Rural America is at heart of Buttigieg healthcare plan: 5 things to know

Democratic presidential candidate Pete Buttigieg unveiled a 10-page rural healthcare plan Friday morning that includes proposals for "Medicare for All Who Want It," a new designation for rural health facilities and massive expansion of broadband internet for telehealth. 

This week, a Business Insider analysis found that Mr. Buttigieg, mayor of South Bend, Ind., has received more donations from the healthcare sector than any of the other Democratic presidential candidates. Healthcare donations to Mr. Buttigieg are less than half of those for Republican President Donald Trump — $548,014 versus $1.4 million, respectively. 

"The fact is, if you live in a rural part of our country, you are more likely to get sicker and die younger than people living in cities," Mr. Buttigieg says in the introduction to his healthcare plan. "That is wrong." 

Here are five plan takeaways of interest for hospitals and health systems. You can read the plan in full here.

1. Strengthen the Affordable Care Act and build Medicare for All Who Want It. Mr. Buttigieg wants to retain the ACA and build on it, while offering a more moderate version of "Medicare for All" than that presented by fellow Democratic presidential candidates Sen. Bernie Sanders, I-Vt., and Sen. Elizabeth Warren, D-Mass. Mr. Buttigieg's Medicare for All Who Want It would make Medicare-type insurance available for all while encouraging competition with corporate insurers. Medicare for All would eliminate private insurers.  

2. Expand rural access to high-speed broadband internet. Mr. Buttigieg proposed executing the broadband buildout within his first term, noting details for such would be "fleshed out" in a forthcoming plan. He also wants to double funding for the Federal Communications Commission's rural healthcare program to $1 billion per year. The FCC program includes the Connected Care pilot, which extends telehealth to rural veterans and low-income Americans. 

3. Support of the Rural Emergency Medical Center Act of 2018 and creation of a new designation for rural healthcare facilities to reduce the likelihood of care deserts. Noting that 112 rural hospitals have closed over the last 10 years, Mr. Buttigieg said he wants a new designation for rural health facilities that provide only emergency outpatient care — which will be titled Rural Emergency Medical Centers — to receive enhanced Medicare reimbursement rates. The designation, designed to protect rural communities from losing access to life-saving services when a nearby hospital closes, will only apply if a facility can transport patients to hospitals if needed. This proposal would modernize the Critical Access Hospital designation, which Congress created in the 1990s and mandates that a rural hospital offer inpatient care to be eligible for enhanced Medicare payments.   

4. Extend Medicare and Medicaid reimbursement toward social determinants of health. Mr. Buttigieg vows to create new pilots that will directly pay Medicare and Medicaid dollars to "community-based social interventions," which were not  specified. He would also create the Office of Health Equity and Justice within HHS. The new arm within the federal health department would oversee the designation and governmental funding of Health Equity Zones — communities with major health disparities and creative plans to narrow or eliminate them. 

5. Draw more medical students and residents to rural areas. Mr. Buttigieg's plan contains provisions to increase Medicare reimbursement rates for providers who serve in medically underserved areas, expand graduate medical education funding for rural healthcare settings and alter federal loan forgiveness programs to apply in rural private hospitals and practice groups in addition to government- and nonprofit-based employment. 

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