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National Rural Assembly

Bethesda, Maryland
June 25, 2013

Thank you, Dee Davis, for that introduction. I want to thank everyone at the Assembly for organizing this week’s conference. And I want to thank all of you for traveling from across the country to join this important conversation about how we can improve opportunity and health in America’s small towns and rural communities.

Like you, I came to Washington from a rural state. My husband and I raised our sons in Kansas, where I entered public service as a state legislator and insurance commissioner. I went on to serve as governor, leading a state in which nearly every one of 105 counties are rural – and where farmers produce more wheat than any other state in the union.

Like you, I’ve seen firsthand the qualities that make rural America so special. I’ve seen the natural beauty. I’ve seen the stewardship that feeds and fuels our country and the world. I’ve seen the strength and resiliency of close-knit communities that look out for one another.

But I’ve also seen the challenges that rural areas face.  I learned early on that if you close a school or a hospital, you close a town.  Education and health care are essential ingredients for rural America to thrive.

But those same values of independence and hard work mean many rural Americans are their own boss with no employer they can rely on for health insurance. Those same wide open spaces that can make small town America so beautiful also mean it’s sometimes dozens of miles to the nearest doctor with a free appointment.

Rural Americans today suffer disproportionately from health problems like heart disease and cancer, and are more likely to be uninsured and pay out of pocket for care. That’s one reason why one in five farmers is in medical debt.

I share the President’s belief that in America, where you live shouldn’t determine your chances for a healthy life. That’s a principle we should all be able to agree on.  And today, I want to discuss the historic steps we’re taking under the Affordable Care Act to make that principle a reality – and I want to talk about how you can help.

Our work starts with making sure affordable health coverage is within reach for every American.

You know as well as anyone that rural Americans are not being served well by today’s health insurance market.

Rural Americans are less likely to get insurance through a job, which means they’re more likely to have to buy it on their own. But in 29 states today, most of them rural, a single insurer dominates over half the market. And with little competition, there’s little pressure on insurers to offer competitive rates or benefits packages.

On top of that, insurers are free to discriminate against people with pre-existing health conditions, which means the people who need coverage the most are often the ones who can’t get it. That’s what the market looks like today.  But the health law is beginning to make health insurance work better for rural Americans.

Beginning October 1st, a new Health Insurance Marketplace will open for enrollment in every state, with coverage that begins January 1, 2014. Instead of piles of papers and layers of bureaucracy, rural families and small businesses will have a single place to visit with simple language that helps them make apples-to-apples comparisons of plans. 

All plans must cover an essential set of benefits, including hospital visits, doctor visits and prescription drugs. Discrimination based on gender or pre-existing conditions, like diabetes or cancer, will be outlawed. And many families and small business owners will qualify for a break on their monthly premiums.

The Marketplace will be a whole new way to shop for health insurance. And yesterday, we launched an updated website, HealthCare.gov, where rural Americans can go right now to get information, checklists, and other materials that will help them prepare for October 1.

For those who don’t have internet access, we also launched a toll-free call center that’s open 24/7 to provide information and answer questions in 150 languages. And by October there’ll be personalized assistance to help callers fill out an application and select a plan.  

I want to be clear: every state will have a Marketplace this October.  And as we get closer to that date, we’re ramping up efforts to help people understand their new options that are around the corner.

That’s because we know that just making health insurance available isn’t enough. There are a lot of people who have been uninsured or underinsured for so long that they simply don’t believe that affordable coverage will ever be within reach.

A big share of the uninsured is young and healthy, and as the mother of two young adult sons, I know that health insurance is not always the top priority. I can’t tell you what the top priority is, but it’s definitely not health insurance. 

We also know rural populations face different health care challenges compared to urban populations. Our team at HHS has taken a deep look at the numbers and identified differences in demographics that find rural populations facing higher rates of being uninsured, earning lower incomes, and being generally harder to reach – making outreach and enrollment even tougher.

