Obama Will Be a Boon for Rural Health

John Commins, for HealthLeaders Media, January 14, 2009

Barack Obama will be sworn in on Jan. 20 as the United States' 44th president and the first African-American to hold the nation's highest office. Regardless of political leanings, Americans should take a justifiably proud moment to mark this truly historic occasion.

But when the hoopla dies down and the nation's business is taken up, we must also remember that Obama didn't get elected because of his race. He got elected because for nearly two years he ran a near-flawless presidential campaign that most voters felt better addressed their anxieties in these rough economic times. And judging by his comments on the campaign trail, and by the people he's picked for key Cabinet posts, I believe that the Obama presidency will be a boon for rural health. Here's why:

First, on the campaign trail, no other candidate came close to matching Obama's understanding of rural healthcare issues coupled with a detailed action plan. The nonpartisan National Rural Health Association says Obama was the only presidential candidate who took the time and effort to respond to its questionnaire about rural healthcare.

If you put 100 rural hospital CEOs in a room and asked them to come up with a list of rural healthcare priorities, it'd look a lot like what Obama has proposed. He has called for: universal health coverage; helping small businesses afford health coverage; promoting fairness in Medicare and Medicaid reimbursements; expanding community clinics; bringing more physicians, nurses, and other healthcare providers into rural areas (What good is coverage if you don't have access?); improving care for rural veterans; and investing in massive IT upgrades and telemedicine for rural hospitals.

"We are very optimistic," says Maggie Elehwany, vice president and chief lobbyist for the NRHA, the Washington, DC-based umbrella group for several rural healthcare advocacy groups. "We know he has a whole lot on a very big plate, but we have been so pleased at his willingness from the get-go to be engaged not only during the campaign but also with the transition team. For a guy from Chicago, he gets it. You have to give him props for being able to communicate those concerns."

Of course, a campaign promise doesn't guarantee anything. But the fact that Obama shows that he at least understands the issues surrounding rural health speaks volumes. It also allows Elehwany and other rural healthcare advocates to hold him accountable. He can't plead ignorance.

Second, the high-profile selection of former South Dakota Sen. Tom Daschle as Obama's secretary of Health and Human Services— the first major post-election announcement from the president-elect--clearly indicates that expanding healthcare coverage and overhauling the nation's healthcare delivery system is a priority. Daschle spent eight years in the House and another 18 years in the Senate and knows how Washington works. He is both a leading advocate for rural healthcare and a consummate Beltway insider, and his first Senate confirmation hearing as HHS Secretary-nominee was a love fest with old colleagues.

Even though conflict is guaranteed in the coming months, right now Daschle is saying all the right things about forging bipartisan solutions. Republicans on the Senate Finance Committee this week are expected to press him on any attempts to expand government-funded healthcare programs.

"Obama knows the game is going to be played in the Senate, and he picked someone like Sen. Daschle who understands what works," Elehwany says. "We've worked with Sen. Daschle for years and he is someone who gets it. He understands that just giving people coverage doesn't equate to access. Access is the No. 1 problem in rural America."

Third, fears that this recession could sink into a full-blown depression or hobble the economy for a decade or more –- like the economic malaise that hit Japan in the 1980s and 1990s -- mean that Obama will not be constrained by deficits. Obama has already outlined an $850 billion recovery package and he's indicated that he will spend freely to bolster the economy. One area that the president-elect has targeted for investment is healthcare.

"We'll create hundreds of thousands of jobs by improving healthcare -- transitioning to a nationwide system of computerized medical records that won't just save money, but save lives by preventing deadly medical errors," Obama said this week. As part of his efforts to mend the nation's infrastructure, there will also be federal money available for capital improvements, building or expanding existing hospitals and healthcare clinics.

This column is not a pep rally for Obama. So far, it's been mostly talk. But if you're an advocate for rural healthcare, it's hard not to be encouraged by what the president-elect has said. Rural healthcare is on his agenda. He recognizes the issues. He's got a plan. He's on record.

Now, it's our job, as rural healthcare advocates, to make sure he delivers on those promises.

John Commins is the human resources and community and rural hospitals editor with HealthLeaders Media. He can be reached at jcommins@healthleadersmedia.com.
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