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Obama Looks to Improve Rural Health

Cheryl Clark, for HealthLeaders Media, May 8, 2009

Though the Obama administration's proposed 2010 rural health funding for the Health Resources and Services Administration was cut by $44 million, the budget also includes many increases for rural health, according to the administration.

In fact, the overall reduction from the 2009 budget of $125 million comes primarily because of the elimination of two programs, the $26 million Delta Heath Initiative in Mississippi and the $20 million Denali Project in Alaska.

"It was felt that the needs in the region were largely met through prior investments," says Health Resources and Services Administration spokesman David Bowman.

He says the full funding for rural health includes many increases, much of them found in budgets for other parts of the administration that serve urban areas as well as rural. For example, health centers will receive $2 billion, and while some health centers are in urban areas, "most health centers are located in rural areas," Bowman says.

Professional training, grant support and scholarships for physicians, dentists, and other types of health providers will receive $2 billion, largely through increases of National Service Corps, which received $135 in 2009, but will go up $34 million in 2010. The NSC provides scholarships for medical and dental school and helps physicians and dentists repay loans.

Many of those who benefit will agree to serve in rural underserved areas, Bowman says. The clinic and physician support line items are in other portions of the budget, he says.

Indian Health Services, meanwhile, which serves a large number of Native Americans in rural areas, would be a big winner, with a total of $4.58 billion under the proposed 2010 budget. Clinical services would receive an additional $324 million ($3.74 billion), preventive health support would receive an additional $9 million ($144 million), and Indian health professionals would receive an additional $3 million ($41 million). The administration's line items also include $4.98 billion for Indian health facilities, a $454 million increase.

Alan Morgan, CEO of the National Rural Health Association, says he is "excited to see that the President's budget includes increases to rural health grant programs. I am optimistic that we will see this support for improving our nation's rural health system continue as the debate begins on Capitol Hill."

Morgan also says the Denali Project and Delta Health Initiative programs are very important, but are earmarks. He suggests Congress will put them back in because both programs "have had great results—and they have great champions on the hill too."

Bowman says the Denali Project has received more than $300 million since 2000 for construction of health facilities in rural Alaska. The Delta Health Initiative, launched in 2006, brought seed money to projects providing chronic disease management, pharmacy, dental, school-based mental health services, and teenage pregnancy prevention to rural areas of Mississippi.

Bowman emphasizes that large increases in health center and health professional training, highlighted in other portions of the federal budget, will make up for most deficits in those areas.

Other programs classified as rural received small increases or stayed the same. The budget for Black Lung Clinics, which screen coal miners for the disease and provide treatment and rehabilitation for active and retired coal miners remains at $7 million.

Funding for cancer screenings for workers and residents adversely affected by mining, transportation, and processing of uranium products primarily used in the nuclear arsenal, mostly in the Four Corners area of the West, also stayed the same at $2 million.

Additionally, the administration yesterday released a budget overview that promised $55 million for rural healthcare services grants to improve quality and $8 million for rural efforts to expand telehealth. The $55 million is a $1 million increase over 2009 funding.

The Obama administration's proposed budget also promises to help 50 million underserved Americans, who live in rural and poor urban neighborhoods.


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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