June-July 2012

Main Article – The Patient Protection and Affordable Care Act Helps Rural Americans


            The Patient Protection and Affordable Care Act – the set of health care reforms sometimes referred to as “ObamaCare” – was passed by the United States Congress in March 2010.  This past March, health care reform was in the news again, as twenty-six states brought a lawsuit to the Supreme Court challenging the constitutionality of the act.  The Supreme Court is expected to release its final decision in June of this year.

            Although the Patient Protection and Affordable Care Act will not take complete effect until January 2015, several provisions of the act have already been implemented.  For instance, a provision that eliminates lifetime limits on insurance coverage and one that prevents health insurance companies from denying coverage of children with pre-existing conditions both became effective in September 2010. 

Many of these provisions have benefitted rural Americans, according to a recently released assessment by Jon Bailey at the Center for Rural Affairs.  Bailey claims that these provisions, particularly those that expand health care insurance coverage and benefits, have had a positive impact in rural communities “because of the demographics and unique economic circumstances of rural areas.”  Here, Bailey refers to the high percentage of rural Americans who use Medicare and to the high number of federally-funded community health centers in rural areas, among other factors.  Some of the provisions of the act minimized costs and increased accessibility of services for users of Medicare and community health centers. 

Some highlights of the assessment include:

  •  440,000 rural young adults have health insurance coverage solely because of a provision that allows young adults to remain on their parents’ health insurance plan until they reach 26 years of age.
  • Approximately 500,000 rural seniors have received free preventive services through the Annual Wellness Visit program.
  • Approximately 17.3 million rural Americans have health insurance policies that, because of the act, can no longer limit lifetime benefits.
  • Approximately 3 million children with pre-existing conditions such as asthma and congenital conditions have health insurance coverage because of a provision that prevents health insurance companies from denying coverage for children with pre-existing conditions.
  • 350 new community health centers have been built nationwide, and 1,100 existing community health centers have had their funding increased.  This has created approximately 19,000 new jobs.

 To read the entire document, The Affordable Care Act: Real Help for Real Rural Peopleclick here.

The Center for Rural Affairs is a 501(c)(3) non-profit based based in Lyons, Nebraska.  You can find out more about the organization by clicking here.

In the News

United States and Mexico Cooperate to Improve Health

            During the 65th World Health Assembly held in Geneva, Switzerland this May, Health and Human Services Secretary Kathleen Sebelius and Mexico’s Secretary of Health, Salomón Chertorivski, announced a new joint effort to respond to potential public health threats and address existing needs within the two countries and along the U.S.-Mexico border.

            Secretary Sebelius reminded the public that, in the past, the two countries “have had a long and close relationship” in regards to public health.  However, Sebelius emphasized that our current relationship demands further cooperation, saying, “The trade links between our two countries, our common border, and the high degree of trade in food products speak to the need for close bilateral cooperation in health security for both of our nations.” 

            A formal declaration signed by both countries outlines how the two nations will exchange information and work together on shared epidemiologic events and public health issues.  The declaration emphasizes food safety, strengthening regulations of food products and feed for food-producing animals and identifying potential areas of collaboration between U.S. and Mexican agencies.  The U.S. Department of Health and Human Services suggests that this announcement “is evidence of the ongoing commitment [by both nations] to help ensure that the foods for our populations, as well as foods traded between our countries, are safe and wholesome.”  For more information, see the press release here.

Calcium Supplements May Increase Risk of Heart Attack and Stroke

            A recent analysis of data from the Women’s Health Initiative suggests that women who take calcium supplements may be at a higher risk of cardiovascular disease than women who do not take such supplements. 

            The Women’s Health Initiative (WHI) is one of the largest prevention studies ever completed in the United States.  Initiated in 1991 by the National Institutes of Health, WHI includes several randomized control trials of four large cohorts, which were followed for 15 years. The recent analysis by Bolland, et al., considers women from the cohort that took calcium and Vitamin D supplements. 

