One place this battle is playing out is in western Utah, where a large community health system struggling to serve a 700-square mile area is fighting efforts of much smaller community clinic that wants to become a federally qualified health system. Such a designation would take money away from the larger organization because of the way medically underserved definitions have been set. "It would rob Peter to pay Paul and neither option serves the community," Babitz says.
Another newly appointed committee member, Alice Larson of Vashon Island, WA, says she wants to make sure federal definitions don't leave out migrant farmworkers, and the homeless, populations that are often undercounted when federal funds roll out, but who need healthcare nevertheless.
Additionally, it's important not to just count the number of providers in an area, but the number who will see people who don't speak English or who can't pay. "Just using a physician-to-population ratio doesn't cut it; you have to know those physicians are accessible."
She says federal definitions should recognize that use of census in rural areas is often fraught with error. For example, a community of 20,000 might be said to have a poverty rate of 25%, but the census is only re-examined every five years, with a margin of error of 5%. That means the region could have between 4,000 and 6,000 people living in poverty. That's a big difference, she says.
Babitz, who describes himself as an advocate for rural health care interests and was a National Health Service Corps physician for nine years, is aware how difficult the task may ultimately be. And he's aware that previous administrative efforts failed.
But this time, he says, "I'm optimistic."
By bringing in the various constituency groups to hash it out, and "develop the rule that short-circuits the rulemaking process with much less resistance, fewer negative comments, and in a way that speeds up the process."
"I have some faith in this negotiated rulemaking process. It'll be work but great experience," Babitz says.
The committee is scheduled to present its "draft final" proposal a year from now. Let's hope they succeed.