Six-week-old Lilly was born premature and is struggling to gain weight. She needs regular weight checks to monitor her progress, breastfeeding support for her mother, and a nutritionist to ensure her caloric intake is sufficient.
Her difficulties are particularly stressful for her mother because Lilly's family lives in a rural county in northeast Texas with limited health care resources. Her family drives an hour each way to see me, and her mother has already returned to work, so we must coordinate her nutrition and lactation appointments for the same time. Coordinating care for children in rural areas is challenging. Thankfully, Lilly and thousands of other children in rural Texas have health coverage through Medicaid to provide them the best chance to grow and thrive.
A recent report by Georgetown University Center for Children and Families and the University of North Carolina Rural Health Research Project confirms what many who care for patients in rural areas suspected: Children and families in small towns and rural areas rely on Medicaid for health coverage and cuts to Medicaid could be devastating for rural America. In Texas, 46 percent of children in rural areas and small towns are enrolled in Medicaid or CHIP compared to 41 percent in urban areas.
One promising finding from the report is that since 2008-09 the rate of uninsured adults in rural areas has dropped from 35 percent to 29 percent in Texas. At the same time, the rate of uninsured children in those areas dropped from 18 percent to 11 percent. The increase in the number of children in small towns and rural areas with health coverage was the largest in the U.S.
Nationally, the researchers found a direct connection between increases in Medicaid and Children's Health Insurance Plan coverage and reductions in the rate of uninsured children in small towns and rural areas. Because of these gains there are currently more children in Texas with health coverage than at any other time in our history.
This progress is encouraging for the future of our state. When children receive preventive care, screenings and therapies provided through health coverage, they enter school ready to learn. They miss fewer days of school. They have higher rates of high school graduation and college attendance. As adults they earn higher wages and pay more taxes. Texas simply can't afford to lose ground in this area.
The U.S. Senate is considering whether to include Medicaid cuts in their version of health care reform. Included in the American Health Care Act passed by the U.S. House of Representatives in May was an $800 billion cut to Medicaid. This goes far beyond rolling back the Medicaid expansion created in the Affordable Care Act and will create deep cuts to existing programs and shift burdens to states for care for children, the disabled and the elderly.
Proposed cuts to Medicaid could have a ripple effect in rural areas affecting residents who aren't directly covered by Medicaid. Hospitals, clinics, and physicians serving our state's small towns and rural communities see a significant number of patients covered by Medicaid. Reducing coverage in these areas will result in increased ER visits and uncompensated care that will drive up costs for everyone and put rural hospitals at risk of closing their doors.
Last year, the health care organization I work for served families from 30 counties across northeast Texas. Families are driving 50 to 100 miles for pediatric care because there are no pediatricians in many small towns and rural counties. Any policy or legislation that results in fewer healthcare resources in our rural areas is bad for Texas. If citizens in our rural communities are to thrive, they must have access to quality medical care.
A strong Medicaid program is vital to Texas, especially for residents of our 172 rural counties. For these communities Medicaid is a lifeline to health and future prosperity. The proposed cuts to Medicaid will disproportionately affect Texas because of our large rural areas and the hardworking Texans that live in the small towns and rural communities across our state will suffer.
Dr. Valerie Borum Smith is a pediatrician at St. Paul Children's Clinic in Tyler and a member of the Texas Pediatric Society and the American Academy of Pediatrics. She wrote this column for The Dallas Morning News. Email: firstname.lastname@example.org
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