Rural schools, hospitals could be hurt under federal changes

Bill Knight column for Thursday, Friday or Saturday, Feb. 23, 24 or 25

Education and medicine in rural areas are vital, but they’re threatened by changes being considered in Washington, according to rural advocates. First, hometown schools may be overlooked by newly confirmed Secretary of Education Betsy DeVos.

“She’s coming into the job with no sense of the realities of rural education and no indication that she actually cares,” says Robert Mahaffey, director of the Rural School and Community Trust. “Will that change? Will she be open to those conversations? It remains to be seen.”

Married to Dick DeVos, heir to the Amway fortune, Secretary DeVos and her four children attended private schools. Her main education issue is “school choice,” a market-driven approach that lets parents put their children (and their tax dollars) into charter schools or private schools through “vouchers.”

“I think there’s a lot of panic right now on school choice and vouchers,” adds Allen Pratt, director of the National Rural Education Association. “When you’re looking at rural areas, there’s not school choice a lot of times.”

DeVos’ confirmation hearing was so contentious that two Republican Senators, Susan Collins of Maine and Lisa Murkowski of Alaska, opposed her nomination, partly because they said vouchers would be bad policy for their states.

“I’m concerned that Mrs. DeVos’ lack of experience with public schools will make it difficult for her to fully understand, identify and assist with those challenges, particularly for our rural schools in states like Maine,” Collins said.

In her confirmation hearing, DeVos’ only comment about how “choice” could work in rural areas was a suggestion that distance learning might be an option.

“I’ve been to a lot of Senate confirmation hearings for Cabinet members, in both Republican and Democrat administrations,” Mahafrey says. “I’ve never seen a nominee so unprepared to discuss the issues and the policies that she will be overseeing.”

If rural communities’ schoolkids are a big focus of public concern, rural health facilities are even bigger, affecting young, old and everyone between. And if DeVos has no real idea of how to impose her notion of “school choice” on rural towns, Republicans eager to dump the Affordable Care Act have no appreciation for the health-care consequences to regular people living outside cities.

The rural health-care system is already fragile, as shown by a new study from the federal Centers for Disease Control (CDC) showing that Americans living in rural communities are more likely than city dwellers to die prematurely from the top five causes of death (accidents, cancer, heart disease, respiratory disease and stroke).

At the same time as rural and urban mortality rates have been diverging, 80 rural hospitals have closed over the last few years. In addition, according to iVantage Health Analytics, almost 700 rural hospitals are financially vulnerable and could close. That’s more than a third of the rural hospitals in the country.

“If we don’t act now, we will see a massive round of rural hospital and clinic closures,’ says Rural Wisconsin Health Cooperative director Tim Size.

The rural hospital challenge is comparable to the 1980s, when Medicare implemented a new way of paying providers – the Prospective Payment System (PPS), a reimbursement method in which Medicare payments are made based on a predetermined, fixed amount derived on Medicare’s classification system of services. PPS “threw the rural baby out with the reform bathwater,” Size says, writing for the Center for Rural Strategies.

The National Rural Health Association and similar advocates want standards for rural medicine basics: accessibility (access for consumer reflecting “historical patterns of care”), transparency and consumer engagement (consumers have the ability to determine which providers are in the network and accepting new patients); choice (a choice of insurers and providers for consumers); and affordability and cost effectiveness (adequacy standards must not result in unaffordable health insurance costs). Such basics may soon be unachievable.

“Through the 1980s, the design of PPS hurt rural hospitals in ways that made neither professional nor political sense,” Size says. “Today, a shift to premium support, block grants or reducing state oversight of insurance companies, would be at least as devastating unless the rural context is fully taken into account. We have learned nothing from our past if we allow this to happen to us once again.

“As bad as the rural hospital closure crisis already is in many, but not all, parts of the country, it will become a tidal wave across all of rural America.”

[PICTURED: Rural School and Community Trust director Robert Mahaffey, from REL-NEI.org.]