By Katy Stewart and Kelly Mae Ross
The Rockbridge area is older, poorer, less insured and less doctored than many other areas of the country.
And its 36,000 residents are likely to be sicker as well.
All of these factors seem to affect each other—it’s difficult to say what causes what. Lexington family practitioner Lyle McClung says that some of the biggest issues he’s noticed are a lack of insurance coverage and limited access to care.
“From knowing people in the community, I hear that people with Medicaid or [the] uninsured have a harder time finding access to care because practices are full, the free clinic is pretty full, and it takes more effort to get there,” said McClung, who is also medical director for the Rockbridge Area Health Center.
Rural areas face specific health care delivery problems, and Buena Vista, Lexington and Rockbridge County are no exception.
In a 2010 article in the West Virginia Law Review, Sidney Watson, a professor at Saint Louis University School of Law’s Center for Health Law Studies, identified several “interlocking problems” that rural areas face nationwide, and they echo the Rockbridge area’s — more illness, higher levels of underinsured and uninsured people, and less access to care.
People in rural areas tend to get sick more frequently because they are often older and poorer, factors that put them at higher risk for illness.
In Rockbridge County, one in five people are 65 or older. In Lexington the figure is 15 percent and in Buena Vista it’s 16 percent, according to the Rockbridge Area Community Health Needs Assessment, an extensive survey spearheaded by the Rockbridge Area Health Center in 2012.
The area also has an above-average number of low-income residents, or people living below 200 percent of the federal poverty guideline, compared to both state and national averages: 38 percent in the Rockbridge area versus 25 percent in Virginia and 32 percent of the U.S. population.
The federal poverty guideline for a family of four in 2012 was an annual income of $23,050, according to the U.S. Department of Health and Human Services. So 200 percent of the federal poverty guideline for four people is an annual income of $46,100.
Watson also said that people in rural areas tend to be either uninsured or underinsured. That creates problems for rural-area hospitals as well as the people who do not have coverage when they need care.
In Rockbridge County, 18 percent of the population is uninsured. In Lexington, 19 percent of the population has no health insurance, and in Buena Vista the number is 15 percent, according to the community health needs assessment.
Last fiscal year, the area’s one hospital, Carilion Stonewall Jackson Hospital, performed $8 million worth of uncompensated care, according to the hospital’s Community Health Coordinator, Holly Ostby.
Hospitals budget for uncompensated care, for when uninsured or underinsured patients cannot pay their bills. And in rural areas, the number of uninsured or underinsured people is higher, because the local economy is composed primarily of small businesses or self-employed people.
It is easier for larger employers, like Washington and Lee University, to offer employees health insurance coverage because it’s less costly to coordinate health insurance for a greater number of employees.
Washington and Lee, one of the biggest employers in the area, can afford to pay a benefit consulting firm to help negotiate better health insurance packages for its employees, said Kim Austin, assistant director of human resources for the university.
“[In a smaller business,] you’d have to do all the work yourself,” Austin said.
In fact, in the Rockbridge area, about 85 percent of businesses registered with the Chamber of Commerce are small businesses, meaning they employ 20 or fewer people, said chamber Executive Director Sammy Moore.
The chamber started offering seminars this year to help small business owners evaluate health insurance coverage options for their employees.
“Our goal is to save businesses money,” Moore said.
According to Watson, rural areas also have a limited number of doctors, hospitals and other health care providers. Low-income residents of the Rockbridge area have collectively been designated a medically underserved population by the U.S. Health Resources and Services Administration.
The area has also been designated a primary-care health professional shortage area and a dental health professional shortage area for low-income residents. For everyone in the Rockbridge area, not just low-income residents, there is a short supply of mental health professionals as well.
Nearly one in five Americans lived in a primary care health professional shortage area in 2012, according to data from the Henry J. Kaiser Family Foundation. That included more than 1.2 million Virginians.
Local and federal organizations have identified the problems. But it’s hard to prioritize these health issues when so many people in the area need help. Proposed solutions require coordination and cooperation between governmental and local organizations. Can these problems be legislated away? Or will the solutions come from other community institutions? Will the answer be:
- The federal grant that the Rockbridge Area Health Center might qualify for in the fall?
- Recruiting more physicians to the area?
- Creatively using the resources that are available in the area; for example, having members of the Rockbridge Regional Dental Clinic teach dental education at local elementary schools?
- Preventive efforts, like tougher nutritional guidelines for school meals, and obesity counseling for adults?
- A possible expansion of the Medicaid program in the state, which would offer more Virginians, including 3,844 local residents, access to public health care coverage that they currently don’t have?
This reporting project, “The State of Health Care in the Rockbridge Area,” explores who’s doing what in the battle to keep Rockbridge healthy.