Update, UHCAN Ohio Newsletter

Vol. 3, No. 1 -- February 2002

Access to Health Care Faces Roadblocks in Rural Ohio

by Reina Sims

Over one-half of Ohio's 88 counties are considered rural. Twenty-six percent or roughly 2,807,706 people live in rural Ohio. The majority of this rural population live in Appalachia, a 29 county area located in southeast Ohio. Access to health care services for this population is a very real challenge.

Health care access issues in rural areas may include:

• Inferior roads with poor maintenance
• Fewer roads per square mile which add greater travel distances and time to the nearest health center
• Geographical barriers such as mountainous terrain or large bodies of water
• Lack of public transportation
• Deficiency in technological advancements in health care
• Lack of insurance
• Shortage of health care professionals.

The 1998 Ohio Family Health Survey reported that the unemployment rate was the most significant predictor of insurance status. A lack of employment and health insurance means a lack of routine preventive care. In turn, individuals wait until a health situation becomes critical before they seek health care and often present in the emergency room for primary care conditions where treatment is considerably more expensive. The same survey also indicated that "uninsured Ohioans are more than twice as likely as insured Ohioans to have no usual source of care or to use emergency rooms as their usual source of care." Research has shown that utilization of the emergency room decreases as access to health insurance and affordable health care increases.

Affordability of health care services is an issue for all, but even more pronounced in rural areas because there are fewer choices for clinics, providers, and hospitals. Affordability and availability are made more difficult because:

• Physicians often cannot afford to accept Medicare or Medicaid clients or to offer a sliding fee scale due to poor reimbursement rates and the driving cost of recruitment/retention of skilled health professionals as well as costs to maintain facilities.
• Rural physicians often work longer hours and earn less than their urban counterparts. Consequently, rural areas are not among the top practice choices of health care professionals.

Thirty-one of Ohio's 57 rural counties are full or partial geographic, population or facility health professional shortage areas (HPSAs). Between 1995 and 2000 Ohio has placed 326 health professionals in underserved communities, 107 of them in rural and Appalachian counties. Federal designation as a HPSA is of value due to:

• Increased access to additional staff through placement of National Health Service Corps providers, Ohio Physician Loan Repayment Program physicians, and J-1 Visa Waiver Program physicians.
• Increased reimbursement from Medicare.

Facilities that utilize the programs mentioned above are often the states' federally qualified health centers, migrant health centers, and rural health clinics. Ohio currently has 15 rural health clinics. In the past year alone, four rural health clinics have closed their doors, largely due to an inability to make ends meet financially in often very economically depressed rural communities.

Rural health coalitions, community support, federal designations and clinics located in rural areas have helped to alleviate the access to care issue in rural Ohio. However, more work remains. We need better methods to provide transportation to providers. We need to focus on integration of services. Recently, Secretary of Health and Human Services Tommy Thompson created a rural initiative and task force to address these concerns. At the state level, the Ohio Rural Health Coalition unites the efforts of existing health provider associations and provides a vehicle for informed action by rural consumers, health care purchasers, and local policy makers.

The primary goal of Ohio's Primary Care and Rural Health Program and its State Office of Rural Health is to increase access and decrease disparities in health services to Ohioans. Health is a right, not a privilege, for everyone.

Reina Sims is Program Consultant in the Rural Health Section of the Primary Care and Rural Health Program, Ohio Department of Health.

Update and Action for Affordable Rx

Public pressure in support of the Prescription Drug Fair Pricing Act (HB 290; SB 127) is building in Ohio. Already, eight Boards of County Commissioners, twenty municipalities, over 200 organizations, and 18,000 petition-signers are calling for affordable prescription drugs for all Ohioans. Statewide organizations backing the legislation have launched the Coalition for Affordable Prescription Drugs; in the Northeast, Northwest and in Southern Ohio, people are working in regional coalitions.

With the legislation, the state would negotiate with the pharmaceutical companies for substantial rebates and discounts, and pass those savings on to the consumer. Everyone would benefit: consumers able to afford needed medications; pharmacists, reimbursed and given handling fees; businesses, currently unable to provide prescription coverage or feeling the pressure of escalating costs, relieved; even the drug companies, as they compensate for "loss" with increased volume of sales.

