When Pleasure meets Money

Is health insurance a boon or a bane? It is a question on which people can argue till the cows come home and still not be any wiser.

At one end of the spectrum are the people, whose lives have been saved by different types of medical insurances, including California Individual Health Insurance, which made personally unaffordable medical treatment available to them. At the other end of the spectrum are people who have paid through their nose for medical coverage but were refused it because the insurance company decreed it that their condition was a ‘pre-existing’ one. Hanging in the middle are the myriad uninsured people who have no health insurance in CA or anywhere else.

The uninsured people, from the state of California, are likely to be in need of California Individual Health Insurance. Those who need individual health insurance in CA are mainly those who are not covered under any group insurance because they are either not working, or are self-employed. Insurance providers are often apprehensive of providing California Individual Health Insurance to self-employed people, as the companies are doubtful about their credit worthiness and ability to pay the premium on time.

Health insurance in CA may become available to a self-employed if his or her spouse is covered under a group health insurance plan provided by the spouse’s employer. Many group health insurance in CA automatically cover the spouse also. Sometimes an individual may leave an employer and start self-employment on his own. In that case he has the right to extend up to 18 months, the employer-sponsored group health insurance in CA under which he was covered. This will give him time to make alternate arrangement for his California Individual Health Insurance. However, during this time he has to pay the premium of the insurance himself.

After the 18-month period when he will lose the benefit of keeping the group health insurance in CA, he can buy a California Individual Health Insurance from any one of the myriad insurance companies that offer California Individual Health Insurance. A little searching around and comparing quotes will be necessary to select the right one, but it should not be difficult considering the number of sites that offer a whole range of covers available for the area where you are stationed. The snag in shifting out of the employer-sponsored health insurance in CA to a private California Individual Health Insurance is that the latter is unlikely to cover any pre-existing condition. As long as the person is within the protective arms of the former, he gets coverage for his pre-existing medical problems also.

Besides the self-employed, those who seek California Individual Health Insurance are those who find their employer-sponsored group coverage insufficient, or those who need additional health insurance in CA for their family members.

Rural should not mean less when it comes to health care.

As health care reform begins, and we struggle to get a state budget passed, we have an opportunity to ensure that all Pennsylvanians have access to quality health care. The health and welfare of rural Pennsylvania affects the entire commonwealth. All but two of our 67 counties have rural residents, 48 are predominantly rural and five are completely rural. But the bulk of our resources go to urban areas, organizations, communities and residents. This includes health care.
Rural Pennsylvanians face multiple barriers when accessing health care services. Four key areas are:
The struggle to build and keep a rural health care work force.

Deficiencies in rural health care infrastructure.

Lower insurance reimbursement for health care services.

Rural citizens are increasingly underinsured and uninsured.

The numbers show it, rural residents live it, and rural advocates continue to tell the story. An adequate supply of providers and practitioners is essential to quality health care for all residents of the state. Rural residents require the same spectrum of skilled providers across the health care continuum — including primary care, pre-hospital emergency medical services, acute care, home health, rehabilitation, long-term care and hospice — as their urban and suburban counterparts.
Rural residents generally must travel beyond their communities to meet tertiary health care needs. Local access to primary and secondary health care is essential to ensure that health problems are addressed before they become emergencies too serious or expensive to treat.

This also means that access to preventive care and effective management of chronic conditions must be provided locally. Too often, the primary and preventive care available is too scarce to serve all those in need.

Health profession work force shortages are among the most pressing issues facing hospitals, health systems and their communities today. For rural communities, the challenge is even greater, since there is not the health care infrastructure for clinical training or health care delivery.

Travel and financial barriers pose increased challenges for those rural residents interested in becoming a health care professional.

Pennsylvania is training the nation’s health care work force. However, a lack of rural resources and infrastructure precludes the many Pennsylvania-trained professionals from choosing to practice in our rural communities. This includes physicians, nurses and other health care technicians, as well as nonclinical workers trained in social services, housekeeping, maintenance and food service.

Maintaining a strong health care industry has important ramifications for the economic vitality of rural communities. Rural hospitals and primary care clinics, such as Federally Qualified Health Centers and Rural Health Clinics, provide quality health care services to rural residents. Hospitals are key providers of health care in rural areas and often serve as the anchor for the entire continuum of services.

The closure of a hospital can significantly impact the local economy. Rural communities across the nation that have lost their local hospital have often experienced a domino effect, with a subsequent departure of primary care physicians, deterioration of home health services, decreased medical oversight and access to health care in general. Rural communities that lose their hospital lose a major employer. They lose the direct and “roll-over” dollars from having that major employer in their community and often lose other health care services across the continuum. Also, they have diminished ability to attract new employers.

Rural Pennsylvanians play a vital role in delivering the agricultural, timber, mining and other business services to the commonwealth’s economy, however, 78 percent of rural businesses employ fewer than nine people. This makes it extremely costly to provide health insurance. When rural residents enter the private insurance market, they are likely to pay higher administrative fees, find fewer health insurance choices and be underinsured.

Rural residents pay a higher proportion of their income for health insurance because premium rates in rural America are comparable to or even higher than those in urban areas. The average wage disparity between urban and rural is more than $12,000. Because rural populations tend to be older and poorer, they rely heavily on public sources of coverage. For this reason, rural residents and health care providers are more heavily impacted by coverage changes and inadequate provider payment rates in Medicare, Medicaid and the state Children’s Health Insurance Program.

Rural Pennsylvanians are less likely to seek primary and preventive care and are more likely to be in poor health. This is the result of many factors, including lower coverage rates, lower incomes, less comprehensive coverage and less access to health care providers. Strong and reliable sources of health care financing and insurance, as well as local access to health care, are critical for improving health status and outcomes of rural citizens.

We have an opportunity, as health care reform gets under way, to make a difference for the better in our rural communities to improve the overall health and quality of life. Indeed, rural should not mean less when it comes to health care.

Walt Eisenhauer is immediate past president of the Pennsylvania Rural Health Association