Obama's a Great Unknown for Rural Health

John Commins, for HealthLeaders Media, November 19, 2008

Will President-elect Barack Obama be a plus or a minus for rural healthcare?

Medical economist and healthcare "futurist" Jeff Bauer says it's hard to say because the president-elect and product of Chicago doesn't have a history on the issue in his few years in the U.S. Senate.

"I'm not aware that Barack Obama brings any particular expertise or personal ties to rural health with him to the White House. Nothing about Obama tells me anything about what his policies towards rural health will be. He has simply not been seen as a leader in that area like (Sen.) Max Baucus (D-MT)," says Bauer, a consultant and futures practice leader for ACS Healthcare Solutions. "There are a number of members of Congress, you tell me their names and I know where they're going. I know their policies on rural health clinics or money for critical-access hospitals. Obama doesn't bring that level of identification with any rural healthcare policy."

That's not necessarily a bad thing. It's just an unknown. It's not like the president-elect will be "anti-rural health." But the emphasis on funding public health policy in tight budget years might be shifted to other areas, like increasing physician reimbursements or expanding medical schools, rather than specifically toward rural health.

Rather than guessing the future actions of a president-elect with no discernable track record in the area of rural health, Bauer says Obama's possible actions in the rural health arena can be more accurately predicted by examining the people he appoints to key public health positions. "I'm a firm believer that people make as much of a difference as budgets and policies. I'm hearing names of people with strong commitments to HHS and CMS, where the future of rural healthcare will be very much decided," Bauer says.

There have been widespread media reports that former U.S. Sen. Tom Daschle of South Dakota has been leading the Obama transition team's healthcare policy component and will likely be offered a key appointment. There is even talk in some circles of making the former Senate majority leader a "healthcare czar," although it's not really clear what that means. At deadline for this column, high ranking Democrats were saying Daschle had been tapped to lead HHS.

"Barack Obama is going to turn to Tom Daschle for something very significant, whether it's HHS or secretary of education," Bauer says. "If it's Daschle, he authored many of the bills that gave money to rural hospitals and clinics, and he is a pro-rural as they come."

Rural healthcare can also expect continued backing from the powerful Senate Finance Committee chaired by Baucus with ranking member Chuck Grassley, R-IA.

Rural health will need all the friends it can get, Bauer says, because the biggest factor will not be who's in the White House, but the state of the economy. Federal tax dollars will be scarce at least for the next year or two, and the fight for funding is expected to be fierce. "This issue will always come back to the economy and whether there is money to maintain critical-access programs or money to get serious about supporting information infrastructure technology development," Bauer says. "That is going to be really tough in the current budget environment."

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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