This story was reported and written by our media partner the Virginia Mercury.
A committee of state lawmakers met in Virginia’s Eastern Shore this week as part of ongoing gatherings to hear from health care providers and other experts about rural health care challenges and possible solutions. The cohort will deliver a report later this year with recommendations.
Topics at the meetings have been broadly about rural health care access. But there has also been time dedicated to specific issues like maternal health care gaps, sparse dental health care in some areas, regulatory hurdles in treating obesity and challenges to telehealth amid insufficient broadband infrastructure.
Transportation issues and health care workforce shortages were common refrains at their first meeting in Tazewell this May and their Farmville meeting in June and were repeated again at the Sept. 16 Eastern Shore meeting this week.
Whether it’s due to a lack of access to a car, fewer public transportation options, or increased travel time compared to urban areas, rural health care providers relayed that patients often miss follow up appointments or have to travel further for emergency care.
Virginia’s Southside also has fewer hospitals than other parts of the state. And though Southwest Virginia has a cluster of providers, both regions are experiencing the closure of obstetric units — fueling maternal healthcare disparities.
As the rural health committee works on proposing enterprising solutions to these problems, they may also look at ways to build on existing state programs or funding. For example, to help alleviate maternal workforce issues, funding was earmarked in Virginia’s current budget for OB-GYN medical residencies. Virginia’s Department of Medical Assistance Services has a program to support non-emergency medical transportation for some Medicaid patients, boosting transportation options.
“We’ve got something that’s at least serving some people,” committee chair Del. Rodney Willett, D-Henrico said of the DMAS program. “Can we leverage that? Is there a way to expand that for non-Medicaid folks who have certain income levels or live in certain areas? Can we fund that?”
While some issues may be addressed or supported s by state funding, there are also regulatory routes to solutions through legislation.
Willett noted how midwives have played a role in Southside’s maternal health care problems. Though not OB-GYNs, some midwives are nurses and they specialize in pregnancy, childbirth and postpartum care. In 2020 Virginia law allowed for the certification of nurse-midwives and a 2021 law allowed for those with over two years of experience to serve as consultants for newly-licensed midwives.
“The state can’t totally solve that crisis,” Willett said. “But we’ve got to start somewhere.”
Blacksburg-area pharmacist Jeremy Counts called in to the meeting to talk about challenges independent pharmacies face, highlighting that these pharmacists will serve the areas of the state that national chains sometimes won’t. He’s hopeful for reimbursement reforms so that smaller pharmacies don’t continue to lose ground.
“Independent pharmacies are in an existential crisis,” he said.
Rx Partnership, a nonprofit that has coordinated the donation of bulk medicines from pharmaceutical manufacturers to clinics with licensed pharmacies, represents a point of progress on that front. Virginia’s General Assembly has already given funding to the organization and commended it through a resolution this year.
As the topic of obesity was also a talking point at the Eastern Shore meeting this week, the state legislature could also explore adjusting criteria for Medicaid coverage of certain weight-loss treatments. Obesity is often tethered to other health conditions; it can contribute to some conditions, occur simultaneously with them, or be their root cause. While diet and exercise can play a role, exercise may be out of reach for those with debilitating chronic illnesses.
“Something about being in the rural areas puts you at an increased risk of having obesity and diabetes,” said Lisa Price Stevens, a chief medical officer at DMAS, of the two often coexisting conditions.
She noted how fresh produce, for example, can cost more sometimes than foods with less nutritional value while committee member Del. Otto Waschmann, R-Brunswick, described seeing fewer grocery stores in his district over time. When people have to travel further or have transportation hurdles to food markets, they are more likely to rely on whatever is readily available close by.
Dr. Susan Wolver, a VCU Health specialist who called into Monday’s meeting, recalled how treating obesity in one of her patients helped improve other aspects of her physical and mental health.
She relayed how she treated a breast cancer survivor who was struggling with depression and obesity along with a gap in employment. Being able to utilize her Medicaid coverage for an injectable medication helped her lose 100 pounds. This led to a domino effect of tackling her depression, finding new employment and finally being able to undergo breast reconstruction surgery.
But, Wolver said, new criteria that took effect this past summer makes it harder for some of her patients to qualify for that type of coverage or other types of treatments. Patients must have certain, elevated Body Mass Index levels and/or have diabetes.
Wolver would rather patients be able to tackle obesity with medications sooner, if that’s the best course of treatment for them. She pointed to another patient who needs a kidney transplant, she said, but his BMI isn’t high enough for medication to be covered to help him lose weight to qualify for the surgery.
“It’s like waiting for cancer to metastasize before waiting for treatment,” she said.
The group also discussed creating a Secretary of Rural Affairs role at the meeting. The possible position, which would extend beyond the healthcare sphere, would be able to focus on the unique issues experienced by rural communities around the state.
“There’s nobody whose job it is to think about the rural communities (all the time),” said Andrew Block, a University of Virginia professor. “Even the governors who are most committed to rural communities just don’t have that kind of bandwidth to focus on that.”
He pointed to bipartisan efforts last year to study whether Virginia should create such a position that failed in the legislature. In an interview with the Mercury, Willett said he would be open to the study if the General Assembly were to take up such a bill again.
For now, the committee, composed of lawmakers from around the state, is expected to meet once more before their report is due.
“We are collecting our thoughts,” Willett said. “We’re trying to get what we’ve heard into a series of categories and within each of those, have a legislative or budget-related suggestion.”
