Editorial: Rural residents being harmed by health care changes

From the beginning under ObamaCare rural residents throughout the nation have had fewer choices for health care coverage and have been charged considerably higher premiums than those in urban areas.

As insurers flee the ObamaCare market there is even less competition and still higher rates.

It has reached the point that in 2017 a majority of Nevada counties — Esmeralda, Mineral, Humboldt, Pershing, Churchill, Lincoln, White Pine, Eureka, Lander, and Elko — will have only one firm offering coverage under the ObamaCare program.

To ameliorate the blow to residents of single-provider counties nationwide, Nevada Republican Reps. Joe Heck, Mark Amodei and Cresent Hardy a couple of weeks ago introduced a bill that amends the Internal Revenue Code to exempt those residents from the requirement to pay a tax penalty if they fail to maintain minimum health coverage under ObamaCare, or as it is laughably titled, the Affordable Care Act.

Heck is running for the Senate seat being vacated by the retirement of Harry Reid, who rammed through ObamaCare — using deals such as the Cornhusker Kickback and the Louisiana Purchase — without obtaining the vote of a single Republican.

The bill is called Protection from Insurance Exchange Monopolies Act, H.R. 6049. It has been referred to the House Ways and Means Committee.

In the coming year there will be only three companies offering ObamaCare coverage in Nevada — Anthem, Health Plan of Nevada, and Prominence Health Plan (formerly St. Mary’s). In the 10 counties listed above the only carrier option is Anthem.

All three congressmen commented on the necessity of their bill in a press release.

“The better way to solve rural Nevada’s access to health care is to replace Obamacare with a fairer and more patient-centered approach,” Hardy said. “But as long as ObamaCare is the law, Nevadans shouldn’t be forced to pay a tax on a monopoly caused by a government mandate that forced out other competition. All Nevadans, and particularly those in our rural communities, deserve access to more health care choices and lower health care costs.”

“The Affordable Care Act promised Nevadans more healthcare choices and lower costs but, as expected, we now know those promises were empty” Heck said. “Nevadans in 10 counties will be living under an ObamaCare insurance monopoly in 2017 and it is unfair to inflict a penalty tax on residents in counties with only one carrier option. This is yet another example of the failures of the ACA and highlights the urgent need to replace the broken parts of the law with healthcare reforms that actually expand access to quality, affordable care.”

“President Obama promised his healthcare law would bring Americans ‘more choice’, ‘more competition’, and ‘real health care security,’” Amodei said.  “Despite the president’s assurances, ObamaCare has delivered nothing more than higher premiums and less choices – with millions of Americans having even fewer choices in 2017. In Nevada, ObamaCare will soon be leaving residents in 10 counties with only one choice – choose what Washington says is right for them – or pay the penalty. By allowing people who reside in areas with less than two provider options to be exempt from the individual mandate, our bill provides much needed relief to those who have been left with no alternative.”

Repealing ObamaCare is the preferred solution, but this is a worthy patch in the meantime.

Adding further problems for rural communities, in January the Centers for Medicare and Medicaid Services changed the reimbursement process for medical suppliers. CMS is now using bids from metro areas to start cutting reimbursement rates in rural areas.

But providing care in rural areas can be more expensive due to distances between patients and providers and the time and expense it takes to cover those distances. The Medicare reimbursement rate has been cut by more than 50 percent for many items.

Health care providers are hoping Congress remedies the devastating cuts to Medicare reimbursement rates that are impacting medical suppliers throughout the country. Many providers are cutting services or refusing to take new patients. Some are even closing their doors.

Congress needs to act on both of these problems for rural America.

A version of this editorial appeared this week in some of the Battle Born Media newspapers — The Ely Times, the Mesquite Local News, the Mineral County Independent-News, the Eureka Sentinel,  Sparks Tribune and the Lincoln County Record.

Where is the nearest doctor?

Where is the nearest doctor?


35 comments on “Editorial: Rural residents being harmed by health care changes

  1. deleted says:

    Maybe we could just convince doctors to start accepting chickens as payment again? Seems to me I remember this as the “conservative solution” to the healthcare issue.

  2. Steve says:

    Obviously, Patrick doesn’t care about people.

  3. Maybe we should get the government helpers to stop helping so much.

  4. deleted says:

    Mabe we should get private companies to stop stealing our tax money.

    As an alternative anyway.


  5. Steve says:

    Maybe the Obama administration should have opened the law up to all Epinephrine delivery systems instead of picking the “winner”, Patrick.
    Perhaps your description of “theft” is deficient in this case.

  6. Rincon says:

    The administration excluded other delivery systems from being used in schools?

