Dear Editor: As a new family physician, I worry about the uncertain future of health care. While imperfect and expensive, the Affordable Care Act realized care for more people with patient protections and preventative services. The Senate's Better Care Reconciliation Act will dismantle small gains to access and quality, hitting our rural communities hard.

I think of a farmer I cared for whose stroke left him speechless and dependent; the tragedy could have been avoided with regular primary care and blood pressure control. Such basic care will be unaffordable for patients like him if the legislation passes.

I gathered stories from rural doctors around the state to assess the impact of health care reform and several themes arose. Rural doctors work incredibly hard. Their patients are generally older with more multisystem disease. Poverty and substance use ravage many of their communities. There is unanimous concern that Medicaid cuts will hurt their patients by limiting substance use disorder treatment, nursing home and home health services. Despite low reimbursement rates, rural hospitals rely on Medicaid funds to keep their doors open. The proposed restructuring of the Medicaid program translates to devastating cuts to these critical-access hospitals, which will leave a huge vacuum, both to patients and the people they employ. All physicians who I spoke with, regardless of political affiliation, agreed that the country needs a basic health plan.

Health care reform deeply influences how and to whom we deliver care. As a country, we decided that people would not die outside of our hospitals for the inability to pay. I challenge us to extend that promise to providing health care to everyone before untreated disease accumulates into a major health event, destroying lives and precipitating financial ruin. We need to act now in securing our country’s commitment to providing quality care to all its citizens.

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Jennifer Perkins


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