Rural Health Crisis: Medicare for All Solutions

Americas Rural Health Crisis Medicare for All to the rescue!

Rural Lives Are Cut Short Today 80 Americans in rural communities lose three years of life compared to Americans in urban communities today. Large Metro Counties Life expectancy at birth (years) 77 Rural Non-Metro Counties 75.7 75.3 1991 2015 Social Determinants of Health in the United States: Addressing Major Health Inequality Trends for the Nation, 1935-2016, Note: 1991 refers to 1990-1992 International Journal of Maternal and Child Health and AIDS, January 2018 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5777389/

Its More Dangerous to be Pregnant in a Rural Community 29.4 Maternal mortality (deaths per 100,000 live births) 18.2 Urban Rural Scientific American analysis of U.S. Centers for Disease Control and Prevention, February 15, 2017 https://www.scientificamerican.com/article/maternal-health-care-is-disappearing-in-rural-america/

One in three rural seniors Have No Natural Teeth 33.3% Seniors without any natural teeth 22.7% Urban Seniors Rural Seniors The 2014 Update of the Rural-Urban Chartbook, Rural Health Reform Policy, Research Center, October 2014 https://ruralhealth.und.edu/projects/health-reform-policy-research-center/pdf/2014-rural-urban-chartbook-update.pdf

The more rural your county, The More Likely You Are Uninsured 12.3% 11.3% Percentage of county s residents without insurance, 2017 10.1% Mostly Urban Mostly Rural Completely Rural Rates of Uninsured Fall in Rural Counties, Remain Higher Than Urban Counties, U.S. Census Bureau, April 9, 2019 https://www.census.gov/library/stories/2019/04/health-insurance-rural-america.html Accessed Feb. 28 2020

Rural communities are charged Higher Insurance Premiums $1,572 $1,512 Annual difference between rural and urban premiums, 2017 $1,428 $1,272 $1,248 Across the USA, insurance premiums in rural areas average 10% higher than in urban areas. $840 CA CO FL IL MO NV Data for 2nd lowest silver plans on 2017 ACA marketplaces. Data for each state available at the link below. https://www.rwjf.org/en/library/research/2018/11/are-marketplace-premiums-higher-in-rural-than-in-urban-areas.html Accessed Feb 28 2020

Between 2005 and 2020, 166 Rural Hospitals Have Closed 162166 150 143 125 Cumulative rural hospital closures since 2005 128 118 100 106 89 75 73 50 59 50 42 45 25 32 9 26 17 0 2005 2007 2009 2011 2013 2015 2017 2019 https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/

Between 2005 and 2020, 166 Rural Hospitals Have Closed An Unsustainable Path Medicare for All The status quo is wreaking havoc on rural communities. Rural hospitals have been much more likely to close in states that have not expanded Medicaid. Universal coverage means rural hospitals get reimbursed for every patient. The global budgets provided under Medicare for All would provide predictable revenue.

Key health problem: People in Rural Communities Are More Likely To Be Uninsured Public Option Medicare for All Public option plans would leave millions of rural Americans without coverage, preventing them from getting any of the care they need. Medicare for All provides seamless, lifelong coverage for everybody, regardless of income, age, employment, or location. Insurers will continue to target rural communities for higher premiums, making insurance unaffordable. Public funding protects all rural communities with equitable coverage, regardless of geography.

Key health problem: People in Rural Communities Are More Likely To Be Under-Insured Public Option Medicare for All Public option plans would not help most of the people with expensive, low-quality private insurance that prevents them from getting the care they need. Medicare for All ensures patients can get the care they need without copays or deductibles standing in the way.

Key health problem: People in Rural Communities Are More Likely To Suffer and Die from Treatable Illness Public Option Medicare for All Most public option plans require high copays and deductibles, which prevent patients from seeking regular care. Medicare for All provides Americans with the care they need, when they need it, by coveringall medically necessary care, including preventive and primary care, maternity care, dental, mental health, prescription drugs, and long-term care. A public option would not improve the quality or cost of private or job- based health plans.

