Medical deserts in the United States
[2] Although concentrated in rural regions, health care deserts also exist in urban and suburban areas, particularly in predominantly Black communities in Chicago, Los Angeles and New York City.
[4] Limited access to emergency room services, as well as medical specialists, leads to increases in mortality rates and long-term health problems, such as heart disease and diabetes.
In 2019, the federal government identified nearly 80 percent of rural America as “medically underserved,” lacking in skilled nursing facilities, as well as rehabilitation, psychiatric and intensive care units.
In states that chose not to expand Medicaid programs under the Affordable Care Act–Alabama, Georgia, Missouri, Oklahoma, Texas and Tennessee–rural Americans face limited options as hospitals close their doors.
[20] In 2016, the Kaiser Commission on Medicaid and the Uninsured, in conjunction with the Urban Institute, conducted a case study analysis of three privately owned Southern hospitals to determine the causes and effects of their closures in Kansas, Kentucky and South Carolina.
[26] For example, in parts of rural Alaska, transferring patients to hospital emergency rooms can "depend on the schedules of rickety charter planes" which are often prevented from flying due to the weather.
[28] Advocates for the Native American community have argued, however, that the government chronically under funds the IHS, resulting in a lack of accessible health care facilities, particularly emergency room departments for those living on reservations.
[29] The IHS provides services to 573 tribes and 2.56 million Native Americans primarily living on or near reservations and in rural areas concentrated in Alaska and the western United States.
[30] In 2016, the Office of Inspector General (OIG) issued reports criticizing the IHS's hospital care for tribal members, citing lack of oversight, outdated equipment and difficulty in recruiting and retaining skilled staff.
[32] In New Mexico, where Native Americans, in 2020, make up six percent of the population but 25% of positive COVID-19 cases, members of the Navajo Nation live without access to running water to frequently wash their hands, as recommended by the CDC.
[39] The American Medical Association (AMA), noting structural inequities gripping communities of color, urged the federal government to collect COVID-19 data by race and ethnicity.
[40] During the COVID-19 crisis, New York Times reporter Michael Schwirtz wrote (April 26, 2020) of the disparities in hospital services and finances between New York's white communities and those of color, with a private hospital closer to Wall Street able to tap reserves and exercise political influence to treat more patients, boost testing and obtain protective gear, even arrange for a plane from billionaire Warren Buffett's company to fly in masks from China, while a Brooklyn public hospital serving patients predominantly poor and of color resorts to plastic and duct tape to separate infectious patients' quarters and launches a Go Fund Me page to raise money for masks, gowns and booties to protect doctors and nurses from a virus that is "killing black and Latino New Yorkers at about twice the rate of white residents.
[42] Journalist Vann Newkirk writes of Black Codes that led to racially segregated clinics, doctors' offices and hospitals in which African Americans were assigned to separate wings to receive inferior medical treatment.
[46] The 2010 passage of the Affordable Care Act expanded Medicaid eligibility for low income Americans, but several Southern states with large poor black populations opted out of the expansion, its Republican governors opposing the Obama-led initiative as federal over-reach.
According to the survey, the suburbs, receiving a fraction of public health care funding compared to cities, are home to 17 million Americans who struggle in poverty, exceeding the numbers in urban centers and rural areas and straining hospitals with aging infrastructure.
Additionally, the Health Affairs study noted large numbers of uninsured or Medicaid-reliant suburban dwellers either can't find doctors and hospitals who will serve them or must travel great distances to see specialists.
Backers of single-payer or Medicare for All note that minorities and the poor, as well as rural residents,[50] in general, are less able to afford private health insurance, and that those who can must pay high deductibles and co-payments that threaten families with financial ruin.
[60] Medicare for All proponents also say a hybrid system of private insurance coupled with a public option would result in added bureaucracy and paperwork, and therefore fail to lower health care costs.
[67] To address the rural health care crisis, advocates of telehealth promote the use of digital information and communication technology—cell phones and computers—that can be accessed from home or work without encumbering the patient with long travel times to hospitals at least 60 miles from their residence.
[69] Critics of telehealth argue on-line doctor visits are no substitute for in-person evaluations which can provide a more accurate diagnosis and that uninsured rural Americans still won't be able to afford quality medical care.
The Network lists the following incentives rural legislative and medical entities could offer prospective doctors: health insurance, retirement packages, sabbaticals, sign-on bonuses, low-interest home loans.
