This month, we’re looking at the health access issues unique to one of Pennsylvania’s rural counties: Perry County. With a population of about 45,820 and very few hospitals and doctors, folks have difficulty accessing medical and dental care. Many people prefer not to use Medicaid even if they’re uninsured. The opioid crisis has decimated many families. And the local Amish and Mennonite communities often opt out of the traditional health insurance system entirely in favor of faith-based cost-sharing programs.
We did a Q & A with our Community Health Organizer in Perry County, Tori Decker, to learn more. As a lifelong rural Pennsylvanian, Tori is passionate about improving access to healthcare in her community.
Q. What’s your biggest challenge when helping folks get insured in Perry County?
A. It’s challenging to get people to buy into the concept of medical assistance. Many folks grew up thinking of medical assistance as “welfare” or as the government intruding in their lives. It’s often an uphill battle to convince folks that medical assistance is really health insurance and that they are “worthy” of getting healthcare.
Q. Can you give us an example?
A. Sure. I recently worked with a woman, Leona, who is Mennonite. She is pregnant and lives with her husband and young son up in the north of Perry county in a very rural area with other Mennonite and Amish families. Her 3-year-old son has craniosynostosis, a condition that required multiple surgeries soon after he was born. They have a cost-sharing plan through Christian Healthcare Ministries, which previously served them well, but they learned in the fine print that there was a cap for how much they would cover towards birth defects. It was only $25,000, so they were saddled with tens of thousands in medical bills. After working with her to help her understand the role of Medicaid, we were able to get her and her young son enrolled, and we’re working toward getting those bills paid. Her husband, however, still opted not to enroll himself.
Q. What are some of the healthcare access issues that are unique to rural communities?
A. There are a few access issues that are particularly prevalent in the communities I work with. Access to high-quality dental care is a huge issue. In general, it can be hard to find care even if you’re insured. The population is spread out and many folks lack access to transportation. There are only a few centers that accept Medical Assistance, and some of those have caps for the number of people they’ll take who are on Medical Assistance. Even the local hospitals can’t always handle complicated cases, and people may need to go to a larger hospital that is hours away. Some people have never been to see a primary care physician and end up with a preventable serious problem that sends them to the ER. People don’t necessarily understand the value of preventative care, so I am always talking with people about the importance of seeing a doctor regularly before something becomes serious.
Q. What’s one of the most urgent health problems in Perry County?
A. Central Pennsylvania has been hit hard by the opioid crisis, and we need more access to treatment. I see many families where the grandparents are raising young children because the parents have overdosed. These grandparents are often retired and don’t have much disposable income themselves. I work with many of these families to understand that they need to get the children enrolled in Medical Assistance, but many are resistant.
Q. What steps are needed to improve some of the health access issues you see in Perry County?
A. We need to work toward eliminating the health disparities we see in rural communities by getting people the care and services they need to stay healthy. Helping folks understand that Medicaid is life-saving health insurance and that they’re worthy of being insured is an important first step. We’re slated to get a new federally qualified health center in Newport that will offer primary care and opioid addiction services, so that should be another big step in improving access to care once people get insured. I also think it will be essential to involve leaders of the faith community in educating their congregations about the importance of taking care of their health and helping them get plugged into services.
Want to get involved in our rural community health organizing work? Contact Tori at email@example.com.