For Spencer Tuma’s work as director of national legislative programs for Missouri Farm Bureau, she and the organization advocate for policies to support farmers and rural areas. This includes hearing from farmers about what issues are important to them.
“One of the non-ag issues we hear about the most from members is lack of access to affordable health insurance options, and lack of access to health care,” she says. “A lot of farm families are telling us that health insurance is not affordable. A lot of farmers are self-employed, and can’t rely on their employer for insurance.”
She says her organization continues to advocate for overall federal health care reform to drive down insurance costs.
Tuma says a lot of rural people live far away from hospitals and medical facilities, and supporting hospitals that are out in rural areas are important.
“Missouri Farm Bureau has a policy supporting critical access hospitals in Missouri, a special designation and funding when a hospital is located a certain distance from a major metro area,” she says.
Telemedicine has a lot of potential for rural health care providers, Tuma says. It allows doctors and specialists from far away to options like live video links to see and often diagnose patients where they are. However, it requires reliable high-speed Internet.
“Unfortunately, we still see that many rural communities don’t have access to broadband,” she says. “We see a lot of potential with it if we can get that broadband.”
Melissa VanDyne, executive director for the Missouri Rural Health Association, says care has unique challenges.
“Health care in rural areas is quite different,” she says. “They have barriers that they don’t have in urban areas. Most of rural Missouri is in a health provider shortage for mental health.”
Some areas are looking at integrating behavioral health and primary care centers. VanDyne says often the lack of behavioral health facilities means those visits have to become in-patient events when they could be out-patient.
VanDyne says six rural Missouri counties lack a primary care physician, and 71 Missouri counties lack OB-GYN services. Missouri has had eight rural hospitals close since 2014.
This is due to a number of factors, she says. One issue is Missouri does not have enough residency spots to meet the needs of medical students.
“When we ship residency students off to other states, that’s often a time when they’re putting down roots,” VanDyne says.
Dave Dillon, spokesman for the Missouri Hospital Association, says Missouri faces some demographic challenges, especially in the rural areas.
“Missouri does not compare well to other states in health behaviors,” he says.
This includes smoking rates and a lack of activity, as well as aging populations in rural areas.
“Our rural patients tend to be sicker,” he says.
VanDyne says her organization is also working to help rural communities deal with opioid use disorders.
“It would really help if the state would adopt a PDMP, a prescription drug monitoring program,” she says. “We’re the only state that doesn’t have one.”
She says expanding telemedicine, as well as expanding the broadband that supports them, would be another step to help rural communities.
“I think that technology plays a big role,” VanDyne says. “Transportation is a big issue.”
She says the University of Missouri has a “rural pipeline” for medical students to expose them to what practicing medicine in rural areas would be like.
Tuma says farmers can also be leaders in their community when it comes to bringing in medical professionals.
“We encourage farmers to try to play an active role in the recruitment of medical professionals,” she says.
Dillon says every community is different, but the Missouri Hospital Association holds a conference every year so communities can share stories of what’s worked for them with health care.
The USDA provides some grants for health care in rural areas, and another goal is using state funds as efficiently as possible, avoiding duplicating services.
“The state could probably look at utilizing funds a little more efficiently and effectively when it comes to rural health,” Dillon says.
He says workforce development is important.
“The state can play a role in making sure we have a health care workforce,” he says.
Dillon says the state has anywhere from 17,000 to 49,000 fewer primary care physicians than it needs.
Hospitals remain a key part of communities, and they are often one of the biggest employers in an area.
“In these communities, these are important economic institutions,” Dillon says.
These issues are important for farm families, and young people deciding if they can remain on the farm.
“Access to these facilities plays a huge factor when it comes to keeping farmers on the farm,” she says.