Our state legislators would also benefit. During this time of budget restraints and cuts, state representatives and senators can now give their electorate something - affordable prescription drugs - without straining the budget or cost to the taxpayer.

It's a win-win scenario, but grassroots action is needed for the scenario to become reality!

Here is what you can do:

Write now to members of the House Health and Family Services Committee and tell them you want a hearing on HB 290; to members of the Senate Health and Human Services Committee and tell them you want a hearing on SB 127. The bills won't move unless there are hearings scheduled. (A list of the members of the two committees is included with this newsletter.)

Write a letter to your state legislators letting them know your need for affordable prescription drugs. Legislators like hand-written letters - which do not have to be long. (You can include a copy of your bills for medications.)

Publicize the issue. Hold a Town Hall Meeting or other event in your community. Invite your legislators. Let them hear how high prescription drug cost affects you. Get the media there.

The Fight for Affordable Prescription Drugs:
Why It Helps the Fight for Universal Health Care

By Deborah Socolar, MPH and Alan Sager, PhD

Addressing prescription drug affordability is now a crucial component of the fight for universal health care for several reasons:

Necessity: The need to solve the problem is urgent.

• Prescription drug costs now double every five years-a major driver of today's soaring health care costs. So implementing equitable, workable strategies for reining in drug costs will make health coverage for all more affordable. (Indeed, proponents of universal health care need strategies for making prescription drugs affordable in any universal health care plan.) And such steps will help avert a meltdown before we win universal health care.
• Over 70 million Americans (1 in 4) of all ages are uninsured for prescription drugs-including some 30 million otherwise considered "insured." Millions more have minimal coverage. Lack of drug coverage is one of the main forms of under-insurance

Awareness: Lessons from the prescription drug arena boost public understanding of health care.

• It may be the area where awareness is now greatest that there is and can be no free market in health care and that state or federal government action is vital to make care affordable.
• Prescription drug makers' monopolies for what are often life-and-death essentials help to make a strong case that this industry should be treated much like a public utility. Because government-granted monopolies (patents) give the industry pricing power, they must be offset by government action to make needed drugs affordable.
• This is a part of health care where it's easy to show that cost control, universal coverage, and quality improvements are allies, not antagonists.

Financial and technical feasibility: Solving this problem can point the way to care for all.

• Prescription drug coverage and financing can be more easily disentangled from the rest of health care than can other sectors.
• It's the easiest problem inside health care to solve, because spending is already so high, and the marginal cost of making all the added pills that Americans need is so low.

A few related issues

• Necessity: A great many physician visits today lead to a prescription. If patients can't afford the drug, their care is thwarted. The caregiver is put in the position of a fire-fighter told to work without water in the hose. The care's value is undercut-and the caregiver frustrated.
• Necessity: The pharmaceutical industry is one of the key sectors in which the nation must grapple with the role of profit-making organizations in health care.
• Awareness: It may be the area where awareness is now greatest that Americans have worse access to care than people in many other nations (given our high prices).
• Feasibility: Solving this can show that competent, compassionate public solutions are possible.

Indeed, winning affordable prescription drug coverage for all is a feasible first step towards universal, comprehensive health care.

Sager and Socolar (dsocolar@bu.edu and asager@bu.edu) direct the Health Reform Program at the Boston University School of Public Health.
See reports on prescription drug issues at http://dcc2.bumc.bu.edu/hs/ushealthreform.htm.

Organizing for Access on Cleveland's East Side

UHCAN Ohio has been working with residents of Glenville, a community on the East Side of Cleveland, to organize the Glenville Health Care Task Force. Glenville was one of the communities served by Mt. Sinai Hospital which closed two years ago, leaving a huge gap in health care services, especially for the uninsured and other people facing barriers to care. The community is economically mixed with a large number of low-income residents.

