BECKLEY, W.Va. — Under the Republican health care plan, tens of millions of people are expected to lose access to coverage.

But according to the Center on Budget and Policy Priorities (CBPP), a nonpartisan research and policy institute, those in rural areas are expected to be some of the most impacted.

In rural areas, where incomes are lower than their urban counterparts, many residents simply could not afford coverage before the Affordable Care Act (Obamacare).

“I saw first-hand many patients coming in with illnesses that could have been prevented with regular care,” shared Mary Wakefield, a former nurse in rural North Dakota and former acting deputy secretary of the U.S. Department of Health and Human Services.

“Many working people could not afford health care, but they did not qualify for Medicaid.”

Under the Medicaid expansion, hundreds of thousands of individuals gained access to care — according to West Virginians for Affordable Health Care, more than 165,000 West Virginians were enrolled under Medicaid expansion.

Before the expansion, Wakefield said many patients refused preventative screenings, such as mammograms, because they could not afford the service.

And without preventive screenings, which could have illuminated treatable health problems, their health conditions became more serious, causing time away from family and work.

But the Affordable Care Act helped bring the uninsured rate from 17 percent in 2013 down to 12 percent in 2015.

“The Affordable Care Act, especially Medicaid expansion, helped many get the treatment they need.”

Not only did the health care reform help rural residents, but also rural hospitals which struggled with uncompensated care costs.

When a patient does not have insurance, a hospital cannot turn them away due to inability to pay. The debt incurred by hospitals is referred to as uncompensated care.

In 2013, West Virginia hospitals had more than $692 million in uncompensated care costs. But as more people were enrolled in Medicaid expansion, fewer people were unable to pay. After the expansion, West Virginia’s uncompensated care dropped 38.3 percent — down to $427.44 million.

“Coverage expansions are a financial lifeline for many rural hospitals,” Wakefield said. “And those hospitals are a lifeline for the communities they serve.”

Wakefield believes all the progress made, both for rural residents and their hospitals, would be undone with the Senate’s passage of the Republican health care bill, the American Health Care Act.

As CBPP senior policy analyst Jesse Cross-Hall points out, closures of rural hospitals around the country over the past few years have been concentrated in states that have not expanded Medicaid.

He said 1.7 million residents of rural America gained coverage — in West Virginia more than one-third of those gaining coverage were from rural areas.

Rural populations would also suffer under the new plan in terms of tax credit distribution, noted another CBPP policy analyst Tara Straw.

Currently, under the Affordable Care Act, tax credits are based on income and the cost of the actual plan, which can be higher in rural areas due to less competition among insurers and fewer providers. Under the new plan, however, tax credits are based solely on age.

“West Virginia’s rural communities already face a lot of challenges, and policymakers in Washington shouldn’t make life harder for the people who live there,” said Ted Boettner, Executive Director of the West Virginia Center on Budget and Policy.

“That means our senators should reject any bill that takes coverage away from people, ends the Medicaid expansion, caps or cuts the program, makes insurance coverage unaffordable, or takes away protections for people with health conditions.”

In her concluding remarks during the conference call Tuesday, Wakefield referenced the oath medical students take at graduation — “Do no harm.”

“When it comes to the health of rural Americans, Congress should hold themselves to the same,” she said. “Listen to the doctors and nurses who say they want to build on the ACA’s gains, not go backwards.”

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