February 11, 2021 - Fixing Chronic Neglect of Rural Healthcare
Fixing Chronic Neglect of Rural Healthcare
February 11, 2021
Today brings more evidence of progress in Alabama’s battle against COVID-19. Like the rest of the United States, Alabama is witnessing an unmistakable decline in new daily cases (1,503 w/358 probables) and hospitalizations (1,281 patients in 103 reporting hospitals, 12.4 patients per hospital). Still, we received the tragic news of 133 more deaths, which takes our overall death toll to 9,021 since the pandemic began.
In the past week in the U.S., new daily reported cases fell 22.8%; new daily reported deaths fell 15.1%; Covid-related hospitalizations fell 15.6%; and the positivity rate was 6.5%. In Alabama, new daily reported cases fell 35.4%; new reported deaths fell 35.6%; Covid-related hospitalizations fell 23.1%; and the positivity rate was 17.1%. Alabama’s death rate declined faster than the national average mainly because it began the week in a much worse place. After taking into account this week’s decline, our per capita death rate (13.5/100K) remains the 2nd highest in the nation, just behind Kansas (14 deaths/100K).
This morning, the WSJ published an article headlined, “Alabama Has the Worst Covid-19 Vaccination Rates”, which examines why our State is saddled with the worst vaccine distribution and positivity rates in the country. The article points to several factors: (i) the public-health system has been depleted by years of poor funding, leaving some counties with thinly staffed health departments or no department at all, and (ii) administrative and technological problems, including inadequate appointment programs and outdated software.
According to the article, 41% of Alabama’s population is rural, while 36 of the State’s 67 counties are so underfunded that they have only one nurse, or none at all, in their health departments. Staffing at county health departments in 2019 was 65% of the 2010 level, leaving counties particularly overwhelmed when the pandemic hit. Large hospital systems, notably UAB and Huntsville Hospital, have had to become surrogate rural health care departments on top of operating hospitals that cared for mounting crisis-level patients.
As we know, Alabama was one of 15 states that refused to adopt Medicaid expansion under the ACA, thereby declining $4.9 billion in federal dollars over 10 years (90/10% split in federal/state funding). A 2020 analysis by the Robert Wood Johnson Foundation estimates that, of those 15 states, Alabama would see the largest decrease in its uninsured rate by expanding Medicaid (43% drop in uninsured). But, so far, those incentives have fallen on deaf ears in the Legislature.
The COVID relief bill working its way through Congress would give Alabama an added incentive to expand Medicaid - a 5% boost in federal matching funds for 2 years. When this relief bill is approved, will Alabama make the same mistake again? After witnessing first-hand what chronic neglect of rural healthcare looks like during a global pandemic, what will Dr. Harris and Gov. Ivey say or do? And, finally, will our major health care stakeholders, who have guided us through this COVID crisis, lead the effort to educate and motivate Alabama citizens in order to make their voices heard? Let’s all hope so. The totals:
1/28 - 3648
1/29 - 2848
1/31 - 4057
2/2 - 2078
2/3 - 2118
2/4 - 2767
2/5 - 1496
2/6 - 1992
2/7 - 1112
2/8 - 925
2/9 - 1318
2/10 - 1401
2/11 - 1503
What about Jeff County