The first project of the Task Force was to carry out a health needs assessment of the community. Members surveyed 168 residents about their health care needs. We discovered that 26 percent of those surveyed had at least one uninsured member of their household. More than half reported that either sometimes or almost always they did not fill or had to stretch a prescription because of the cost of the prescription. Fifty-eight percent said they delayed or did not get dental care due to cost. A majority said they either sometimes or always had to choose between paying medical expenses and paying regular bills. And 40 percent indicated they either sometimes or almost always delay seeking medical care because of unpaid medical bills.

The Glenville Health Care Task Force is working to make primary health care more accessible through a local health center and wants to address the need for a source of affordable prescription drugs in the community.

For more information or to join the Glenville Health Care Task Force, contact Cindy Maxey at 216/241-8422 or cjmaxey@uhcanohio.org.

Training programs for advocates

The UHCAN Ohio Columbus office is launching a series of trainings, beginning in March 2002. Offered throughout the year, the trainings will cover free health care programs available, immigrant health care benefits, and other topics of interest for advocates and service providers. Nursing and Social Work contact hours have been applied for through the Columbus Health Department.

The first training is scheduled for Tuesday, March 19, from 8:30 A.M. to noon at the new Columbus Health Department, on Parsons Avenue. It will provide information to assist people in need of free or reduced rate health care services. The session will offer a wide overview of available financial assistance options, including eligibility and the application processes for Medicaid, HCAP (hospital free care), hospital financial assistance programs and immigrant health care benefits, as well as available resources for primary care. Materials will include nuts and bolts information on how to navigate systems and contact people. This training will be offered again later this year.

A training focused specifically on immigrant health care benefits will be offered in April.

To register for either training, or to find out about future sessions, contact Kim Dill at (614) 253-4340 or kimdill@uhcanohio.org. Space is limited, so contact us at your earliest convenience.

Ohio Legislation Highlights

UHCAN Ohio keeps an eye on Ohio health legislation. For more information on pending
bills, either check our website or call the policy director, Cathy Levine, in our Columbus office, (614)253-4340. Full texts and summaries of bills are available on the state's website: www. legislature.state.oh.us.

House Bill 405, Budget Corrections Bill: The legislature had to fill a $1.5 billion hole in the state budget caused largely by falling revenues.

Some of the big losers:

• Most state agencies received 7% cuts, on top of previous cuts.
• Anti-smoking and other public health programs lost $260 million "borrowed" from the tobacco settlement (to be paid back in 2013 and 2014, if at all).

Relative winners:

• Medicaid programs were protected from cuts, although nursing home and pharmacy costs keep driving up spending so future cuts are possible.
• Mental health advocates received $23 million to keep state institutions open and avoided $30 million in cuts other agencies received, BUT the mental health system is in crisis, even without cuts and needs a substantial spending increase to meet community mental health needs.

House Bill 4, Prescription drugs (Hagan): This bill would provide Rx discounts to holders of the Golden Buckeye Card -- residents 60 or older or disabled. The discount would come from the retail pharmacists, not the pharmaceutical manufacturers. The retail pharmacists have slowed this bill down. The Department of Aging has not estimated the amount of discount; a representative for pharmaceutical giant Merck, estimated the discount at 5-17% (hardly enough to help most people). For a better solution to Rx costs, see article on HB 290/SB127.

Standards for Interpreters

Representatives from Columbus hospitals and community-based agencies recently completed draft standards for health care interpreters in Central Ohio to improve access to qualified interpreters for limited English-speaking patients. UHCAN Ohio's policy director coordinates the effort.

For a copy of the standards or more information on improving language access, contact Cathy Levine, (614) 253-4340, uhcanohio@ee.net.

Save the Date

Wednesday, February 27, 7 P.M.
Sheet Metal Workers Hall
3666 Carnegie Ave., Cleveland
(Parking immediately adjacent to the meeting hall.)

Sponsored by Single-Payer Action Network Ohio; endorsed by UHCAN Ohio.

Are you a UHCAN Ohio member?

Not yet, you say? Please hesitate no longer. Join UHCAN Ohio now and help us work for comprehensive, affordable, and publicly accountable health care for all. We look forward to welcoming you into the UHCAN Ohio family -- and the movement for health care justice!