Why Populations Behind Stay Behind
A small grant was made to predominantly African American rural counties to help with maternal health. Why not add some perspective based on the past decades of policies?
Rural populations are growing slowest, the slowest growth of all is the rural population in 2621 counties lowest in health care workforce. This is a stagnant 37 million. They have been most abused by health care designs since forever. But there is a larger and fastest growing urban population in these 2621 counties that is essentially ignored, and their health care designs continue to kill hundreds of hospitals with even more damage done to their practices and basic health access.
Summary of data takeaways from Center of Rural Innovation:
1. In 2019, there were an estimated 4.8 million rural Americans that identified as Black, representing 8.6% of the total rural population.
2. Over 80% of the rural Black population lives in the South.
3. Over 75% of the rural Black population today lives in counties where Black populations have lived historically.
Why Does H2S Stink in Dollar Distribution?
Offices of Rural Health were brought about by rural associations and advocacy groups. They can do little and represent only 16% of the population and big health located rural tends to be a distraction. Only about 12% of the population is rural and behind in health care. Over 40% of the US population growing fastest is even more behind than the rural population. It has no advocacy group. There are not offices or grants for them. They are distant, designers fail to be aware of them or their needs, and nearly all of the past 40 years of health programming has made their situations worse across hospitals, practices, planning, workforce, and access.
CMS Design Kills HRSA Workforce, Planning, and Health Access Grants
HRSA will likely spend about 16 billion in 2024 mostly on Community Health Centers with less than 1 billion for workforce programs. CMS will have over 1.5 trillion which will favor those with the most lines of revenue from CMS and others and with the highest levels of payments because they are bigger, more powerful, and more organized. This also helps them to resist true reform such as moving 50 billion into primary care for 130 million Americans to move from half enough primary care to sufficient.
CMS is so much more powerful than HRSA that there is nothing can do to overcome what CMS sets in concrete regarding have enough primary care, womens health, mental health, and basic surgical.
Only Hill Burton and the first decade of Medicare and Medicaid did anything to build up workforce, access, hospitals, facilities, labor units, emergency rooms and access, and locally focused health care leadership.
Since that time CMS has denied the necessary support and has added new costs of delivery and has raised these costs of delivery and has added new micromanagement tasks that force more multitasking where care is most overwhelmed and where the financial design shapes fewer and lesser delivery team members - far less than are needed to do the care and caring.
Remember that HRSA funding had to be regulated to keep urban settings from capturing all of the dollars. But there is still difficulty getting funding to rural and other areas in most need of such dollars. The political process often fails.
The federal designation has failed reform attempts multiple times and is easily manipulated. FQHCs can be engineered by big health working locally through other entities and the state health department, to defend it from the higher costs and complexities of various populations near their facilities. The federal designation for Medicaid populations with poor access is commonly used in counties higher to highest in concentrations of workforce - but the problem is poor quality worst paying Medicaid, which does not get fixed. There is nothing fair about the way that patients with worst quality health insurance are treated, especially the plans expanded for over a decade.
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Back to the Maternal Health Grant for African American Rural Counties
Maternal health care grants are too little, too late, higher in cost, for little change in outcomes. The poor outcomes are difficult to reverse after decades of previous life influences dating back to the mother and her mother and so on.
There is a long history of dedicated efforts to improve health care where care is most lacking...
Bolivar County Mississippi was the recipient of one of two original Community Health Centers at Mound Bayou in 1967. You will find the same poor outcomes despite so many generations of hard working health care team members for decades. They need help to actually improve outcomes.
Requirements for True Reform with Outcome and Access Improvements
Counties need to have major changes in the population for any improvement in health, education, and other outcomes. Literacies, social drivers, child development, home environments from birth on, work environments, conditions, behaviors, and more...
For improvements in rural health access, they must have better employers with their better paychecks, jobs, work environments, benefits, and much better health insurance quality. Better health insurance quality is denied by the US design. Without better employers these populations are stuck with the worst Medicare plans, worst Medicaid plans, and the worst private plans from the worst employers or what can be afforded.
Since the US Health Insurance Problem is Quality of Plan, Expansions of the Worst Quality Health Plans IS NOT a Good Solution
See the shift to concentrations of the worst quality worst paying most abusive plans in the 2621 counties forever behind in health care workforce, access, services...
AND THE KILLING BLOW
Since these counties lack good health care with half enough of each basic and worse deficits in the rest, they cannot recruit and retain the best employers. Agriculture, mining, and trade policies work against them also.
Recruitment and retention are more costly, turnover is higher, costs of turnover are higher, small and medium size practices and hospitals suffer from relatively higher costs of delivery and lower payments for services.
Solutions Arise From the Community and Require Community Control
Top Downers In Health Care Leadership Fail Them and Abuse Them. Outsiders farm them for what limited dollars they have and do as little as possible and cannot improve their outcomes or access.
It is hard to design a worse situation for most Americans most behind - and being made worse by health care design.