Physician assistant Jon Bigler looks at a patient's leg at Ashland Health Center in Ashland, Kansas.

[imgcontainer] [img:rural_doctor.jpg] [source]Photo by Orlin Wagner, The Associated Press[/source] Physician assistant Jon Bigler looks at a patient’s leg at Ashland Health Center in Ashland, Kansas. [/imgcontainer]

Even though the federal government is headed for a shut-down, Americans may begin shopping for health insurance today under provisions of the Affordable Care Act that go into effect October 1.

We asked some folks who are familiar with rural healthcare and the Affordable Care Act to tell us what they are watching, and what they hope to see, as “Obama Care” moves into its final stages of implementation. Here’s what they had to say:


Alan Morgan at the National Rural Health Association says he and others with the 20,000-member association are concerned about the number of rural residents who will sign up for insurance under the new health-care law.

“There is a great push to sign up large numbers (for insurance), and that effort is focused in urban areas where large numbers are to be found,” he said.

Rural residents are more likely to qualify for government subsidies to help pay health-insurance premiums because rural income is below the national average, according to a Health and Human Services fact sheet. But Morgan said he and others worry that rural residents may not know about the assistance because of lack of information.

 (For information on how to get access to your state’s health insurance marketplace, visit

The Rural Health Association is also concerned about the fiscal health of rural hospitals, Morgan said. Twenty-one states are likely to reject expansion of their Medicaid systems, as allowed under health-care reform. That will mean the amount of money flowing into rural health-care facilities may not keep pace with the cost-saving cuts that are part of the Affordable Care Act.

“With the great uncertainty surrounding the ACA impact on rural healthcare, Congress needs to safeguard rural providers in all discussions regarding existing funding levels for the Medicare program,” Morgan said.


Wayne Myers, former director of the federal Office of Rural Health (and a frequent contributor to the Daily Yonder), said he expects implementation of Obama Care in rural areas to take some time.

“It will be slower in rural than the urban areas, and slower in the poorer states whose governors are resisting Medicaid expansion,” said Myers, a retired pediatrician who lives in rural Maine. “But it will get started.”

 “Sales of subsidized insurance through the ‘marketplaces,’  previously called ‘exchanges,’ will probably go slower in rural communities  …  though the insurance companies may ramp up their advertising,” Myers said.

“It is likely to take two or three years to reach most of the eligible buyers of subsidized private insurance,” Myers said.

Myers also said he was concerned about the future of rural hospitals. “Some small rural hospitals will go broke in states refusing Medicaid expansion,” he said.

“In the big picture, Obamacare is extremely important,” Myers said. “Conservatives have reason to be afraid that it will succeed. … A  lot of our people have been shut out of [medical] care because they couldn’t afford health insurance.  Once they get affordable access to insurance, and health care for themselves and their children, they are not going to want to give it up and are likely to vote accordingly.”


For Joyce Hospodar with the Arizona Center for Rural Health, the big concern is communication.

“I just don’t think the messaging is getting out there about all of this,” Hospodar said. The primary conduit for information about the Affordable Care Act is state and federal websites. And that could be problematic for some rural residents.

“If you are uninsured or underinsured, you’re less likely to be able to afford online access through someone like Comcast,” she said. That means people who need the information the most may be the least likely to get it.

To help get the word out, Hospodar and partners in other rural groups in the Southwest U.S. created an informational brochure on the Affordable Care Act. The brochure has versions for Arizona and New Mexico, and both are available in Spanish.

(Hospodar said she’d be glad to talk to folks who would like to adapt the brochure for other states. Her contact information is here.)

Other groups have created a series of 13 radio public service announcements, which are available for download. The 30-second spots are available in English and Spanish. 

Hospodar said Obama Care needs a big, grassroots communications push that does more than just rely on the ACA websites. Some folks won’t be comfortable learning online, she said. The government website “is a lot to read, and it’s not tangible,” she said. “They can’t pick it up and take it with them to study.”

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