In the original analysis of data from the “CaD cohort,” no link was found between cardiovascular events (such as heart attack or stroke) and calcium and Vitamin D supplementation.  Unlike the original analysis, however, Bolland, et al. consider the fact that many of the women randomized to the placebo group had previously taken non-protocol calcium supplements.  Consequently, they argue, the original analysis missed the link between cardiovascular events and calcium supplementation because of contamination of the placebo group.  When Bolland et al. removed women who had taken non-protocol calcium supplements from the placebo group, they found that calcium supplementation significantly increased a woman’s risk of suffering a cardiovascular event within the study period.

            Bolland et al. state that further research is needed to conclusively determine if the risk of calcium supplementation outweighs the benefits.  Women who take calcium supplements as a treatment for osteoporosis should consult their doctor.  To see the complete study, click here



First Things First

            First Things First (FTF) is governed by The Arizona Early Childhood and Health Board, which works with local councils to distribute funding to organizations that effectively meet the early care and education needs of local young children from birth to age five.  There are 31 Regional Partnership Councils comprised of local volunteers who help FTF determine what services need to be funded in their communities.The funding that FTF distributes comes directly from the revenue collected from the Arizona state tobacco tax.   

            FTF began in 2006, after voters overwhelmingly supported an initiative to fund quality early childhood health, development, and education.  FTF carefully evaluates its activities, and aims to ensure “effectiveness, transparency, and accountability to our state and our kids.”  

         FTF works in close partnership with a network of organizations and community-based providers of early childhood services to assure that Arizonans know how very crucial early childhood education is to the future of our state.

            One of First Things First’s current goals is to make families aware of the services available to them that are being funded by FTF and their local council.  Click here to go to FTF’s website.  Follow the directions outlined below to find available services for children birth to age five in your area!


To find programs in your area:

  1. Go to azftf.gov
  2. Enter your zip code under “Find Your Local Council”
  3. Click “Go”
  4. Click “Reports and Publications”
  5. Select the link that includes “Guide” in the title


Save Medicare Dependent Hospitals!

            A Medicare Dependent Hospital (MDH) is a small hospital (fewer than 100 beds) that serves a high proportion of patients who are on Medicare and is located in a rural area.  These Medicare Dependent Hospitals meet a vital need in rural communities and provide essential care to rural residents. 

            The federal program that recognizes Medicare Dependent Hospitals and provides a modified Medicare payment schedule to help these small rural hospitals remain open is set to expire on October 1, 2012.  Without this designation, many rural hospitals will be forced to close, negatively impacting the health of rural residents and communities. 

            The National Rural Health Association is organizing an extensive advocacy campaign culminating in a March for Rural Hospitals in Washington D.C. on July 30-31, 2012.  The goal of the campaign is to encourage members of Congress to renew the MDH designation.

            To learn more about MDH designation or how you can get involved, click here.


Upcoming events and trainings

39th Arizona Rural Health Conference: Innovations and Opportunities
Dates: September 13th – 14th
Presented by: The University of Arizona, Mel and Enid Zuckerman College of Public Health
Location: Desert Diamond Casino and Hotel, Tucson, AZ
Details: On-line registration will be available mid-June
Contact: Rebecca Ruiz, (520) 626-2243, raruiz@email.arizona.edu
Click here to go to the website. 



Cataract Awareness Month
Dates: June 1 – 30
Click here to go to the website. 

National Cancer Survivors Day
Date: June 3
Click here to go to the website. 

National HIV Testing Day
Date: June 27
Click here to go to the website. 

Cord Blood Awareness Month
Dates: July 1 – 31
Click here to go to the website. 


Editor’s Note

The Arizona Rural Women’s Health Initiative (AzRWHI) is a project of the Center for Rural Health at The University of Arizona’s Mel and Enid Zuckerman College of Public Health.

Jennifer Peters,  Coordinator (520) 626-2254, petersjs@u.arizona.edu

Jessica Hersh-Ballering, Graduate Assistant, hershballering@email.arizona.edu