What healthcare reform means for rural America

All healthcare is local, to adapt a phrase made famous by the late speaker of the House of Representatives, Tip O’Neill. The local character of healthcare has become even more apparent under reforms prompted by the Affordable Care Act (ACA), particularly in rural America, where political and ideological perspectives are often not sympathetic to an expanded role for government, as envisioned in that legislation.

The problems of rural healthcare are not just a scaled down version of those seen in urban and suburban areas, says Tom Morris, associate administrator for rural health policy at the US Department of Health and Human Services. In rural areas, people are more likely to be on a low income and uninsured; they are also less likely to have employer sponsored insurance coverage.

These people also tend to be older, sicker, and have less access to specialized care. They are more dependent on federal programs and would be even more dependent if they knew they were eligible for those programs and enrolled in them.

Providers in rural areas also tend to operate on smaller profit margins, largely because of the types of services they provide—basic healthcare rather than more profitable specialized care. Patient density is insufficient to support expensive technologies and specialized skills. Healthcare reform will have to be tailored to local conditions in rural areas.