Key health problem: Many Rural Hospitals Have Closed or Are in Danger of Closing Public Option Medicare for All Public option plans do nothing to support underfunded hospitals and clinics. Since everyone is covered, rural hospitals would no longer absorb the costs of treating uninsured patients. Rural hospitals would continue to close, leaving communities without access to care. Medicare for All funds hospitals through global budgets that are based on community needs not profits.

Why Single Payer Medicare for All? Protect Rural Lives Much of the difference in rural/urban life expectancy is preventable. Protect Rural Hospitals Predictable, reliable funding based on community health needs. Protect Rural Communities Hospitals are often a rural community s largest employer.

Physicians for National Health Program Non-profit, non-partisan, member-supported 501(c)3 Membership open to everyone www.PNHP.org @PNHP Facebook.com/DoctorsForSinglePayer

Supplemental Slides

Rural Health in America Today Insurance is often more scanty and expensive. Hospitals are closing and doctors are scarce. Health and well- being suffer; lives are cut short.

Rural Americans Have Poor Access to Care 45% Could not afford care 26%: Unable to get care 23% Location too far 22% 19% Hours not what s needed No physician in network https://www.npr.org/sections/health-shots/2019/05/21/725059882/poll-many-rural-americans-struggle-with-financial- insecurity-access-to-health-ca Poll: Many Rural Americans Struggle With Financial Insecurity, Access To Health Care, National Public Radio, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health, May 21, 2019

Chronically Ill Rural Americans Have Worse Health Outcomes 40% Increase in rates, rural vs urban 23% Mortality Rates Preventable Hospitalizations Rural Health Issue, Health Affairs, December 2019 https://www.healthaffairs.org/do/10.1377/hblog20191203.960326/full/

Insurance premiums in rural areas average 10% Higher than in Urban Areas $5,496 $5,424 2017 Annual Premiums (2nd-lowest Silver plan) $5,172 $5,160 $5,052 $4,824 $3,996 $3,984 $3,984 $3,912 $3,900 $3,480 Urban Area Rural Area CA CO FL IL MO NV https://www.rwjf.org/en/library/research/2018/11/are-marketplace-premiums-higher-in-rural-than-in-urban-areas.html Accessed Feb 28 2020

Insurance based on employment does not fit the Entrepreneurial Spirit of Rural America Higher Higher Disability Business Owners Unemployment Rural Americans are more likely to be unemployed Rural Americans are 50% more likely to be disabled Rural Americans are nearly twice as likely to own their own business https://www.ers.usda.gov/webdocs/publications/85740/eib-182.pdf?v=43054 https://www.kff.org/medicaid/issue-brief/the-role-of-medicaid-in-rural-america/ https://www.usnews.com/news/national-news/articles/2017-03-20/6-charts-that-illustrate-the-divide-between-rural-and-urban- america

Rural Americans have higher rates of the Five Leading Causes of Death in the USA More heart disease More cancer More unintentional injuries More lower respiratory disease More strokes Potentially Excess Deaths from the Five Leading Causes of Death in Metropolitan and Nonmetropolitan Counties United States, 2010 2017, Centers for Disease Control, November 8, 2019 https://www.cdc.gov/mmwr/volumes/68/ss/ss6810a1.htm?s_cid=ss6810a1_e&deliveryName=USCDC_921-DM12720 2017 data

Rural Americans have lower rates of the Primary Care and Health Screenings Less advice on diet, exercise, and tobacco Fewer well-child visits Fewer colorectal cancer screenings Fewer Pap smears Fewer mammograms National Healthcare Quality and Disparities Report Chartbook on Rural Healthcare, Agency for Healthcare Research and Quality, Department of Health and Human Services, October 2017 https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/chartbooks/qdr-ruralhealthchartbook-update.pdf