Health care reform to increase rural access


Minnesota stands to benefit enormously from national health care reform, both short term and long term. Some of the big and more talked-about benefits include creating tax credits for some 72,000 small businesses in the state to help make insurance more affordable, prohibiting health insurance exclusion of children with pre-existing conditions, closing the “donut hole” and reducing Medicare premiums, and allowing young adults to stay on their parents’ insurance longer.

But there are some benefits that we haven’t heard that much about, perhaps because they are less evident. So let us talk about some of them now.

Already this year, the Federal student loan repayment programs to public health professionals will begin, offering repayment up to $35,000 per year. As a requirement of the repayment, public health professionals will remain with the agency for three years and may be moved to a high-priority area if necessary — areas such as rural Minnesota.

The reform also encourages increased use of telehealth technologies like allowing telehealth face-to-face meetings to determine eligibility for Medicare home health services and durable medical equipment. The bill also encourages increased use of telehealth services in medically under-served areas and facilities of the Indian Health Services.

Beginning later this year, funds will become available to build new or expand existing community health centers, as well as expand funding for scholarships and loan repayments for primary care physicians working in underserved areas.

In 2011, there will be an increase in training support for primary care physicians and the introduction of pay incentives to primary care physicians of 10% of payment on top of the regular salary. This is a much-needed policy change and pay incentive in a time where more medical students choose specializations to receive higher pay.

School loan repayments will not exceed 10% of discretionary income and the loan will be forgiven after 20 years for those who have stayed current on payments — another helpful piece of legislation for those who want to work as in the less profitable area of primary care, but who will have an equally large student loan as those who go into more profitable specialties.

By Jan 1, 2011 the Secretary of Health and Human Services will deliver their report and recommendations regarding Medicare payments to rural providers, as well as access to services and quality of care. The expectation is that this will be followed by changes in how Medicare payments are determined and a fairer distribution to states like Minnesota where the cost of care is cheaper relative to other states.

Putting these somewhat minor, seemingly less important provisions of the bill together, you see the sum total of the provisions enables more doctors to work in rural areas and as general physicians since the financial pressure of school loans is eased, and the increased implementation of telemedicine provides professional support similar to that in larger cities.