While Democrats and Republicans can’t seem to agree on much these days, there is one issue bringing politicians together and making headlines: problems in accessing quality health care in rural America. Presidential candidates are discussing their proposals in Iowa, the secretary of Health and Human Services is highlighting it as a top priority, and Democrats and Republicans in Congress are coming together on bipartisan legislation, including Iowa’s own Sen. Chuck Grassley, chairman of the Senate Finance Committee.
This is all good news and long overdue. Rural residents often travel long distances to get to a hospital or health clinic, and many small hospitals are closing at alarming rates. Since 2010, more than 100 rural hospitals have closed throughout the United States, and an additional 647 are at risk of folding, including 17 in Iowa. Rural areas are also experiencing shortages in physicians and specialists.
It is time to transform the rural health system in the United States to ensure that all residents get the right care at the right time that best suits the needs of their local communities.
To address these issues, we joined the Bipartisan Policy Center’s new Rural Health Task Force, which plans to develop policy recommendations to improve access to affordable, quality care in rural America. Members of the task force were in Des Moines this week hosting a special event at UnityPoint Health with Sen. Grassley, local physicians, patients, and hospital and rural health clinic leaders, who all shared their opinions on the barriers and opportunities to securing quality health care.
It is clear — people living in rural areas face greater challenges in accessing high-quality, high-value health care than those living in urban and suburban areas. Nearly 60 million Americans live in rural communities, and these individuals face a greater risk of dying from heart disease, cancer, stroke, and chronic lower respiratory disease, according to the Centers for Disease Control and Prevention.
A recent survey commissioned by BPC and the American Heart Association exposed the seriousness of the problem and the drive to take action — in Iowa and across the nation. Our findings showed that 92% of Democrats and 93% of Republicans nationwide consider access to rural health an important issue. While rural health has never been a top-tier issue in elections, three in five voters said they are more likely to endorse a candidate in 2020 who makes access to rural health care a priority.
While the survey focused on voters nationwide, we also specifically asked rural Iowans about their concerns, and nearly half (46%) said they believe access to medical specialists such as cardiologists, oncologists and gynecologists was a problem in their community, as was access to quality health care generally.
This issue came to light last week with news that the hospital in Marshalltown, Iowa, is shutting down its obstetrics unit and women’s health clinic in September due to declining patient numbers and workforce shortages. Today, more pregnant women are choosing to travel to large urban hospitals to deliver their babies. Officials said the closure of the maternity unit was part of an effort to strengthen the facility.
Geography should never be an impediment to quality care. Strengthening the rural health workforce is, therefore, one of several areas that our task force will address over the next year.
We are committed to developing recommendations that will build and support a sustainable and diverse workforce. For every 100,000 people in rural areas, there are only 30 specialists, as compared to 263 in urban areas. Meanwhile, the patient-to-primary care physician ratio in urban areas is 53 physicians per 100,000 people and rural areas have only 40 physicians for the same number of residents.
The importance of access to primary care clinicians, in particular, cannot be overstated. Research shows primary care services lead to lower long-term health spending and better health outcomes. A BPC report issued last year supported a growing consensus that not every community may need a full-service inpatient hospital.
Giving inpatient hospitals the flexibility to transform into stand-alone emergency departments, clinics, or other types of outpatient centers focused on primary care may better address the health needs of rural Americans. It could also make the rural health system more efficient. Expanding telemedicine services is also a promising way to connect patients with providers and create a peer network for rural health care workers that would improve recruitment and retention.
In order to address health care in rural America, federal laws should better align to meet the unique needs of rural areas. And, health systems must look to long-term infrastructural changes to ensure residents have access to sustainable, quality services.
Addressing these challenges with bipartisan solutions now, not later, is a good first step toward giving rural residents the quality and value of care they deserve.
Tom Daschle served as a Democratic majority and minority Senate leader from South Dakota from 1987 to 2005. He is co-founder of the Bipartisan Policy Center.
Tom Tauke served as a Republican congressman from Iowa from 1979 to 1991. He is co-founder of the House Rural Health Coalition.
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