  7. Steve says:

    Yes. Epipen was able to directly benefit from an Obama signed law requiring it’s use in all public schools nationwide. Don’t take my word for it (you never do) Here is the Washington Post and PBS. Two hysteric conservative outlets if ever there were any….
    Of course, you will have to read them closely to see the reality, they do like burying liberal actions in riddles.
    But it is in the stories. (Of course, there are other stories that detail the riddles and make them clear, but you wouldn’t like them.)
    So, here you go. Happy reading! I look forward to your cherry picked portions attempting to refute what they really say.



  8. deleted says:

    “The settlement with the Department of Justice follows news that EpiPen has been incorrectly classified since late 1997 as a generic product under the Medicaid health program for the poor and disabled.
    However, the federal government says EpiPen is a branded drug, meaning Mylan should have been paying Medicaid a far higher rebate under the government’s complex pricing rules. Drugmakers are required to pay Medicaid rebates of just 13 percent for generic products it purchases, versus a 23.1 percent rebate for brand-name drugs, which cost far more.”

    “Mylan has become the latest poster child for pharmaceutical industry price-gouging, for hiking the price of a pair of EpiPens from $94 in 2007, when it acquired the product, to $608 this year, despite making no substantive improvement to EpiPens over that stretch. Meanwhile, analysts and others have estimated that it costs less than $10 to produce one EpiPen.
    Government health programs, particularly Medicaid, are major purchasers of EpiPens. The amount Medicare and Medicaid spent on EpiPens rose to $486.8 million in 2015 from $86.5 million in 2011, a jump of 463 percent.
    While EpiPens have some competition, they’re so well known that they hold more than 90 percent of the market for epinephrine auto-injectors, which are jabbed into the thigh to halt runaway allergic reactions to insect bites and stings and foods such as nuts and eggs.”

    “Multiple members of Congress have been investigating the exorbitant price hikes, and Mylan CEO Heather Bresch was called on the carpet for the price increases at a Sept. 21 hearing of the House Oversight and Government Reform Committee. It was later discovered that Bresch incorrectly claimed her company only made a $100 profit on a pair of EpiPens, when the real profit was significantly higher.
    Besides paying Medicaid a too-low rebate on EpiPen purchases, CMS said Thursday that Mylan hasn’t been paying Medicaid a second rebate that’s required whenever the price of a brand-name drug price rises more than inflation. The price of an EpiPen pack rose 23 percent a year on average between 2007 and 2016. Inflation has averaged less than 2 percent a year over the same period.”

    They lied, they cheated, they stole. Which makes them a “good” private enterprise.


  9. Steve says:

    And makes Obama a “good steward” of our health care system.

    After all, he signed the law that gave Mylan the ability to run with it’s price increases.

  10. deleted says:

    “The settlement with the Department of Justice follows news that EpiPen has been incorrectly classified since late 1997 as a generic product under the Medicaid health program for the poor and disabled.”

    “The Social Security Amendments of 1965 created Medicaid by adding Title XIX to the Social Security Act, 42 U.S.C. §§ 1396 et seq.”

    “On November 4, 2008 Obama won the presidency with 365 electoral votes to 173 received by McCain.”

    Steve, you are a fuking idiot.

  11. deleted says:

    Steve, you are a fuking idiot.

  12. Rincon says:

    I do agree that the law was unnecessary. What I do not agree with is that the law is responsible for the massive price increase for 2 reasons:

    1) While Epipen sold 915,000 units in the 4th quarter in 2015, https://www.drugs.com/stats/epipen-2-pak there are only 98,000 or so public schools in the U.S. https://www.google.com/#q=number+of+schools+in+the+united+states So do schools count for 10% of the market? Heck no. Each school should only have to buy epinephrine every 2 or 3 years, depending on the product dating. This means school purchases account for something closer to perhaps 2% of the market, hardly enough to influence price significantly

    2) I believe the law specifies epinephrine, a generic drug, not the Epipen specifically. Schools can buy a different brand of autoinjector or even the stuff in the bottle (which I stock in my hospital), which is dirt cheap in comparison.

    And of course, you completely ignore the fact that the law was passed by Congress. No blame for them? Of course not. You hate Obama so much that you can’t even think straight.

  13. Steve says:

    School districts, bought the Epipen.over any of the alternatives, because the program, created by the federal law, may well have prohibited them from taking any other action. In the face of federal law, the schools were taking action in their own best interests.

    BTW, as every method of injection requires ongoing training, the cheapest way would be to pre-load syringes and keep them at the ready. Gotta wonder if the “agreement” that law, in reality, created; allows for keeping a few syringes at the ready…

  14. deleted says:


    The lawsuit Mylan settled with the Justice Department had NOTHING to do with school systems. It was based on Mylan misrepresenting it’s product and thereby defrauding the Medicaid Program, as well as due to Mylans intentionally fraudulent actions of not properly reporting information regarding the rebate program.

    This nonsense was created in the mind of the fuking retard Steve as some distraction for a private company stealing and lying and cheating.

    Go figure.

