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Options that could improve health insurance for rural residents
Thus far, all the Congressional legislative proposals to repeal and replace the Affordable Care Act (ACA) worsen health care insurance for rural and farm residents. The alternatives increase premiums and deductibles for people in the 50-65 age group; they decrease coverage for preexisting and chronic conditions such as cancer.
Keeping the parts of the ACA that most people like (e.g., affordable coverage for preexisting and chronic health conditions, children on their parents’ insurance plans until age 26, parity for physical and behavioral health care and expanded Medicaid for the disabled, aged and others without viable options) is an alternate approach that most Americans say deserves consideration.

The latest Congressional alternative to the ACA (as of July 26) reduces insurance coverage disproportionately for behavioral health care, which penalizes farm and rural residents. Behavioral health conditions such as depression and anxiety disorders are more common among agricultural people and in rural communities than amongothers in the United States.

There are big income and health care gaps between agricultural and rural residents who can pay for health insurance and those who depend on subsidized assistance. Those who need care the most may have depleted their resources, such as farmers in economic trouble, people dependent on opioids or other addictive substances and those who exhausted their insurance limits and will have to sell off assets to afford further care.

Prior to the ACA, paying for health care after insurance was used up was the main cause of farm bankruptcy.

I obtained several ideas for fixing the ACA from five Midwest farmers and one from Colorado (two women and four men) with whom I spoke about alternatives to the ACA. Information from the nonpartisan  Congressional Budget Office and the PewResearch Center also helped shape the following recommendations:

•Members of Congress should have the same health care insurance that is available to everyone else in the U.S. Senators voted to exempt themselves from the provisions of their own legislation in June, in order to keep their special privileges.

•Allow U.S. residents, including Congress, the option of purchasing private health insurance coverage with superior benefits if they are willing to pay for superior care, but require all U.S. residents to obtain health insurance of somekind.

This is so everyone is in an insurance pool and everybody pays something, even if it’s a co-pay. A two-tier private and national health insurance system works well in many countries.

•All insurers, including those that pay for superior care and those on a national health care service, should utilize a single government-supervised entity to process all insurance claims. Administrative costs for insurance coverage for everyone would almost certainly decline.

Private insurers currently expend 31 percent for administrative costs, while the federal Medicare system consumes 2.6 percent of its total expenditures for administration. A government-regulated, single processor would also halt tactics some private insurers undertake, such as denying claims even when they are submitted correctly. This tactic delays payments to providers and drives up health care costs for their resubmission, or shifts the burden to the consumers.

•Negotiate prices with drug manufacturers for medications. Current statutes, for which drug manufacturers lobbied heavily, ban bargaining for medications in the United States and drove up medication costs.

•Allow private insurers to compete in all states, thereby expanding options for private coverage, but require that they do not exclude any counties within any state in which they compete.

•Expand rather than curtail Medicaid for residents who can’t afford insurance, but charge co-pays based on income. Medicaid currently pays 55 percent of costs for all people in nursing homes and for most disabled people living in residential care and home programs. Cutting back on Medicaid by eliminating the ACA, rather than modifying it, would make it difficult for a majority of the poorest, the elderly and disabled people to receive the services necessary for their well-being.

•Place reasonable limits on medical malpractice awards; currently there are no limits.

•Require states to develop programs to recycle unused and unexpired medications from pharmacies, hospitals and other health care providers, while making these medications available to people in greatest need. This also would eliminate incineration costs until after their expiration dates.
These are practical solutions to our health care insurance problems. Although critics say fixing existing problems of the ACA is socialized medicine, that’s not accurate. Allowing private insurers to offer competitive insurance policies for all, and/ or to especially appeal to those who desire higher-quality care, is an example of a common-sense, capitalistic alternative to the ACA.

The U.S. currently ranks 35th in the world in health care outcomes, but pays twice as much as the average of the countries that are ranked higher. We can do better – but doing better involves practical rather than political thinking.

Let your senators and representatives know how you feel about revising federal health care legislation. Please also share any further useful ideas with me, and thanks to everyone who helped with this column.

The views and opinions expressed in this column are those of the author and not necessarily those of Farm World.