So my first ask of you today is to help us educate rural America about the new coverage options that will be available. You can start by visiting HealthCare.gov and signing up for updates you can share. You can partner with our outreach workers who will be on the ground in your towns and communities. You can work with your local community health centers, which have received grants to help enroll the uninsured in underserved areas.

Today, somewhere in your community there’s a farmer with chronic pain who doesn’t think he’ll ever be able to get it treated.  There’s a small businesswoman going without a preventive cancer screening because she thinks she can’t afford it.  There’s a high school graduate who doesn’t realize that if she got into a car accident tomorrow, her family’s savings could be wiped out.

We need you to help us reach them. We need you to help ensure that no one goes without health insurance this fall simply because they don’t understand why it’s important or how to get it.

And we also need you to join the conversations happening in states right now around extending their Medicaid programs.

Medicaid fills gaps in rural health, protects families from financial ruin, and ensures that doctors and hospitals – especially Critical Access Hospitals in rural areas – get paid for the care they deliver. It’s a lifeline for families and providers alike.

Under the health care law, states can expand Medicaid to cover uninsured adults with incomes at or below 133 percent of the federal poverty level. That’s up to $15,000 a year for an individual and $31,000 for a family of four.

These are the people who are falling through the cracks today.  And the best part from the states’ perspective is that the federal government will pick up 100 percent of the bill for the first three years – and at least 90 percent of the bill from then on.  As a former governor of a rural state, I know this is a deal that can’t be beat.

But while I’ve been heartened to see governors and state legislatures across the political spectrum seizing this opportunity, there are many states that are still leaving this money on the table.

So my second ask is we need your help to make sure people in rural states understand exactly what is at stake when it comes to this decision.

If Medicaid isn’t extended in these states, millions of working people could be left with no support and no source of affordable health coverage.

On the other hand, if Medicaid is extended, it would reduce the burden of uncompensated care, particularly for rural hospitals. It would inject significant new federal resources into rural economies. And it would allow hundreds of thousands of rural families to finally be able to benefit from the daily security of health coverage.

This conversation is too important. We need you to bring the facts and stories of your communities to this debate.

But we also know that it’s not enough to simply provide coverage. Far too many people in rural areas go without care today simply because there’s no one for them to receive the care from.

That’s why the law supports a multi-pronged approach to increase access to quality rural health care.

It supports the largest expansion of community health centers in history. And it nearly triples the size of the National Health Service Corps, which helps health providers repay their student loans if they serve in underserved areas. Ten thousand primary care providers are now part of the Corps, many of whom stay in those rural areas after their commitment is complete.

We’ve also listened to rural health leaders and taken steps to reduce regulatory burdens on rural providers, health care workers, and Critical Access Hospitals to help them stretch their resources further.

And we’re helping providers reach more people through new technologies like telehealth networks that are linking rural ERs with urban trauma experts.

We’ve had particular success with our new network of Health IT Regional Extension Centers – based on the agricultural model – that’s already helping nearly 25,000 rural primary care providers implement electronic health records. That’s over half of all rural primary care providers nationwide.  And I want to thank Secretary Vilsack and his team for their tremendous partnership on this and other areas of rural health.

Many of these efforts have been inspired directly by what we’ve heard from rural leaders like you. You’ve told us what’s working and what’s not working. We’ve listened and responded.  And we’re committed to continuing to strengthen that partnership through vehicles like the National Rural Assembly and the White House Rural Council.

Those of you here today represent the diversity of rural America. But whether you’re a small business owner, farmer, educator, business, community, or tribal leader, each of you shares a belief that improving access to health care is critical to improving the wellbeing of all rural Americans.

In the coming months and years, we have a once-in-a-generation opportunity to do just that. But we can’t do it without your help – as an Assembly, as leaders in your organizations, and as individuals in your communities.

I encourage you to build partnerships with other organizations. Talk to your colleagues.  Educate your family and friends.

Together, we can build a country where every American – no matter where they live – has the chance to live the healthy life they deserve.

Thank you.