I live in a rural, poorer part of America where the ER frequently won’t accept patients. The $3.5 trillion reconciliation package is finally giving me hope that this broken system can be fixed.

A female nurse has her arm around an elderly woman in a blue sweater. They are walking down a hallway in a hospital.
A nurse walks a resident of the assisted living center in Dayton General Hospital in rural Dayton, Washington back to her room. Rural Americans are lacking vital healthcare resources.
  • The pandemic underscored challenges people in poor, rural areas face in trying to access healthcare services.
  • The reconciliation package currently features several initiatives that could prove lifesaving for rural Americans.
  • Including telehealth coverage in the bill would be essential for people who live hours from specialists.
  • Bobbi Dempsey is a freelance writer, economic justice fellow at Community Change, and reporting fellow at Economic Hardship Reporting Project.
  • This is an opinion column. The thoughts expressed are those of the author.
  • See more stories on Insider's business page.

Among the many elements of the proposed reconciliation package, the initiatives involving support for rural health and increased access by the poor and working class to healthcare services are some of the most important to me, my family, and members of my community.

The $3.5 trillion reconciliation bill - officially known as the Build Back Better Act - is a massive legislative package encompassing a wide range of proposed initiatives and expanded safety net programs that would take up to 10 years to fully implement. It's a lofty plan that is likely to undergo major changes before it could have a realistic chance of congressional approval. The House Budget Committee voted in favor of the bill on September 25, meaning it is now being debated in the House.

I know the impact these actions would have on people in high-poverty rural communities because I am one of them - and I've experienced the consequences of inaccessible healthcare firsthand.

The benefits to rural people would be lifesaving

I live in a rural, low-income area with limited medical resources that are often stretched way beyond their capabilities. There's one small hospital within a half hour of me. Even during non-pandemic times, it's often filled to capacity with few or no available beds and the ER is frequently on diversion status - meaning, it's not accepting any patients at all, even via ambulance.

There are few specialists in or near my town, and it can be nearly impossible to get an appointment with those we do have. When our town finally got a part-time neurologist, my mother spent nine months on a waiting list even though, as someone with advanced Parkinson's and dementia, she was considered an urgent case. She cannot manage long car rides, and at that time - before the pandemic - Medicare wouldn't cover telehealth services for her. Those rules have changed temporarily, but I fear they will revert back to the old policies once the pandemic is deemed over.

I know firsthand how valuable telehealth services can be for patients in rural areas, both in and out of the hospital. When I suffered a stroke a few years ago, I arrived at the ER of our local hospital only to discover they had no neurologist on staff. Thankfully, a neurologist based at a hospital 90 minutes away was able to assess my condition and dictate a treatment plan remotely via telehealth technology.

Initiatives in the reconciliation bill - coupled with proposed additions or separate supplemental legislation - would address many of these problems and could make a huge difference in healthcare accessibility and affordability for people like me in rural, low-income communities.

What's in the bill?

In its current form, the bill includes several initiatives that could have a major impact on healthcare access for poor, rural populations.

Prior to the pandemic, more than 12% of people living in completely rural counties lacked health insurance, according to US Census Bureau data. The reconciliation bill's extension of marketplace plan premium subsidies and federal expansion of Medicaid would help more people in rural areas get insurance coverage.

Increasing Medicaid coverage and funding to residents and facilities in states that didn't pass Medicaid expansion will in turn make it more likely that the hospitals they do have will stay open. Research by The Chartis Center for Rural Health found that rural hospitals located in a Medicaid expansion state had a 62% lower chance of closure on average than their counterparts in non-expansion states.

The bill includes support for the Pathway to Practice Training Programs, which provides medical school scholarships for physicians who practice in rural and underserved communities.

The bill also has several provisions aimed at making medications more affordable, such as allowing Medicare to negotiate lower prescription drug prices - which the president has said would have a ripple effect leading to lower prescription costs for people covered by private insurance, as well.

Needed additions to the bill

In addition to what's in the bill's current form, there are recommended additions being pushed by an assortment of medical groups and lawmakers that would further support rural health.

Telehealth in particular is a high priority for healthcare organizations and those who advocate for the poor, because it is seen as a valuable tool that could have a substantial impact on healthcare access and inequality, especially for low-income and working-class rural populations. Large organizations including American Hospital Association and the American Association for Respiratory Care have urged President Biden and congressional leaders to include significant support for telehealth services either in a revised version of the reconciliation bill or in a separate healthcare bill sometime this year.

The initiatives currently in the proposed reconciliation bill - and those that advocates hope will be added - continue progress made by other recent actions, including those that were included in the American Rescue Plan that was passed in March.

These include opening a special open enrollment period for healthcare marketplace plans - which the White House said resulted in more than 300,000 rural Americans gaining medical coverage - and establishing a new healthcare provider type, Rural Emergency Hospitals , which can provide outpatient hospital services such as emergency department treatment in rural areas to help fill a gap in healthcare services in those communities.

The reconciliation bill in its current format is extremely ambitious, and I realize many of the items proposed in this version may end up getting cut before they can ever become a reality. But I am cautiously optimistic, based on important strides we've already made recently to advance rural health accessibility and sustainability.

Whether through the reconciliation bill or other legislation, it's crucial that we continue this momentum and seize the opportunity to make better, more accessible healthcare a reality for working-class rural Americans.

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