Despite a ragged launch of the healthcare.gov exchange, the federal online marketplace for insurance coverage, regulatory agencies indicate that access to healthcare for rural residents has increased since enrollment began last year.

Tom Morris is the associate administrator for rural health policy at the Federal Office of Rural Health Policy.

It operates within the Health Resources and Services Administration arm of the U.S. Department of Health and Human Services (HHS). It helps train health professionals and gets them to areas where they’re most needed.

“ACA expands health insurance coverage through the health care marketplace and Medicaid expansion. Getting the rural uninsured into coverage, perhaps for the first time in their lives, is the critical first step,” Morris says.

“In addition, rural hospitals and clinics may see improvements in their bottom lines as care that was previously written off as bad debt or charity care may now be paid for through increased insurance coverage.”

The law expands the National Health Service Corps. As a result of ACA investments, there are now 9,500 community health center service sites. More than 40 percent serve rural areas.

Additionally, the agency’s Partnership for Patients creates a network of rural hospitals to focus on their unique operational needs. Morris says this is important since rural areas typically see higher rates of chronic disease, shorter life expectancies and higher mortality rates.

Advances rural interests
“The ACA is increasing health insurance coverage rates and expanding coverage for children via the Children’s Health Insurance Program,” David Young, extension community health specialist with Montana State University, says.

“As expected, residents in states that expanded Medicaid have fared better than those in states that didn’t.”

An April report from the Rural Policy Research Institute at the University of Missouri shows that rural residents have already experienced increased access to insurance, reduced exposure to financial loss from medical expenses and improved access to primary care.

Its authors recognize the full impact of the ACA remains uncertain. They caution that as payments shift from volume to value, constant re-evaluation of performance and how care is delivered is needed. Areas of concern include:

• Health insurance coverage
• Medicare and Medicaid payment
• Quality and delivery system reform
• Public health
• Healthcare workforce
• Long-term care

Another effort in the works
“The Cooperative Extension Service launched a national initiative in March to be implemented over the next five years,” Young says. “It will involve public, private and non-traditional partners to engage in resource development, program implementation and reporting on six priorities.”

They are:

• Integrated nutrition, health, environment and agricultural systems
• Health literacy
• Health insurance literacy
• Chronic disease prevention and management
• Positive youth development for health
• Health policy issues education

Ranchers in the mix
Insurance enrollees’ occupations aren’t public, but Sandra Bailey, a family and human development extension specialist with Montana State University, says the ACA is helping some farmers and ranchers find health coverage they previously couldn’t afford or get.

That doesn’t mean it’s a snap. Peter and Carrie Bakken and their children, Makayla and Eli, operate a 2,000-head feedlot near Garretson, South Dakota.

They also graze 250 mama cows and raise enough corn, soybeans and alfalfa to keep everything fed.

Carrie was a full-time teacher, but multiple health challenges forced her to quit several years ago. She then lost health coverage.

“The kids and I had insurance through our local agent,” Peter says. “Because Carrie was uninsurable, she was able to get coverage through the Minnesota Comprehensive Health Association (MCHA).”

MCHA was a non-profit organization that offered insurance to people with pre-existing conditions.

“Things went well,” Peter says. “It was reasonably priced, considering Carrie had multiple hospital stays. Then along comes the ACA, and the Minnesota program was cancelled. We got a letter that said we should go online and get insurance.”

Peter says with help from a local agent, they determined the insurance he and the kids had was a better deal than anything at healthcare.gov. Carrie got a policy with a major insurer.

“The combination of our existing insurance and the new policy that ACA offers runs about $20 a month more than before,” Peter says.

“My irritation is why didn’t you just leave us alone,” he adds. “And, what happened to all the MCHA employees?

“The communications part of this thing was its downfall,” Peter says. “This was a decision we felt like we were making because we were forced to. Once we did it, we didn’t know if it was good or not. It seems to work, but I still don’t have a lot of confidence in it because of the way things happened.”

Carrie is one of few Progressive Cattleman readers to use the official website. A late-spring reader poll showed that 88 percent of respondents had no use for healthcare.gov. More than 67 percent already had insurance, and just fewer than 6 percent used it to find new insurance.

In general though, rural residents are using healthcare.gov and state insurance exchanges.

“We saw a high level of acceptance in rural areas,” Anne Gonzales, public information officer for Covered California, says. “Rural providers are participating in regulated health networks as well.”

The agency’s base projection for all enrollees by the March 31 deadline was 580,000. The final count was 1,395,929. Counties with large rural populations, such as Fresno and Riverside, surpassed enrollment projections by 160 percent and 172 percent, respectively.

Gonzales attributes these high rates to a broad communications program that later narrowed to incorporate tactics that focused on rural communities.

Kentucky’s kynect health benefits marketplace saw similar success. As of April, 413,410 Kentuckians, many from rural counties, had enrolled in new health coverage.

Coverage option, employer mandate, upcoming costs

“Farms and small businesses have sometimes struggled to find affordable healthcare options for their employees,” Morris says. “The Small Business Health Options Program, or SHOP, can help businesses with up to 50 employees find comprehensive coverage.

Businesses with fewer than 25 employees making an average of $50,000 a year or less may be eligible for the Small Business Health Care Tax Credit if they provide health insurance through SHOP.”

The picture differs for larger employers. According to the U.S. Treasury, the employer mandate for 2015 means that most businesses with 100 or more full-time employees must provide coverage to at least 70 percent of those employees and 95 percent of them in 2016. Employers with 50 or more employees will fall under this guideline in 2016.

While no program will ever address all healthcare coverage needs, the ACA is a starting point that will evolve. Open enrollment for 2015 coverage from health care marketplaces begins November 15, 2014.

New coverage may even be affordable. Covered California announced in August that 2015 rates will increase an average of 4.2 percent, a far cry from annual double-digit increases that used to be common. 

Rick Purnell is a freelance writer based in California.

PHOTOS
TOP: Tom Morris, associate administrator for rural health policy, Federal Office of Rural Health Policy. 

MIDDLE: David Young, Extension community health specialist, Montana State University. 

BOTTOM: Sandra Bailey, Extension specialist, family and human development, Montana State University.

Extension aims to engage, educate
You don’t have to wade through new health insurance procedures alone. If you’re not working with an insurance agent, certified application counselor or navigator, your local extension office is a likely source for help.