  15. Steve says:

    No citation from no name


  16. Steve says:

    Here’s some more citation.

    “But Mylan wanted more, and a series of savvy maneuvers allowed them to get it. From FDA policy changes that expanded the number of consumers to which the product could be marketed, to legislation signed in 2013 that put EpiPens in schools across the country, the federal government has helped Mylan stack the deck for its product. Oh, and Sarah Jessica Parker helped too.”

    Oh, no! Not a Hollywood liberal! Say it isn’t true!

    pfft, no name, you give no name a bad name.


  17. Steve says:

    Democratic governor: Health law ‘no longer affordable’
    From Associated Press
    October 12, 2016 11:54 AM EST

    ST. PAUL, Minn. (AP) — Minnesota’s Democratic governor says the federal health care overhaul “is no longer affordable.”

    ACA is going to rip apart the Democrats just like Trump is tearing apart the Republicans.

  18. Rincon says:

    Steve: You’re completely ignoring the fact that schools make up only the tiniest fraction of Epipen sales. You also make the assumption that school nurses, who have to be genuine nurses, don’t know how to give an injection. How do you come up with this stuff?

    Some idiot in Minnesota claims that Obamacare is unaffordable. Well, in 2009, we spent 17.1% of GDP on health care. In 2013, after 3 years of Obamacare, we spent 17.1% of GDP. When Bush took office, it was about 14%. Care to explain the comments of the Minnesota governor? http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective

  19. Steve says:

    The “idiot in Minnesota” is that states governor.
    My source was the AP.

    As for your Epipen claim….
    no citation.

  20. Rincon says:

    So the opinion of a Governor is automatically correct? Hey, can I apply that to a Secretary of State?

    You have a short memory, Steve:

    https://www.drugs.com/stats/epipen-2-pak there are only 98,000 or so public schools in the U.S


  21. Steve says:

    That governor is the same guy who promoted ACA and the state exchange in Minnesota.

    So, was he and idiot then or is he an idiot now?

    Or (more likely) is ACA rapidly getting out of hand….?

    A little snippet from another source…again the AP.

    Oct 12, 8:11 PM EDT

    Democrat Dayton: Health law ‘no longer affordable’ for many

    Associated Press
    AP Photo
    AP Photo/Jim Mone

    ST. PAUL, Minn. (AP) — Minnesota’s Democratic governor said Wednesday that the Affordable Care Act is “no longer affordable” for many, a stinging critique from a state leader who strongly embraced the law and proudly proclaimed health reform was working in Minnesota just a few years ago.

  22. Rincon says:

    OF COURSE it’s not affordable! Health care costs continued to rise under Obamacare, just a little slower than previously. Escalations in the cost of health care cannot go on forever. It’s simple arithmetic. My only point is that we’re better off with Obamacare than we would have been if we had continued with the abominable system we had previously.

    You still haven’t provided a cogent counterargument, just one guy’s opinion. Would you feel better if I post the opinion of someone that sings praises about Obamacare? Then we could go back and forth for the rest of our lives.

  23. Steve says:

    According to that “idiot in Minnesota” ACA has made it more expensive for people who get subsidies. This was not supposed to happen.
    That “one guy’s opinion” was very different a few years ago.
    You conveniently avoid my question, was he an idiot then or is he an idiot now?

  24. nyp says:

    “The popular narrative that health-care prices and spending are growing at ludicrous speed is completely, utterly false. On nearly every metric, health care today is actually much cheaper than anyone predicted when Obamacare was signed into law.
    “Since Obamacare passed, health prices have been rising at the slowest rate in 50 years, according to the Bureau of Economic Analysis’s index of health-related personal consumption expenditures. Year-over-year price increases have averaged about 1.6 percent each month since the law passed in March 2010. That’s roughly half the rates seen over the prior decade.”

  25. Steve says:

    OK Nyp.

    Is Minnesota’s governor wrong now, or was he wrong then?

  26. Rincon says:

    Don’t know his situation. When you have a system that is inequitable and you make it more fair, there will be people that will feel that they’re losing out when you make it more fair. That may or may not be the case here. Whether he’s an idiot or merely an imbecile or moron is irrelevant. My point is that exchanging opinions of individuals usually isn’t productive unless perhaps they are experts.

  27. Steve says:

    Rincon adds another to 1984.

    Doublespeak is logic

  28. Rincon says:

    I’ll try to stick to words having no more than three syllables in the future.

  29. Steve says:

    You di a great job with the ambiguous reply.
    Then you decide to acknowledge your surrender by attempting to insult me with weak words.

  30. Rincon says:

    OK. You win.

  31. Steve says:


    How about you go back a actually read what you wrote, then read your own progression.

    You simply don’t want to acknowledge ACA is flawed and has been flawed from the start.

  32. […] to a recent editorial, ObamaCare is particularly affecting rural […]

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