Challenges and Opportunities Facing Rural Communities Explored at Kansas Farmers Union Convention
From population changes to rural healthcare and farming and food access
On January 9, Gov. Laura Kelly announced that she had reached a deal with Republicans who control the Legislature to expand Medicaid under the Affordable Care Act. Senate Bill 252 to expand Medicaid is scheduled to have four days of hearings in the Senate Public Health and Welfare Committee beginning Thursday, Jan. 23. Kansas Farmers Union policy has included a special order to expand Medicaid since 2016.
MCPHERSON, JANUARY 21 - Kansas is predicted to eventually look a lot different than it does now, and as populations age, people will need services to help them live independently with quality health care and hospitals. That critical message rang loud and clear during a session at the Kansas Farmers Union state convention last month.
“The average age for farmers in Kansas is 60 years old. When people hit 60, they’re more likely to have several chronic diseases, and the health care system becomes really important,” said panelist Sheldon Weisgrau, Senior Policy Advisor for Alliance For a Healthy Kansas; Topeka Kan.
“What we’ve seen over the last decade or so, is a lot of hospital closures, and hospitals are traditionally the cornerstone of the health system in rural communities. So, when hospitals close, an attached nursing home may also close, physicians leave town, and that impacts the economy of a rural community,” explained Weisgrau.
Health care actually employs more people in rural Kansas than agriculture does. So, it’s vitally important, and there are some solutions that are readily apparent that can be jumped on, and others that take more time. One readily apparent solution, Weisgrau emphasized, is Medicaid.
“I can’t sit on a panel without talking about Medicaid. Kansas is one of only 14 states in the country that has not expanded eligibility for its Medicaid program, but this alone is the single biggest thing that Kansas can do to support its rural health infrastructure...which is hospitals,” Weisgrau told the crowd of farmers, producers, agriculture business officials, and state legislators.
“Every hospital provides care to everyone who walks in the door. A lot of folks are uninsured or have high deductibles and cannot pay for their care – so the hospital eats that cost, and actually those costs are passed on to the rest of us,” said Weisgrau, adding, “Expanding the Medicaid program would cover insurance for about 150,000 people in Kansas rural communities who currently don’t have it, and would provide an immediate boost in revenue for rural hospitals.”
Kansas has many hospitals. Each county has at least one hospital. “Whether that’s sustainable or not, is questionable moving forward. One-third of our hospitals are in real financial trouble. They’re considered financially-vulnerable and are considered ‘on the edge.’ Four of those hospitals have closed in the last several years, and when a hospital closes, the community is really impacted in many ways,” cautioned Weisgrau.
“Expanding the Medicaid program is the single biggest thing that our Legislature can do to help rural health and rural communities, and is probably the biggest thing they’ve had on their plate to directly impact rural communities in 20 years...and they just have to do it!” Weisgrau emphasized.
There has been much resistance to expanding Medicaid from leadership. There’s actually a majority supporting it in the Kansas Legislature. “It finally looks like we’re moving forward though. The Senate Majority leader has proposed a plan, so we’re now talking about what Medicaid expansion might look like, and how quickly we might do it, versus whether or not we should do it. But we’re already six years behind most of the states in the country,” said Weisgrau.
Regarding longer term solutions: “We need to start looking at alternative models for how we deliver health care – particularly in rural communities. Twenty years ago, we came up with critical access hospitals, which were a real boon in helping hospitals. That program has been incredibly successful in preserving the life of rural hospitals. Kansas is close to the top of the list in having the most critical access hospitals in the U.S.” added Weisgrau.
Two-thirds of the states where hospitals closed did not expand Medicaid, Weisgrau noted.
Then there’s the critical issue of life expectancy, which had been increasing for decades in the U.S.. But surprisingly, life expectancy has actually been on the downslide lately.
“Life expectancy actually declined in 2015 for the first time in more than 20 years, and then it declined again in 2017. In a wealthy country like the United States, it’s something that’s simply not expected,” said Charlie Hunt, Epidemiologist and Senior Analyst with the Kansas Health Institute. He attributed the life expectancy decline to increased mortality rates in people ages 25 to 64 from drug overdose, alcohol, and suicide, noting Kansas hasn’t been spared from these national issues.
So what’s driving this?
It’s surely not that the U.S. isn’t spending enough on health care, Hunt said.
“The amount we’re spending isn’t getting us an advantage for health care. We also understand more than ever now that health is largely influenced by where we live, where we work, where we go to school, where we play and so forth,” noted Hunt.
“So, we can talk about the importance of eating a healthy diet and getting plenty of exercise and not smoking. But if you’re living in a neighborhood that doesn’t have sidewalks and adequate street lighting, and it’s hard to send your kids out safely to play, and if you don’t have a grocery store in your community or close by to get healthy fruits and vegetables and other food, then you’re most likely being affected,” Hunt said.
Therefore, what’s going on in communities does have a large impact on our health. In addition to those personal choices we make, health is influenced by the environment, including economic and demographic influences.
Pointing to the scarcity of population growth, Hunt said between the years 2000 and 2016, the population in Kansas increased by 8 percent due primarily to minority populations, and that growth wasn’t uniform across the state – 82 of Kansas’ counties actually experienced a decline in population.
“If we project these trends forward, Kansas is going to look much different in 25 to 30 years than it does today, and these changes will have a big influence on health services.”
Based on projections between 2016 to 2066, the population is expected to increase by 25 percent, but the growth rate of people 65 and over will be four to five times higher than the younger age groups. “So we project by year 2066, more than 20 percent of the population will be over age 65, especially in rural communities. Kansas is expected to be much more diverse; and at some point between 2061 and 2066 based on these figures, less than half the population will be non-Hispanic white and growth will continue to be concentrated in those urban areas,” said Hunt.
On average, Hunt expects that rural counties in western Kansas will see a 19.9 percent drop in population. Rural counties in the eastern part of Kansas will see a population drop of more than 30 percent.
“So, how are local governments and schools going to support basic services to local communities as populations decline. That’s really the challenge here,” Hunt sad. “The health of the communities is also very dependent on what’s going on here, and what are the economic impacts of these changes...”
A few of those economic impacts – also called ripple effects – do impact communities, and continue to do so.
“Big stores impact small grocery stores, and if small stores close, its harder to get the kinds of food that constitute a healthy diet,” noted session moderator Jim McLean, managing director of KCUR's Kansas News Service.
Farmer Ed Reznicek, of Nemaha County, also sat on the panel, adding his concern.
“For farmers out there, you know you’re not in control of your farms. What we have, is a system where corporations dominate agriculture on the input side and the marketing side. I think to understand rural issues we face, it’s our system of corporate industrial agriculture that dominates rural economies. It’s an economy that extracts and exports wealth from our rural communities and is a major contributor to what I call, the emptying out of the population of our rural communities. So, we’re not going to solve these issues of health care, housing, child care, access to land, robust local business community without dealing with systemic problems we face in agriculture,” Reznicek said.
Reznicek urged the crowd to reinvent their cooperatives, since they develop where farmers are, and they can assist with many areas of concern.
Regarding health care, Weisgrau emphasized the importance of looking at health care differently now. “We look at health care now, as a service for individual people...and we have to look at it as a necessary piece of public infrastructure.”
Sponsors for the 2019 convention included the Farm Credit Associations of Kansas, the Midwest Regional Agency, Farmers Union Insurance, Kansas State University’s Kansas Center for Sustainable Agriculture and Alternative Crops, and the Organization for Competitive Markets.