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In some parts of the rural United States, accessing in-person health care can feel impossible. Local emergency rooms and specialists might be nonexistent, and a trip to the clinic can take hours.
Telehealth has changed the game. Stephen Martin, a family physician and addiction medicine specialist, has witnessed how the recent influx of virtual appointments has increased access to medical care for rural patients from his practice in Barre, Mass. People seeking long-term addiction treatment who may have shied away from health care in the past because of stigma in a small town or lack of transportation can now receive substantive treatment.
But no one knows how long telehealth will remain a viable option for many people on Medicare. Policies introduced during the COVID-19 pandemic made it easier for people in rural America to access virtual care, but some of these programs are now set to expire early next year.
While bipartisan support for the extensions remains, legislation that could implement them long-term is currently in limbo. The Medicare benefits, which were set to expire December 31, were temporarily extended to March 31, 2025, under an emergency government funding bill signed by President Joe Biden December 21. Come April, if the benefits aren’t extended again, many people living in rural America will face renewed hurdles to accessible care.
Physician shortages, hospital closures and the shuttering of critical services, such as labor and delivery care, have made it increasingly difficult to find reliable health care in rural areas (SN: 12/11/24). According to the Center for Healthcare Quality and Payment Reform, almost 200 rural hospitals have closed since 2005, leaving millions of people without emergency care or inpatient services in their communities. Late insurance payments and tight profit margins have left 360 more rural hospitals at risk of immediate closure. As of this year, there are about 1,200 rural hospitals throughout the country.
When these hospitals vanish, the patients they leave behind still fall ill and require care. People living in rural areas across the United States are more likely to die from heart disease, cancer, chronic lower respiratory disease and stroke than their urban counterparts, researchers reported in May in Morbidity and Mortality Weekly Report. Sixty-five percent of nonmetropolitan counties across the country lack a psychiatrist, and rural patients have higher rates of suicide and depression than urban residents, other studies have found.
If you don’t get along with the only doctor in town, Martin says, you’re in a tough spot. “You’re left to the idiosyncrasies and vantage points of any small number of practitioners in that area. So if those practitioners aren’t interested in addiction, you won’t have addiction care. If they’re not interested in mental health, you won’t have mental health care.”
Unsurprisingly, transportation to different providers is often a limiting factor for rural patients. For the millions of people living in rural parts of the country, it can take nearly twice as long to reach a hospital than it does for urban residents. Numbers vary wildly, but the average car travel time to the nearest hospital for someone in a rural area is 17 minutes; the average urban dweller needs just about 10 minutes. For people living in remote, hard-to-reach areas, it can take hours to reach in-person care.
There are patients who “literally have to take off an entire day of work to come and see us,” says U.S. Representative Gregory Murphy, a urologist who represents North Carolina’s 3rd District. “So many of the areas, sadly enough, in eastern North Carolina are rural and impoverished areas. So for people to lose half a day or a full day of work, it is a lot of lost wages.”
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