losing their jobs and they were willing to destroy the mission to provide insurance to the poor to save them. Chaos ensued for a short while then the next speaker was introduced.

Reid Rasmussen, a former citizen of Canada, was next to speak. There wasn't much he said that wasn't a distortion of the facts. He intimated that when Hillary Clinton proposed over hauling health care that "he heard" "someone" suggest that her proposal was simply to adopt the Canadian model of a government run health care system. Then without a skip in his rapid fire banter he inferred that President Obama was proposing the same thing. In fact no such thing has been proposed by Obama and no such proposal has been considered in either the Senate's Finance or Health, Education, Labor and Pensions Committees where the legislative proposals for heath care reform are being considered.
A proposal has been made to offer a public plan option as part of a wide range of health insurance programs.

In the time I was there the only constructive information I heard was from the second speaker, Ron Dobervich. He spoke about ways in which consumers can be more assertive and informed about their care. He advocated that people keep a copy of all of their medical records, shop for lower prices for procedures and negotiate with physicians about their fees. He gave a very accurate map of the wide variance in prices for health care within a given city. I left at this point but many more brave democrats spoke out that night after me. So what started out to be a marketing plan by insurance salespeople actually turned into a real town meeting.