Americans living in rural areas are more likely than urban dwellers to die from preventable afflictions. A move by the Trump administration and Congress to consider block grant funding for Medicaid could threaten the means to address these rural health issues.
Two stories this month illustrate the dire needs and perilous status of healthcare delivery in rural America.
First, the Centers for Disease Control and Prevention has issued a new report that shows that many of the 46 million or so people living in rural America, roughly 15% of the population, are more likely than their urban counterparts to die from five preventable diseases.
According to CDC, potentially preventable deaths in 2014 included 25,000 from heart disease, 19,000 from cancer, 12,000 from unintentional injuries, 11,000 from chronic lower respiratory disease, and 4,000 from stroke.
Pilot Program Throws Lifeline to PA Rural Hospitals
The percentages of potentially preventable deaths were all higher in rural areas than in urban areas. The findings were detailed in a new rural health series in CDC's Morbidity and Mortality Weekly Report.
Furthermore, unintentional injury deaths were 50% higher in rural areas than in urban areas, due in part to motor vehicle crashes and opioid abuse. Making matters worse is the challenge of accessing trauma care and emergency medical services in remote, sparsely populated areas.
"This new study shows there is a striking gap in health between rural and urban Americans," said CDC Director Tom Frieden, MD, in commentary accompanying the report. "To close this gap, we are working to better understand and address the health threats that put rural Americans at increased risk of early death."
None of this is surprising. This column has written extensively over the years about the special health needs for rural Americans and the challenges of delivering coordinated, effective care to these underserved areas.
Numbers of studies and population data have shown us that people living in rural areas generally tend to be older, sicker, poorer, less likely to have health insurance, and have less access to care than their urban counterparts. In addition, they are more likely to use tobacco, more likely to be obese, and more likely to have the health issues associated with overweight, including high blood pressure.
A Call for Block Grants
The grim CDC findings were released amid reports that the Trump Administration and Republicans in Congress will attempt to shift Medicaid to a block-funding program.
It's expected that such a shift would mean considerable cuts to federal match funding for Medicaid, which President Trump pledged he would oppose during the campaign. Proponents say that block grants reduce fraud and waste and give states more flexibility to fashion Medicaid programs that fit their needs.
Skeptics remain concerned, however, that the block grant proposal is a ruse designed to shift costs to states.
"While we strongly support maintaining and increasing flexibility for states proposals that suggest states be provided with more flexibility and control must not result in substantial and destabilizing cost shift to states," Massachusetts Republican Gov. Charlie Baker said in a Jan. 11 letter to Congress.
"We are very concerned that a shift to block grants or per capita caps for Medicaid would remove flexibility from states as the result of reduced federal funding," Baker wrote. "States would most likely make decisions based mainly on fiscal reasons rather than the healthcare needs of vulnerable populations and the stability of the insurance market."
Baker suggested in his letter that every state's current federal/state share for Medicaid, which can range from 80/20 to 50/50, serve as a baseline for any reforms.
Be Afraid
Count me among the skeptics.
States already have flexibility to create Medicaid waiver programs, as Gov. Baker and former Indiana Republican Gov. Mike Pence, now the vice president, can attest. Block grants provide political cover in the name of states' rights and flexibility, when their real purpose is to reduce federal expenditures, which Congress will need to offset the loss of revenue from proposed tax cuts.
The Trump Administration and Congress have already begun dismantling the Affordable Care Act with no alternative plan in place, which would dramatically reduce the numbers of Medicaid enrollees.
Now they want to radically refashion the federal funding mechanism for Medicaid, which very likely will reduce funding, and impede access to healthcare that rural Americans so desperately need.
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John Commins is the news editor for HealthLeaders.