How Will Health Reform Help?
Together with Families USA we released Nebraska and North Dakota specific reports detailing how provisions in H.R. 3200 – the House health reform bill – would help all individuals, families and businesses in the two states. The reports focused on how the proposed legislation would fix problems and fill gaps in the current health insurance system, for both the insured and uninsured.

It is important to note that the House leadership is currently reconciling the three committee versions of H.R. 3200, and there are bills from two committees in the Senate that will also require reconciling. But many of the items discussed in the Families USA reports are contained in all five bills. Among the highlights of the reports, health reform will:

• End the practice of denying health insurance due to pre-existing conditions, basing premiums on gender and health status, and revoking (or rescinding) coverage in most cases.
• Provide sliding-scale subsidies to low- and moderate-income individuals and families to make insurance more affordable. Over the past decade, health insurance premiums rose significantly faster than earnings in both states – 2.7 times faster in North Dakota and 2.9 times faster in Nebraska. Obviously, these unsustainable increases in premiums are pricing many families out of affordable, quality health insurance.
• Provide tax credits to small businesses to help provide health care coverage to workers. As we have discussed before, rural states like Nebraska and North Dakota are dominated by a self-employment and small business economy. Yet fewer and fewer small businesses in both states provide health care coverage to their workers – less than a third in North Dakota and less than 20 percent in Nebraska. The proposed tax credits for small businesses and the proposed Health Insurance Exchange will provide small businesses and their employees more affordable and quality health insurance options.
• Place limits on out-of-pocket health care costs. Currently, there are no limits on how much an individual or family has to pay in out-of-pocket costs – deductibles, co-pays and other costs. About 10 percent of non-elderly adults in both states spend more than 25 percent of their income on health care. The proposed legislation places a cap on the amount of out-of-pocket costs any individual or family must endure, with a sliding scale that provides more protection at lower income levels.
• Provide health insurance coverage to significantly more people. About 30 percent of working age residents in both states were uninsured for at least one month during 2008. The proposed legislation will not only provide those people with the benefits of health insurance, it will also help to mitigate the $1,000 annual “hidden tax” insured residents in both states pay for health care for the uninsured.

Families USA is a national nonprofit, non-partisan organization dedicated to the achievement of high-quality, affordable health care for all Americans. Information about the organization and their publications may be found at http://www.familiesusa.org.

Family Farmers and Ranchers and Medical Debt
The Access Project recently released Who Has Medical Debt and What Are the Consequences?, its latest Issue Brief related to its 2007 survey of family farmers and ranchers in seven Great Plains states. The issue of medical debt is related to the issue of out-of-pocket costs discussed above, and, of course, sets the stage for large number of bankruptcies and home foreclosures that are attributable to health care debt.

This report again demonstrates how the current system does not work well for rural people, particularly the self-employed and those who own and work for small businesses. Highlights include:

• Those farmers and ranchers with lower income have higher rates of medical debt.
• Nearly twice as many farmers and ranchers reporting good, fair or poor health have medical debt compared to those who report excellent or very good health.
• Farmers and ranchers uninsured for at least some time during the year are twice as likely to have medical debt.
• Those with medical debt spent nearly twice as much in out-of-pocket costs as those without medical debt.
• Those with medical debt were more than twice as likely to delay medical care.
• Those with medical debt were much more likely to use resources such as savings to pay down debt. Over half of those with medical debt reported that the medical debt contributed to family and business financial problems.

An interesting finding of the report was that the average medical debt was not attributable to catastrophic medical conditions or events. As the report states, this may represent the “tip of the iceberg” of medical debt, or what debt is remaining after all other resources have been exhausted. It also suggests that families are being “nickeled and dimed” on health care costs to the extent that they end up in debt.

Whatever the situation, these findings cry out for solutions in health reform legislation, including limiting out-of-pocket costs, providing adequate health insurance subsidies for low- and moderate-income people, and imposing reasonable limits on the percent of income people are required to spend on health care.

Sweet the Bitter Drought
On October 1, we and the Center for Community Change released Sweet the Bitter Drought at a Congressional briefing in Washington, DC. The briefing was sponsored by Representatives Tom Perriello (Virginia) and Peter DeFazio (Oregon), and featured health care stories from rural people from Nebraska, Maine, Wisconsin, Virginia and South Carolina.

The report is a reissue of our previous report The Top 10 Rural Issues for Health Care Reform, now with stories from rural residents highlighting each issue. The stories were obtained at county fairs and state fairs across the nation by the Center for Community Change. Those stories can be viewed at www.statefairstories.org.

The report’s title is taken from a passage in “The Task,” written by the English poet William Cowper in 1785:

God made the country, and man made the town;
What wonder then, that health and virtue, gifts
That can alone make sweet the bitter drought

That life holds out to all, should most abound
And least be threatened in the fields and groves.

Contact: Jon Bailey, jonb@cfra.org or 402.687.2103 x 1013 for more information. All of the reports discussed above may be found at http://www.cfra.org.