Issues in Health Care Reform


States play a key role in the delivery and financing of healthcare as well as public health in the United States.   Indeed, any healthcare program adopted at the national level affect the healthcare delivery in the states. According to the U.S health care ranking of 2015, a report by the United Health Foundation (2015), Alabamians have less access to primary health care doctors and dentists, compared to other states. Indeed, Alabama had the third lowest dentists per 100,000 people among the fifty states (Office of the Governor, State Alabama, 2016).  More significantly, access to healthcare is even worse in many of the Alabama rural counties. For instance, eight counties lack acute care hospitals serving the general public, according to the Alabama Hospital association. Additionally, three counties have no full-time dentist according to the Alabama Rural Health Association.  Politics through legislative reform has a great capacity to influence healthcare provision as demonstrated in the summary of the interview conducted by Jack Williams, the Alabama Rep of 47th district.

Notably, health care is a notoriously complex field, specifically in the United States where there are array of policies and stakeholders at every level of the federal system. Nonetheless, almost all political conflict over health care is based on fundamental differences of opinion about how the risk of illness should be borne (Chen & Weir, 2009).  However,   Alabama has a serious challenge of reaching the rural areas with healthcare provision (Office of the Governor, State Alabama, 2016). Therefore, the interview with Rep Jack Williams focused primarily on his rural health reform philosophy. Rural residents are in greater need of healthcare reform as demonstrated by their higher uninsured rates especially in the rural communities (Cutler, Davis & Stremikis, 2010).   Observably, Rep Jack concurs that the rural-urban disparities in health coverage is driven by higher uninsured rates among the rural adults. Indeed he adds that the group should be a part of any strategic effort to improve coverage.

Whereas coverage   of the rural population varies from state to state based on the various population dynamics, the Rep suggest public sources of coverage such as Medicaid and CHIP   offer an important source of   health insurance of rural Alabamians, and can really reduce the number of the uninsured rural population (Chen & Weir, 2009). However, he notes that lack of income among the rural poor who only depend on agriculture hinder even programs such as Medicaid since they are not preferred by the insurance companies.  As a solution, he suggests that Community Health Centers are well placed to reduce the health and Mortality gap. Particularly, he observes that these centers are more likely to accept poor and minority patients than other health care providers.  Besides, he argues that they can provide more preventive care than another setting; something that has really been lacking among the Alabama rural patients.

Among the rural poor, the children are particularly affected and the health disparities are weighing significantly on them. So I sought to know   from Rep Jack if healthcare reforms under Affordable Care Act (ACA)   are likely to reduce the health gap for Alabama children. According to the representative, there are number of studies suggesting that reforms implemented as part of the ACA can reduce the rural –urban disparity in healthcare (Sommers, 2010).  For instance, he gives evidence that healthcare coverage improves prenatal care, thus reducing infant mortality and low birth weight; reduces avoidable hospitalization of children; and increases the probability that children will receive recommended immunization.

Furthermore, he pointed out a recent data by Center for Rural Affairs, which show that about thirty five percent of rural children aged b below 18 years old are enrolled in   Medicaid nationally as compared to about twenty-eight percent of the urban children (Bailey, 2012). In 2010 for instance, Rep Jack submits that about forty-two percent of rural children and health insurance coverage from these public health programs compared to thirty-six percent of children nationally and forty-five prevent of them in central cities (Bailey, 2012). Hence, here is a strong case that these programs have the capacity to improve the health of the rural population especially the children.

Apart from the issues of health insurance programs, the representative submits that here are specific healthcare reforms that hinder attainment of quality healthcare in the rural areas. For instance,   a lot of barriers exist in rural areas to the expansion of health care information technology (Sommers, 2010).  Specifically, he explains that broadband and high-level telecommunications technology coverage in rural areas is a significant barrier.  Furthermore, he explains that capital resources are also constrained for the rural healthcare providers, therefore, making them choose between medical equipment, building improvement and technology resources. Coupled with the difficulty in recruiting d retaining health information Technology experts, Rep Jack concludes that quality rural healthcare provision in various states and in Alabama specifically, requires comprehensive reforms supported with adequate financial allocation.

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  1. Bailey.J. (2012).  Medicaid and Rural America; a series examining health care issues in rural America. Center for Rural Affairs. No.15. Online from  On 23 Jan,2017.
  2. Chen, A. S., & Weir, M. (2009). The long shadow of the past: Risk pooling and the political development of health care reform in the States. Journal of Health Politics, Policy & Law, 34(5), 679–716.Print.
  3. Cutler.D, Davis.K, & Stremikis.K. (2010). The Impact of Health Reforms on Health System Spending. Center for American Progress. 1405(88). Print.
  4. Office of the Governoe, State Alabama. (2016).  2015-2019 Strategic Plan. Retrieved Online From, . On 23 Jan, 2017.
  5. Sommers, B. (2010). Enrolling eligible children in Medicaid and CHIP: A research update. Health Affairs, 29(7), 1350.  Print.
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