Judy Baker answers a question from Lowell Shachtsiek at a forum on health care reform in Moberly, Missouri.

[imgcontainer] [img:richard1.jpg] [source]Richard Oswald[/source] Judy Baker answers a question from Lowell Shachtsiek at a forum on health care reform in Moberly, Missouri. [/imgcontainer]

I introduced Judy Baker to the group attending the Missouri Farmer’s Union ACA Healthcare Forum in Moberly Missouri on March 31st as someone who was knowledgeable about the Affordable Care Act, also known as Obamacare.

 “Obamacare,” she said. “But do you know what? When I tell people the truth about ACA, do you know what they say? They say ‘That’s not Obamacare!!’” Judy’s pretty low key, but I have to say her voice rose just a bit on the last sentence.

Some in Congress on the Republican side of the aisle call Obamacare “the job killing Affordable Care Act,” even though it makes employee health coverage cheaper for employers, and for many people it’s a new lease on life. Judy, who is the Regional Director for the Department of Health and Human Services (HHS) over Missouri, Kansas, Nebraska, and Iowa, pointed to statistics showing that the United States has the highest healthcare costs of any developed nation. Then she showed her audience a line chart. Our costs in the U.S. looked like Mount Everest compared to the Wisconsin Dells. On the same chart the U.S. life expectancy is in the Grand Canyon.

Life in the US has its ups and downs, I guess.

One of the things ACA does is smooth mountains into molehills by requiring health insurance companies to fold some of those double digit profit increases into preventive healthcare. Deductibles and co-pay aren’t required for things like colonoscopies and mammograms anymore. That lets doctors discover illness sooner and cure it cheaper. 

It might also help guys like me who just won’t go to the doctor because of all the expensive office calls and tests those pesky MD’s ask for. 

For instance, when I went to the doctor awhile back, they couldn’t find my file. “When were you here last?” the nurse asked. “Not sure about the date,” I said, “but I remember I had a draft card in my wallet.”

To be fair, I have to point out that not all health insurance companies make a killing. Some “only” earn about 15%. That’s figured after all costs and employee salaries are deducted, including high seven figure executive pay scales. Just for the sake of comparison, farmers usually earn from sub-zero up to about 10% on what they do, and that IS the paycheck.

With ACA, young adults can now stay on their parent’s insurance plans longer, until they’re 26. And lifetime limits on what insurance companies pay for treatment aren’t allowed. ACA also forbids denying coverage to children under the age of 19—even if they have a pre-existing condition.

Requiring that everyone have a health insurance plan didn’t set well in rural areas, even with people who had coverage. We all get our backs up when the government tells us what to do. 

[imgcontainer] [img:richard2.jpg] [source]Richard Oswald[/source] Lucy Brenner, a nurse, talked health care reform at Rural Life Day at Lincoln University back in December. The Missouri Farmers Union invited her to talk at forums across the state, including this one in Moberly. [/imgcontainer]

We had our doubts, but Missouri Farmers Union board members decided ACA was a good thing after listening to Nurse Lucy Brenner during Rural Life Days at the Jefferson City, Missouri, Catholic Diocese last December. 

Lucy is a RN with a Masters Degree in education who taught nursing at Lincoln University. Rural Life Day is the brainchild of Barbara Ross from the Social Concerns office at the Diocese. Each year Barbara lines up a list of speakers covering diverse subjects of life in rural Missouri. Lucy was one of those.

That led to ACA Forums in Monroe City, then more in West Plains, Moberly, and Palmyra. No matter where we go we’ve found people just like us, confused but curious about the ACA, because healthcare in rural areas is a big deal. Although rural areas have about 25% of the population, we have only 10% of the doctors. 

We have higher rates of diabetes, high blood pressure, and heart disease. And our people are older than the national average. That means more trips to the doctor, and more time spent undergoing treatment. 

Our health plans cost on average 25% more than the nation as a whole, partly because farmers and small rural businesses lack clout needed to get better rates. 

We also have more uninsured patients, something that costs the nation $75 billion a year in Medicaid coverage.

Judy told the group in Moberly that beginning in 2014, consumer friendly health insurance exchanges will be established. “Think of them as Travelocity for insurance,” she said. That’s where Nurse Lucy stepped in to talk about Missouri’s plans for a state health exchange.

In the 2010 election year, Missouri Lieutenant Governor Peter Kinder sued to have the healthcare law overturned. There was also a ballot referendum against the Affordable Care Act. Missourians voted resoundingly for an end to the ACA. 

Missouri already had near double digit unemployment, and we lost a Congressional seat when our population dropped in relation to the rest of the country. Voters decided we couldn’t afford it, but it all reminded me of people who keep doing the same thing over and over all the while expecting something different to happen. That’s one definition of insanity. 

By the way, mental health is another growing cost of health care.

Fortunately for us, Nurse Lucy had read the bill and knew a lot of the claims made by detractors were overheated rhetoric. There are no facts to back most of them up.

But still, voting along party lines in January, the Missouri House called for State Attorney General Chris Koster to fight the bill by challenging its constitutionality. Just the same, Lucy has spoken to one member of the Republican delegation in the Missouri General Assembly, Representative Tom Loehner, who assured her he will have a bill before the House to establish a state insurance exchange. He’d better work fast. Loehner faces term limits and will leave the House after the 2012 session.

Some critics of ACA claimed there would be “death panels” for the elderly. That was just a cheap shot at end of life counseling and hospice care for the terminally ill. Nobody lives forever, but increasingly costly means of life support are being used to extend lives without any real hope for improvement or cure. That’s something we all go through sooner or later.

So Lucy always talks to folks about the rhythm of life and advance directives. Like any good song, she says, life has a beginning and an end. It’s full of sweet music, but once in a while health problems cause some sour notes. As we get older the beat changes, and the music slows. 

In order for rural Americans to get the most out of life we need a healthcare system that works for everyone so we can stay healthy, listen to the rhythm, and dance to whatever tune life plays. 

Richard Oswald is a fifth generation Missouri farmer, president of the Missouri Farmers Union and author of the Letter From Langdon.

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