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Rural Health Advocates See Opportunities with Trump

Analysis  |  By John Commins  
   November 30, 2016

Republican President-elect Donald Trump has promised to repeal and replace Obamacare with 'something better.' Amid this upheaval, rural health advocates see opportunity.

More than any other demographic, rural American voters contributed to the unexpected election of Donald Trump. Alan Morgan, CEO of the National Rural Health Association, says Trump's election has put the issues facing rural America on the front burner after years as an afterthought. The following is a lightly edited transcript.

HLM: What was the message rural America sent in this election?

Morgan: It is the result of a lack of focus on a substantial population in America that's seen declining health, declining life expectancy, a rural hospital closure crisis that we are engaged in right now, and yet a lack of focus on how to bring access to high-quality healthcare services to 60 million Americans.

We are hopeful, recognizing the importance that health and especially hospitals play in rural communities from an economic standpoint too, that we can start looking at what we can change and modify to ensure that we maintain access in rural communities.

HLM: How big of an effect will this election have on rural health?

Morgan: We are hopeful it will have a substantial beneficial impact on rural health because of the national focus on what is happening in rural now.

We have been beating the bushes for the past 10 years about workforce problems and the declining life expectancy of rural populations and we just haven't been getting a lot of traction on that among policy makers.

So, I am hopeful that now that this refocuses attention on the population that has been largely forgotten at the national level.

HLM: President-elect Trump and Republicans controlling Congress have called for radical overhauls of healthcare. Are you concerned that proposals to eliminate Obamacare, block grant Medicaid, and privatize Medicare could harm rural America?

Morgan: It's always a concern when you're proposing significant changes in the healthcare system. You always run the risk of making things worse. We've always communicated that the rural safety net is like arctic tundra; you step on it and trample it and it may never come back.

You can look at this two ways: Things are already not well and we are looking to roll back some of these insurance coverage issues and what that will mean to rural. Or you can look at it from a more positive standpoint that you can't go ahead with reforming the healthcare system and having rural as an afterthought. There has to be a rural focus as we move ahead.

Our organization would oppose any Medicaid block grant proposals. We are concerned what that would mean for rural populations. We are concerned that if they do any major modifications to Medicaid, we don't make the situation worse. And the rural hospitals have closed in states that have not expanded Medicaid, so rolling back Medicaid isn't going to help things.

We are looking at trying to make the health exchanges work better in the rural context; what marketplace revisions need to be made. It is true that more people have health insurance now in rural America because of the exchanges.

But it's also been well documented that we haven't had the uptick sign on of the exchanges from rural populations that we expected, and with the high deductibles and high copays the future of the health exchange, even if Hillary Clinton had won, would've been problematic. That needs to be addressed.

HLM: Was there anything that Trump said in the campaign that shows he "gets it" with rural health?

Morgan: We are going to run with his pledge to invest in infrastructure. Obviously, if he maintains his commitment to the economy, to infrastructure, not leaving people behind that have been forgotten in the past, we can build on that, and how can we have a federal-local partnership in investing and transforming our healthcare system.

In the debates he referenced the need to invest in healthcare and hospitals. I know a lot of my peers question what the investment would be.

Certainly, from a rural standpoint, these old Hill-Burton hospitals that are designed for a large inpatient volume need to be restructured for 24/7 emergency services and an outpatient delivery system. If he maintains that focus on putting America first and investing in infrastructure there is a lot we can work with.

HLM: What signals will you look for in the first few months of the Trump administration?

Morgan: First and foremost, will this new administration be talking about the rural hospital closure crisis? I'll be honest, that is one thing we haven't seen the current administration acknowledge, that we have a rural hospital closure crisis on our hands.

We are hoping that they acknowledge that we are heading in the wrong direction when it comes to healthcare access in rural communities.

Second, as they talk about innovation and transformation of the healthcare system, are they going to include rural? A lot of the transformation efforts by the current administration have exempted critical access hospitals and rural health clinics from the reporting process and really put them over to the side. Are we going to embrace rural facilities as we move forward? That is something we will be looking for in public statements and signs from CMS, what directions are they going to head on.

If they go ahead with the ACA repeal and replace, I want to hear how they are going to replace these high deductibles and the problems with the insurance market in rural underserved locations.

This is putting a lot of emphasis on the Trump administration, and Republicans will control Congress, but I am optimistic that Democrats recognize that this is a tremendous opportunity for them as well. They too have a focus about ensuring that rural is not left behind. How do we change this perception that DC simply doesn't get it from a rural standpoint?

HLM: NRHA is apolitical, but at some point are you going to have to get political to advance your agenda?

Morgan: I hope not. We have worked really hard to keep rural health a nonpartisan issue. That is going to be difficult.

Looking at how strongly rural America supported a certain political party makes it more difficult to do that. At the end of the day, when you are talking about low-income populations with high health disparities and a large senior population, you have to have Republicans and Democrats find some common ground.

HLM: What are you telling your members in the "flyover" states?

Morgan: The key message is now's the time to strike while the iron is hot. We are pushing an optimistic message that this is a great opportunity now to focus finally on rural.

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.


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