HARRISBURG, Pa. -- A new report shows Pennsylvanians are experiencing disparities in access to health care, especially in rural areas and among under-represented racial and ethnic groups.

The report, by AARP Pennsylvania and Drexel University's College of Nursing and Health Professions, showed gaps in access to health care the authors say will continue to grow as the state's population ages.

Angela Foreshaw-Rouse, manager of state operations and outreach for AARP Pennsylvania, said 14% of Pennsylvanians live in medically underserved areas, and 22% live in areas with shortages of health professionals.

"Geographic, racial and economic factors restrict access to health-care services for many Pennsylvanians, creating disparities that have become more pronounced during the COVID-19 pandemic," Foreshaw-Rouse stated.

The report also found people age 65 and older are less likely to use the digital technology that has become critical for telehealth visits and to find COVID-19 vaccinations.

The report noted older Pennsylvanians are predominantly white, poor and live in rural areas.

Dr. Laura Gitlin, dean and distinguished university professor at Drexel University, cautioned by 2040, Southeastern Pennsylvania, the most densely populated and diverse part of the state, will see huge growth in its aging population.

"New competencies are needed for a culturally diverse group of older adults," Gitlin asserted. "Different kinds of cultural competence, and knowledge of evidence-based care for prevention and chronic disease management, is severely lacking."

She added the current workforce is unprepared to address complex and serious health conditions and lack training in geriatric care.

The report makes recommendations for developing of a culturally competent health-care workforce, and Foreshaw-Rouse argued providing broadband access across the state will be vital.

"Not only access to high-speed internet connectivity, but also technology and the literacy to use the technology," Foreshaw-Rouse urged. "We know that our internet access is not available equitably across the state, and that is something that we can change."

LEWISBURG, W. Va. -- Political canvassers and organizers in the state are expecting they will continue to struggle with challenges to traditional campaigning, as the coronavirus crisis shows little signs of letting up.

Data showed low-income and minority voters are difficult to reach by phone or the internet, which is why door-to-door knocking can be one of the most effective ways to reach voters.

Daniel Withrow, former candidate for the Greenbriar County Commission, said his campaign was drastically impacted by the pandemic.

"Probably the biggest thing was not being able to actually canvass or go door to door," Withrow recounted. "What I did during my campaign was, I would park somewhere along the road with signs and wave at people, and hope that people would stop and want to discuss the issues."

But he pointed out as more residents get vaccinated, there might be more opportunity to interact with voters next election cycle, compared with last September, when almost two in three voters said they were apprehensive of door-to-door political canvassers amid the coronavirus pandemic, according to a POLITICO/Morning Consult poll.

Withrow believes the current situation is a setback for state Democrats, who already have had difficulty connecting with voters. More than 68% of West Virginians voted for former President Donald Trump in 2020.

"I just feel like to change what's going on, the Democratic Party statewide is going to have to be a grassroots effort, and that's going to be slow and time-consuming," Withrow stated.

Voting rights, the impact of climate-related disasters and the decline of the coal economy continue to be major issues for West Virginia voters.

DENVER -- Colorado's ability to respond to COVID-19 was blunted by decades of disinvestment in critical public services, according to a new report.

Shar Habibi, research and policy director for In the Public Interest, which along with the Colorado Fiscal Institute co-authored the study, said below-market wages for public-sector workers, who reported loving jobs they view as important, also hurt the state's ability to respond.

"These are jobs like providing housing assistance, or working in mental health care, providing road maintenance, protecting Colorado's public lands," Habibi outlined. "But what we heard was that there wasn't enough staff and capacity to do this work."

Colorado's Taxpayer Bill of Rights (TABOR) is seen as the primary driver behind nearly 30 years of disinvestment.

The constitutional amendment sets strict limits on how much of the state's revenues can be invested in public services and other areas. According to state data from last year, wages and benefits for Colorado public-sector workers are at least 16% below the prevailing market rate. From 2007 to 2018, Colorado state and local governments also cut public health spending per resident by more than 45%.

TABOR is also expected to make it harder for Colorado to recover economically, and address growing inequality, than other states.

Habibi noted public investments can play an important role in ensuring that older Coloradans, communities of color and low-income residents are not left behind.

"And research shows that one of the best ways to ensure an equitable recovery is to ensure robust and well-funded public services to meet the needs of all residents, including more vulnerable residents," Habibi contended.

Habibi pointed to data showing building a modern, more responsive and fairly compensated public sector is highly likely to lead to broad and long-term economic growth.

"And we want to make sure that Colorado is able, in the next economic downturn, that the state is able to stay prosperous," Habibi concluded.

SEATTLE - Washingtonians soon will have a chance to change their health coverage, and a few tips can help folks pick the best plan for themselves or their family.

About 240,000 Washingtonians who aren't covered through their employer get insurance through the state health exchange, where financial help is available to pay premiums. The open enrollment for the exchange is Nov. 1 through Dec. 15.

Dr. Rhonda Randall, chief medical officer, employer and individual, at UnitedHealthcare, said people should keep next year's plans in mind when choosing their coverage.

"Anticipate what your expenses are for next year," she said. "So, are you anticipating you're going to need to have a certain procedure, or you've recently been diagnosed with a specific condition? Or maybe you're planning to expand your family."

The Medicare open-enrollment period is Oct. 15 through Dec. 7. Randall said people on Medicare need to consider a separate, prescription drug or "Part D" program and a Medicare Advantage or supplement plan for additional benefits, such as prescription drugs, vision and dental coverage.

Nationwide, about 180 million Americans get their insurance through an employer-sponsored plan. Randall said employers typically set aside two to three weeks for open enrollment at the end of the year. She said people should think about mental-health coverage as well.

"We have seen an increased interest in mental-health needs lately, so that's another important thing to check on," she said. "Does your employer have an Employee Assistance Program, and does the medical plan benefits that they're offering have the mental health coverage that you're looking for?"

Randall also noted that virtual care is becoming a greater priority for some people.

"Those visits are designed really to be for specific conditions - convenience care, sometimes the maintenance of chronic conditions - and often are more affordable, as well," she said.

She advised people to look into the wellness programs that health plans offer, and any specialty benefits. She added that it's important to understand the terminology - premium, deductible, copay and others - and said UnitedHealthcare offers a guide to these terms on its website.