The Price of Rural Health Care

As Thomas Jefferson once said, “The price of freedom is eternal vigilance.” So, apparently, is the price of rural health care.

In a depressing but not surprising rerun of last year’s budgetary drama, President Bush has once again cut programs that provide health care to millions of rural Americans—this time by 83 percent. Among the programs on the chopping block are those that help hospitals, clinics and other providers work together to reach underserved people and provide higher quality care to all.

I say “drama,” because last year it took an eleventh-hour effort by a handful of House members to restore (albeit only partially) funds for rural health. Indeed, the move by six Republicans, against the party line, halted the multi-billion dollar appropriations bill for the Departments of Health and Human Services and of Labor —all in the name of preserving rural health. One Washington insider described the bold feat as “pretty freaking amazing.”

The question now is how much drama we’ll have this year? Will Congress stand up early for rural Americans? Will it once again wait until the last minute and rely on a brave few? Or will it allow the cuts to go through and rural Americans to suffer?

The Senate has already voted in its budget resolution to fully fund all rural health programs. The plotline in the House isn’t so straightforward. Though not yet passed, the House budget resolution toes the President’s hard fiscal line. What really counts, however, are the spending bills that will come later this year (appropriations subcommittees start work this week). That’s when we’ll know whether and by how much funding that ensures that rural Americans have access to affordable, quality health care will be cut or restored.

The other big question in all of this is why? Why the cuts to rural health care? Cuts that go way beyond the across-the-board belt tightening we’ve come to expect in order to pay for two wars and big tax breaks. Cuts that last year brought howls of protest from the rural health crowd, something my Washington insider described as “rural finally playing hardball.” Why would Congress and the White House again risk such chastening? In an election year no less?

The administration’s stated rationale is that increases to Medicare back in 2003 more than make up for the cuts. But according to National Rural Health Association CEO Alan Morgan, that’s apples and oranges. The Medicare increases, he says, reimburse providers to ensure that existing care continues to be available in rural areas. The programs being cut now are about increasing the reach and improving the quality of care.

“That basic concept,” he told me, “is not catching hold with this administration.”

On top of that—and the faulty logic of equating unequal things aside—many of the Medicare increases are set to expire soon. How will they help then?

In cutting other programs, the Administration has cited poor performance as measured by the Office of Management and Budget’s Program Assessment and Rating Tool, PART for short. The problem here is that the rural health programs are, in fact, judged to be performing adequately.

So, not only do we have drama, we also have mystery.

Fortunately, the story’s ending is not yet written. Rural advocates can—as last year--influence the outcome. Doing so, however, will require staying abreast of developments as bills move through Congress and letting the story’s legislative authors know what we think and want. As with freedom, the price of programs we believe in, is vigilance.