The program uses three types of grants. The first is a grant of up to $100,000. That’s to pay for marketing or public relations. The second is a grant of up to $150,000. That’s advertising, as well as direct-contact efforts. The third is a grant of up to $200,000, for a full-scale campaign to get local voters to decide on whether to expand health care in their area. “We’re putting up as much as we can,” says Henneman.
The biggest difference is that the federal government is in charge of making health care more available. They’ve tried to get involved a couple times, and have had little success. “People just aren’t interested,” Henneman says. “It’s almost impossible to get people to participate in their communities and be in favor of health care expansion when their government is saying, ‘We won’t cover you.’ ”
Another issue that has been the biggest reason for resistance is how it affects rural hospitals. In rural areas, the costs of providing primary care are often more expensive than in urban centers. With health coverage, that can mean a cut in hospital services.
One health advocate, Bob Crippen, has worked on several health care campaigns in his career. He works closely with the Department of the Interior, which wants to put public access to more doctors into the state’s hospital systems. “There’s nothing better at keeping government out of the health care of our people,” Crippen says.
The department is putting funding behind a program called Access Now, a collaborative effort between the Centers for Medicare & Medicaid Services and the Department of Health and Human Services. They’ve been working for three to six years on getting rural hospitals to join the program. It’s the first of their kind to target rural areas, which has some important implications: Health access in rural communities is in decline. “We’re seeing more chronic diseases and better outcomes overall in rural communities,” Crippen says. “We’re seeing declining health status for older adults and the health status for children.”
When people visit a doctor in rural areas, one of the first questions they often ask is, “What kind of health insurance am I going to have?” A high percentage of the rural population relies on subsidies for health care. If Medicaid were to change, the impact on rural hospitals could be devastating. Rural hospitals that have been in the health insurance business for decades would simply have to change their models, and
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