PORTLAND, Ore. - About one in three Oregonians lives in a rural area, where access to medical care is limited, and the issue is also part of the health care reform debate in Congress. As the U.S. House and Senate try to hammer out a compromise, advocates for rural communities say parts of the legislation that would benefit small towns are likely to be approved. For instance, both bills include plans to encourage more physicians to leave the big city.

With only 10 percent of doctors practicing in small towns, Virginia Wolking, rural organizer for the Center for Rural Affairs, says it would be an important step to remedy that shortage.

"That's one of the big issues. Even if somebody wanted to practice in rural area for their residency, there just aren't enough slots for them. And research shows that, when someone comes to a rural area to do their residency, they end up staying there. That's a really positive thing."

Both bills would also allow doctors and nurses to work off some of their medical school debt by teaching, which Wolking says will be critical with the growing national shortage of medical personnel. The American Medical Association says new doctors graduate with an average of $155,000 in medical school debt.

Wolking says she's heard the complaints that Congress isn't doing enough to rein-in drug manufacturers and insurance companies, but says, if the proposal ultimately gets more people insured, it will benefit rural America.

"More rural people are uninsured than people in urban areas, and people who are uninsured receive fewer preventative services. That's part of why having 95 percent of people covered by insurance is so important; that people can get the preventative care they need."

Both the House and Senate bills also would provide more funding for community health centers. Oregon has 24 centers with about 180 clinics statewide, mostly in rural areas, which serve as the health care safety net system for the poor and uninsured.

Community health center data from the National Association of Community Health Centers, at www.nachc.org.








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It's been 13 years since more than 156,000 West Virginians gained health insurance coverage through the Affordable Care Act.

As sweeping and sometimes controversial as the ACA has been, its longer-term effects are still being felt today at the state level.

Gary Zuckett, executive director of the West Virginia Citizen Action Group, pointed to a new West Virginia law capping insulin copays at $35 per month. The law goes into effect January 1.

"I think we now have the best insulin copay cap legislation in the country that we just helped get passed in a very 'red' legislature," Zuckett noted. "Which does show you that health care is not partisan."

Federal data shows since the launch of the federal health insurance exchange, enrollment in health insurance plans has doubled from 8 million to more than 16 million nationwide.

According to the West Virginia Center on Budget and Policy, the Medicaid expansion included in the ACA allowed more than 200,000 West Virginians to gain access to health coverage.

Zuckett cautioned when the "continuous coverage" rules enacted during the pandemic expire April 1, the state will begin re-evaluating people's eligibility, which could signal a setback in progress.

"A lot of people won't qualify or won't fill out the paperwork, and they'll lose their health insurance in West Virginia," Zuckett explained. "That could be as many as 50 or 100,000 people. So, that's going to be a step backwards."

According to America's Health Rankings, around 6% of West Virginians were uninsured in 2021, far fewer than the nearly 16% of the state's population who lacked coverage prior to the Affordable Care Act.

Beginning next year, more Kentuckians will have expanded access to biomarker testing - which helps doctors customize cancer treatment. Advocates of the new law say it will save lives and improve patients' quality of life.

Signed into law by Gov. Andy Beshear, House Bill 180 requires both private insurers and Medicaid to cover biomarker testing after a cancer diagnosis.

Doug Hogan - director of government relations for the American Cancer Society Cancer Action Network (ACS CAN) - explained that without biomarker testing, doctors typically try several rounds of chemotherapy or other treatments, without knowing which will work best for the patient.

He said biomarkers increase the odds of matching the right treatment to a specific cancer.

"We will be the fifth state in the country to adopt an enhanced access to biomarker testing law," said Hogan. "And so, we're on the cutting edge. This is the way that we can utilize technology to improve health outcomes."

The bill passed unanimously in both the House and Senate. According to the American Cancer Society, more than 30,000 Kentuckians will be diagnosed with cancer this year.

Hogan added that the new law will allow care teams to use the latest technology to make the best decisions for their patients.

"It is so important for these patients to get that right treatment at the right time," said Hogan. "It really will improve their health outcomes. It will save lives in many instances, and certainly will improve the quality of life."

Research shows biomarkers can in many cases reduce the cost of therapy, especially for lung cancer and colorectal cancer patients.

Cancer-care costs are expected to top more than $245 billion by 2030, according to the American Association for Cancer Research.





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Oregon's nonprofit hospitals are not doing enough to provide assistance on medical bills for low-income patients, but a bill in Salem aims to change it.

Nonprofit hospitals are required by federal law to alleviate medical costs for patients who cannot afford them.

Matt Swanson, political strategist for the Service Employees International Union Oregon State Council, said investigations have found the institutions are not going far enough to help.

"People really aren't getting the assistance they need," Swanson explained. "Instead, they're getting every last dollar really wrung out of them in order to satisfy a bill that they really can't pay, and it's risking other things in their life, like housing and food and the ability to get over their health issue."

House Bill 3320 is designed to ensure people get the financial assistance they need and hospitals are transparent about their assistance practices. In written testimony on the bill, the Oregon Association of Hospitals and Health Systems said it agrees with parts of the legislation but wants lawmakers to keep in mind insurers are part of the cost picture as well.

Swanson added it is important for people who cannot afford medical bills to know they have assistance available.

"The purpose of this bill is to really tighten up what compliance looks like," Swanson emphasized. "And ensure that everyone gets screened before they are sent a bill, so that the hospital is giving a hand to folks who need the help, instead of letting them get lost in systems that are often confusing and overwhelming at a time when they're really struggling."

The bill received a public hearing last week and is scheduled for a work session Wednesday.


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