By Joe Sammen
Infographic by Sarah Mapes
As the Colorado Legislature began its 69th session earlier this month, issues affecting rural Coloradans were at the forefront. A number of legislators expressed their commitment to working to find solutions around familiar rural concerns, including scarce water resources, protecting agricultural lands and issues around oil and gas production.
But perhaps no other political issue will affect rural Colorado in the future as much as our changing health care landscape. Gov. John Hickenlooper recently announced Colorado’s intention to expand Medicaid eligibility in 2014 for our poorest citizens, creating unprecedented access to health insurance in our state. The Colorado Health Benefit Exchange — created by 2011’s Senate Bill 200 and launching in October of this year — will give Colorado families and small businesses new options for purchasing private health insurance. In addition, countless health care innovations are being designed and tested across Colorado as new opportunities become available under the Affordable Care Act and other state health reforms.
These changes are music to the ears to the over 750,000 people who live in rural Colorado, as rural areas stand to benefit significantly from these new health care opportunities.
Rural Coloradans have much to be proud of, including a nationally-renowned tourism industry, awe-inspiring scenery, a rich agricultural tradition and recent healthy economic growth. Perhaps because of these assets, according to the U.S. Census, a majority of Colorado’s rural counties actually had population growth over the past 10 years — in contrast to the decline seen in many of the country’s rural areas.
However, Coloradans living in rural communities face greater challenges in accessing health care compared to their urban counterparts. We at the Colorado Coalition for the Medically Underserved consider good access to health care to include: having health insurance coverage, having a place to go to receive health care and having a primary health care provider. Rural Coloradans lag behind urban Coloradans in each of these key health care access indicators.
Rural Coloradans are more likely to be uninsured than urban Coloradans. In 2011, 20.3 percent of rural Coloradans were uninsured, compared to 14.9 percent of those living in urban areas. Indeed, rural Americans as a whole are more likely to be uninsured, likely due to higher rates of poverty and less access to employer-sponsored health insurance in rural areas.
While most Coloradans do have a “usual source of care,” rural Coloradans have fewer options. A usual source of care is a doctor’s office, community clinic or a local health department, where a family or an individual goes for basic health care services. Studies have shown that patients with a usual source of care are more satisfied with their care, take advantage of more preventive care measures and utilize the emergency department less frequently. However, since 16 of Colorado’s rural counties have no hospital, and many other counties have limited options for health care services, rural Coloradans may have to travel long distances to get the care they need.
Finally, there is a shortage of health care providers across rural Colorado. In fact, a majority of Colorado’s rural counties have been designated health care professional shortage areas by the Colorado Department of Public Health and Environment. While about 15 percent of our population lives in rural areas, less than 10 percent of our physicians work in rural areas; this means that in our urban centers we have one doctor for every 426 residents, but that number jumps to one for every 672 residents in rural areas. This shortage will likely get worse in the coming years as, according to data from the Colorado Health Institute, our rural physician workforce is aging and considering retirement.
Fortunately, there is already some work underway to address these issues. As Hickenlooper said in his State of the State address, “Belief in a better tomorrow is the story of the West.” With this spirit at the forefront, rural Coloradans are hard at work creating solutions.
A number of rural Colorado’s innovative solutions have received national acclaim and are being replicated in other communities around the state and country. The Western Eagle County Ambulance District is training urban and rural communities across the country in their innovative approach to Community Paramedicine, which will save an estimated $10 million by incenting first responders who typically offer only acute medical care to provide preventive health services as well. Southeast Mental Health Services in Prowers County is training and deploying behavioral health-focused Patient Navigators who will work one-on-one with chronically ill patients to help improve their care and quality of life. The Upper San Juan Health Service District is expanding access to cardiac and stroke specialists in rural Southwest Colorado through telemedicine and remote diagnostic tools.
Add these promising initiatives to established programs like the Colorado Health Service Corps, which trains and places health providers in rural areas, and the future of health care access in rural Colorado will undoubtedly improve. However, it will take political and public will to keep up the momentum and make significant change. As Hickenlooper said, “we have an obligation to represent the best that is Colorado.” The urban/rural divide in access to health care is far from the best of Colorado. We have an obligation to close this divide and ensure everyone has access to the health care they need to lead a healthy and fulfilling life.
Joe Sammen is community partnerships coordinator for the Colorado Coalition for the Medically Underserved. Sarah Mapes is the group’s communications director.