ROBERT SIEGEL, HOST:
There is stark news out this week from the Centers for Disease Control and Prevention about the 46 million people who live in rural America. The CDC's new study shows rural residents are more likely to die from heart disease, cancer, unintentional injuries and other potentially preventable conditions than city people or suburbanites. And researchers found the gap in health between rural and urban America is worsening.
To help explain what's going on, we've called on Brock Slabach. He's senior vice president for the National Rural Health Association, which advocates for rural health. Welcome to the program.
BROCK SLABACH: Thank you very much.
SIEGEL: Are the CDC's findings at all surprising to you?
SLABACH: Well, unfortunately they're not. NRHA has been concerned about the gaps between rural and urban life expectancy for quite some time, and this has largely gone unnoticed in the larger discussion about health disparities which have tended to focus solely on the populations and not looking at geographic aspects of this issue.
SIEGEL: Is it true that smoking is more common in rural areas? And if so, does that account for much of the higher incidence of stroke or heart disease or lung disease?
SLABACH: It definitely is a correlated issue that impacts the health status of rural Americans. And, in fact, yes, smoking rates are higher there, just like lack of exercise, and leisure time activities tend to vary quite a bit as well.
SIEGEL: You ran a hospital in rural Mississippi for 20 years. What kinds of issues were you dealing with that you'd say were uniquely rural?
SLABACH: We had large numbers of patients that had chronic - multiple chronic conditions that needed to be addressed in a holistic fashion, and it needed to span the various aspects of services in the health care continuum. And being able to provide those in a rural context is very difficult and often plagued with patients that are poor and unable to pay for the services that they desperately need.
SIEGEL: Well, do these numbers reflect a failure of the Affordable Care Act, which was supposed to bring health care to all Americans regardless of income or geography?
SLABACH: Yes, I think that there is a failure of the Affordable Care Act in being able to address this problem. First we have lack of Medicaid expansion in a host of states around the United States. The marketplace exchanges did not produce numbers of plans in rural areas to provide competition, which ultimately drives down premiums. These exchange products had exorbitant premium increases over the last couple of years. And last but not least, high deductibles and co-insurances that were making it unaffordable for many patients. And then the third area that has been a problem has been deep Medicare cuts over the same period of time that have compounded some of the issues for rural providers.
SIEGEL: Well, as we look ahead to some replacement of the Affordable Care Act, what would you want to see in a new system that would address these urban-rural disparities?
SLABACH: We'd like to see the populations that are historically underserved such as the Medicaid population be expanded. We'd like to see that - to make sure that the exchange products are transferred into a system that guarantees co-insurance and deductibles are kept low for patients to afford. And then we would like to see the reversal of many of the Medicare cuts that have plagued our providers in rural communities. These are physicians, these are practitioners that are working very hard every day and have seen only reductions in their payments, and it's hard to recruit in that environment.
SIEGEL: Brock Slabach, a senior vice president with the National Rural Health Association. Thanks for talking with us.
SLABACH: You're welcome.
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