I. Three Rural Health Priorities
Assure Local Access to Quality and Cost Effective Care
· Protecting access to local care must be a high priority. Rural health’s many successes in Wisconsin are a testament to the endurance and creativity of rural communities. State and federal laws have long required health insurers to respect the right of people to receive health care locally.
· We believe that if a Wisconsin community has available local providers, health plan enrollees should not be forced to travel beyond that community because the health plan refuses to contract with local providers, when those providers would accept a contract with financial and quality terms comparable to other providers with whom the health plan contracts.
Address Forecasted Health Workforce Crisis in Both Rural and Urban Communities
· The soon to explode retirement of baby boomers will lead to a critical shortage of workers, particularly in rural America for which we are ill prepared. Many rural communities already face staff shortages.
· Make sure promoting diversity in the health workforce addresses the unique recruitment and education needed for rural and inner-city practice.
o Programs like the University of Wisconsin School of Medicine and Public Health’s Wisconsin Academy of Rural Medicine (WARM) and TRaining In Urban Medicine and Public Health (TRIUMPH) acknowledge the uniqueness of rural and inner city practices. Investments in expanding the pipeline needs we must support programs that emphasize recruitment from and training in these target communities.
o The expansion and/or reallocation of resources that currently go into Graduate Medical Education needs to be made more flexible so as to include both new rural training tracks and rural rotations.
Make Workplace Wellness and Healthy Communities a National Priority
· Reform must help individuals and communities to become healthier, to not need as much health care. Rural patients face the most daunting of health care challenges: they are older, poorer and sicker. Rural America is less healthy due to too much smoking, drinking and eating, and too little exercise, education, jobs and income.
o Healthcare reform must address factors unique to the rural context. It should lay down a road map to make our communities healthy. Prevention and Wellness provisions must present a comprehensive policy designed to ensure that all Americans will receive the state-of-the-art in both clinical and community preventive services, undertaking a coordinated effort to make comprehensive prevention research, evaluation, and delivery a permanent part of the national landscape.
o Eliminate cost-sharing on recommended preventive services delivered by Medicare, Medicaid, and insurance available in the Health Insurance Exchange.
o Support incentive models to stimulate multi-sectoral action toward community health improvement such as the University of Wisconsin’s Mobilizing Action Toward Community Health (MATCH). As repeatedly noted by the UW’s Population Health Institute, our health status is affected by multiple determinants beyond Health Care which also need to be addressed: Health Behaviors, Socioeconomic Factors and the Physical Environment.
II. Key Threats to Rural Health in Current Congressional Reform Proposals
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For quite a few years, I have been recording myths about rural health care. I think of myths as something easily proven false but too often assumed to be true. My list started when an urban-based executive told me, with a straight face, “Pay them less, they grow their own vegetables.” But it has been over half a century since most rural Wisconsinites lived on a farm.
