Rural ACA Marketplaces

The Robert Wood Johnson Foundation recently released a report detailing the insurance plan choices and premiums available to rural residents.  Many rural advocates have feared that rural residents will face higher premiums or fewer choices in these marketplaces, and appears that these fears are valid, at least to a degree.

Some key takeaways from the report include:

• Rural residents have, on average, 1.2 fewer providers, 2.8 fewer plan choices, and 0.4 fewer plan types than urban residents
• Premiums were, on average, $18 more expensive (for the second most expensive silver plan) for rural residents
• HMOs and EPOs were less available, and POS more available, to rural residents
• States with a higher proportion of marketplace eligible residents living in rural counties were more likely to have higher premiums and fewer insurers, choices, and plan types than more urban states.

There was considerable state by state variation in premiums, with the range being $201 higher in Nevada to $72 cheaper in Mississippi.  

These results highlight the need to continue to monitor rural resident's enrollment options, and its relationship to actual enrollment proportions.  Higher premiums, particularly in more rural states, could potentially lead to a lower uptake in coverage, furthering an already existing gap in rural healthcare delivery.

Insurance Instability and Rural Residence

An interesting article was published this week in the Journal of Rural Health; "The Impact of Insurance Instability on Health Service Utilization: Does Non metropolitan Residence Make a Difference?"

The authors explored how discontinuous insurance coverage affect actual utilization of services, subset by rural residence. From the abstract:

"Health insurance continuity was significantly associated with several measures of health service utilization, including more ER visits for individuals with gaps in health insurance (IRR [incident risk ratio] = 1.29; 95% CI: 1.16-1.42) and fewer inpatient discharges for individuals without insurance (IRR = 0.50; 95% CI: 0.43-0.57) when compared with individuals with continuous insurance. Individuals who were discontinuously insured or uninsured had significantly fewer office-based visits. They also had significantly fewer dental visits, prescription fills, and home health visits; moreover, the magnitudes of these associations were generally significantly greater for residents of nonmetropolitan areas."

In short, living in a rural area meant lower utilization, particularly among those discontinuously insured. Hopefully, full implementation of the ACA will help to reduce this discontinuity; Adriana McIntyre over at Vox describes how the ACA has shown evidence of reduced churn. If the ACA truly does reduce those who drop (or are dropped from) insurance coverage, then these impacts will be mitigated. However, given evidence of rural residents falling trhough the cracks of ACA implementation (see the Kaiser Family Foundation's report here), it is clear more work needs to be done to ensure rural residents have adequate access to health care.

Loss of a public health champion

It is with deep sorrow that the South Carolina Rural Health Research Center announces the passing of its founding Director, Dr. Michael E. Samuels.

Dr. Samuels, subsequent to service with the US Navy, had an outstanding public health career and a pronounced effect on rural health across the US. Early in his career with the US Department of Health and Human Services, he obtained the legislative authority and implemented the Health Underserved Rural Areas Research Program in the Health Resources and Services Administration (HRSA), predecessor to the current Office of Rural Health Policy. In recent years, Dr. Samuels received both the Distinguished Research Award (2002) and the Distinguished Educator Award (2010) of the National Rural Health Association, as well as the C. Everett Koop Medal of Appreciation from the Koop Institute (2005).

Dr. Samuels’ passion for social justice motivated a long career in public health administration and public health education. Throughout that time, he never stopped fighting for equitable health care for rural poor, underserved and minority populations. We honor his memory and are inspired further to continue his work.

Dr. Samuels' personal obituary is available at the Winston-Salem Journal.

Health Care Providers In Rural America

Our own Jan Probst appears, once again, in Health Affairs to rebut an article published in the Fall of 2013 regarding service utilization comparison across Urban and Rural medicare beneficiaries.  Give it a read!
http://content.healthaffairs.org/content/33/2/346.1.extract?etoc

Congrats to Nathan Hale!

Have to brag slightly on one of our own, Dr. Nathan Hale.  Dr. Hale's paper, "Postpartum Screening for Diabetes among Medicaid-Eligible South Carolina Women with Gestational Diabetes," was chosen by the Board of the journal Women's Health Issues as winner of the annual Charles E. Gibbs Leadership Prize for the journal's best paper of 2012.  Prize and a plaque! 

For those who might want to view it, Dr. Hale's paper appeared in the March, 2012 issue of WHI, issue 2, Pages e163-e196.  Sorry, no free link.

Exciting times at ECU

It was wonderful to represent the SCRHRC at the ninth annual Jean Elaine Mills Health Symposium at East Carolina University in Greenville, NC. The symposium honors the memory of Ms. Mills, a 1984 MPA graduate of ECU’s master of public administration / community health program who died of breast cancer in 2000.

ECU offers a sparkling new health sciences campus and Deans across multiple health fields – medicine, dentistry, nursing and allied health – who are each committed to 1] enhancing diversity in education and 2] reducing rural health disparities.  Wonderful folks doing wonderful work!

And ECU really did a terrific job of making the keynote speech, by one of our very own, available as video.  Folks who can stand an hour of Jan talking about rural health may also spot two one-time locals, Libby Baxley and Minnjuan Flournoy, in the audience.  

News summary (text) 

Video (about 1 hour)

 

Jan Probst receives USC’s MLK Social Justice award

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Dr. Jan Probst, Director of the SCRHRC, received the faculty 2012 Martin Luther King Day Social Justice Award on January 18, 2013.  The Social Justice Award is presented annually to a USC faculty member, a student and a staff member, each of whom have exemplified the philosophies of the late civil rights leader through random or ongoing acts of community service, social justice or racial reconciliation.  Dr. Probst’s continuing work in the field of rural minority health was noted during the award ceremony.  

Dr. Probst joins Dr Saundra Glover of the Center as a recipient of the USC’s MLK award.   Dr. Glover received the Social Justice award in 2010.