If 2 million people in Houston lost their access to health care all at once would anyone notice? What about San Francisco, Austin, Lexington, and Indianapolis combined? That could never happen, right? Of course not.
But why, when the 2 million people who live in frontier communities across the country, do theses Americans become invisible, and why are the programs that serve them Americans labeled as too expensive?
Current health law proposals threaten local health care systems in frontier communities. A working estimate of the nation’s frontier population is 2 million, based on low population density and remoteness. These lands are not empty, and they are not without value. Agriculture, natural resources, National Parks, public lands, recreation, and tourism are the economic engines of frontier areas. Most tribal lands are in these areas and proposed changes to the underfunded Indian Health Service (IHS) endanger the health care of Native Americans.
Low-income frontier residents won’t be the only ones hurt by the healthcare proposals. High income, well-insured frontier residents need emergency and other safety-net medical programs in remote areas. Erosion of safety-net programs is tantamount to a fatal spiral for the entire population but especially for vulnerable populations including elderly and disabled, whether rich or poor.
The Affordable Care Act (ACA) was a job-creation powerhouse. Good jobs; jobs in construction building new facilities. These are high-touch jobs providing the hands-on caring for our communities. Technology jobs implementing and maintaining Electronic Health Records (EHR) and telehealth services. Health care is often the top employer in frontier communities. Medical practices, clinics, home health agencies, skilled nursing facilities and hospitals inject a cash multiplier effect into communities, through payroll, local purchasing, and taxes. Cutbacks in health-care spending will have massive secondary impacts rippling into every corner of the economy of frontier, tribal, and rural communities. The Chartis Group, a rural think tank, estimates that current proposals would cause “a loss of $1.b billion in revenue a year to rural providers and an immediate loss of 34,000 jobs.
Because morbidity and mortality among tribal populations are greater than among other population groups, the National Center for Frontier Communities supports the demands of tribal leaders for additional resources. The Indian Health Service is a clear and decades-long example of how per-capita funding formulas and block grants fail to provide sufficient funds for high quality health services.
The ACA began the process of easing the structural barriers faced by small communities, assuring that everyone is covered with reasonable access to care. ACA funding has been invested in modernizing Indian Health Service clinics and hospitals and increasing the number of Community Health Centers. Provisions in the ACA help keep the doors open at small rural hospitals. Safety-net investments must not be repealed before effective replacement programs are enacted.
The National Center for Frontier Communities calls on Congress to take the time to learn the special needs of frontier communities and our unique challenges developing and sustaining health services. We know improvements are needed, but the rush to reduce Medicaid spending and eliminate other programs that support the health care system in isolated, at-risk, native and frontier communities will hurt, not help. Handing Medicaid over to the states will constitute the largest unfunded mandate to states in the nation’s history.
The National Center for Frontier Communities stands ready to help with any and all efforts to protect and improve health care for the millions of people who live in, work in or travel through frontier areas.
Caroline Ford is board president of the National Center for Frontier Communities, based in Silver City, New Mexico. The center organizes and advocates on behalf of frontier communities, generally defined by low population density and geographic remoteness.
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