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Sebelius: Obamacare good for rural America; USDA extension will help promote participation

Health and Human Services Director Kathleen Sebelius addresses the National Rural Assembly on Tuesday. (From Center for Rural Strategies video)

BETHESDA, Md. — Farmers have a lot to gain under the Affordable Care Act that goes into effect on October 1 and the Agriculture Department’s extension service has agreed to help the Health and Human Services Department promote participation in the new health care program, Health and Human Services Secretary Kathleen Sebelius told the National Rural Assembly here on Tuesday.

Sebelius, a former Kansas state legislator, elected insurance commissioner and governor, appeared before the gathering of farm and rural activists from around the country in an apparent attempt to counter criticism from legislators, including Senate Finance Committee Chairman Max Baucus, D-Mont., that the Obama administration will not be ready to roll out the controversial new health care system that requires almost all Americans have to have health insurance by next January.

Although some of the strongest criticism of Obamacare — the popular term for the Affordable Care Act — has come from rural America, Sebelius noted that “Many farmers and small business owners will qualify for a break in their premiums.”

Noting that in Kansas “almost every one of the 105 counties has some rural portion,” Sebelius said she learned that “if you close a school, if you a close a hospital you close the town. No one is willing to live in an area where health care is threatened.”

“The snapshot of health care in rural America is not pretty,” Sebelius said. Rural Americans, she noted, are more likely than urban Americans to suffer from heart disease and cancer.

The fact that farmers are “their own bosses” means that when it it comes to medical insurance, farmers are individual small business owners who often have trouble getting coverage, have to pay more for it and still may have trouble getting quality care.

“One in five farmers is in some kind of medical debt,” Sebelius added.

The crowd at the National Rural Assembly conference in Bethesda, Md., on Tuesday. (Jerry Hagstrom/The Hagstrom Report)

“Rural Americans and many Americans are not being well served by the insurance market of the past,” Sebelius said. “If you have small business you are more likely to be in the small group market.”

In 29 states, including most rural states, Sebelius said, a single insurer dominates the market. “That is not competition, that is a monopoly,” she said.

The Affordable Care Act will bring more competition among insurance companies, require plainly written policies and prices, and not allow companies to lock people out of the market on the basis of pre-existing conditions, she said, but rural people have to know the policies are available if they are going they are going to benefit from them.

Sebelius said HHS is making a great effort to inform all of America about the new program.

“We know making health insurance available is not enough,” Sebelius said. “A lot of people have been uninsured or underinsured for so long they really don’t believe coverage will ever be within reach.”
HHS has a “special contract” with the Agriculture Department’s Cooperative Extension System to get the word out in rural areas, she said, although she did not describe any details of what the extension service, which has 2,900 offices around the country, will do.

HHS has also established a new website, and has a toll-free 24-hour customer service line at1-800-318-2596 operating in 150 languages at which people can get questions answered.

Urging the hundreds of attendees at the assembly to spread the word about the website, Sebelius said “All of you know potential beneficiaries, someone in pain, a small business owner who goes without tests.” The idea, she said, is “to keep people healthy in the first place, not wait until they get sick.”

She urged the attendees to encourage young people, including their own children, to get health care. Although young people may now stay on their parents’ health care plans until they are 26, “a big share of uninsured are the young and healthy” who think that they don’t need insurance but are “one accident away” from a lifetime of paying for medical care or not getting proper treatment and having to live with injuries, she said.

Young people “think they are invincible. Parents can have a different conversation with them,” she added.

The act will also help rural hospitals, she said.

“We have also listened carefully to rural health care leaders,” Sebelius said. “We have talked a lot about regulatory burden, it is tougher for small hospitals. So we have eliminated a whole series of regulations that have applied to health care across the board.”

The act, she said, will also expand community health centers and triple the size of the National Health Service Corps, a program under which medical professionals get their school debts paid if they work in underserved areas. A lot of health service corps members stay in the areas where they work, she added.

Acknowledging that there is a debate in the states about expansion of Medicaid, Sebelius noted that for states who expand Medicaid, the federal government will pick up 100 percent of the tab for the first four years and 90 percent of the tab in 10 years to cover people who are within 130 percent of the poverty standard, which is an income of $15,000 for an individual or $30,000 for a family of four.

“As a governor I would have given my eye teeth for that deal,” Sebelius said.