Rural Health Clinics Getting Short-Changed?

There was an interesting moment at this week’s annual conference of the California State Rural Health Association. During one of the presentations, a sit-down with two state Assembly members — V. Manuel Perez (D-Coachella) and recently elected Linda Halderman (R-Fresno) — the conversation seemed to veer away from rural health issues.

After hearing about high unemployment, the icy regulatory climate, too much government and arsenic contamination of water supplies, host Steve Barrow gently redirected the conversation.

“You know, rural [medicine] gets lost a lot in the Capitol,” he said. “We care about clean water, and cultural issues, and economic issues — but if we’re talking about economics in rural California, 11 percent of the rural economy is health care. Health care is a big part of economics in rural areas.”

Later, Perez was given an award by the association for his work on rural issues, so he’s someone who’s clearly aware of rural concerns. But the interaction underscored the general feeling that rural health care providers feel abandoned by Sacramento.

Some of that wariness stems from the situation created by the budget impasse. Without a state budget, Medi-Cal reimbursements were suspended to rural clinics in California in September.

“Those hundred days [of the budget impasse] were pretty frightening,” Barrow said after the presentation. “In past years, CEOs of some clinics would literally mortgage their homes to get through it, but with the economy these days, they couldn’t go to that.”

Most rural facilities survived through taking out loans, but Barrow said that six rural clinics did shut down during that time. “We were afraid there would be dozens of them going under,” he said.

More recently, the governor blue-penciled $10 million in funding for rural clinics under the Traditional Clinic Programs. Some legislators have said they hope to revive that line-item cut, as well as several other health services funding cuts, when the Legislature reconvenes in January.

The association has a number of issues it hopes it can get Sacramento to hear. High on its list is a desire to revive the pilot program that allowed some direct hiring of physicians in rural areas. Otherwise, Barrow said, rural areas might have nice clinic offices, without the physicians to staff them.

“The lack of physicians is a big problem in California, but especially in rural areas,” Barrow said. “Rural areas make up about 85% of California, but the population in all of that area is about 5 million. So really, it’s just like the population of a big inner city neighborhood, but spread out over a really large area. Like a really big neighborhood.”

Keynote speaker Paul Moore, a senior health policy advisor for the federal Office of Rural Health Policy, echoed the need for policymakers to pay attention to rural areas.

And, he added in his gentle Oklahoma drawl, rural providers need to pay attention to, and try to influence, policymakers.

“One of my jobs is to read policies, proposed rule-making, give it the sniff test and then weigh in on it. So I get to see those rules before you do,” Moore said.

“But you see those rules before they become regs. You need to stay attuned to what could help you or hurt you, what’s coming down the pike. There’s still too much unknown at this point,” he said. “And unknown is cause for concern.”

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