In Rural America, Skepticism of Health Care Reform

Don't tell Dorothy J. Tenorio that Washington is nearing a deal to improve her health care.

A former grocery clerk, Tenorio's been scraping by on disability benefits for more than a decade. The 60-year-old, and many of her neighbors, are skeptical health care overhauls pending in Congress will change much in Colorado's rural San Juan Valley.

"I would tell Congress, they need to get out here to Huerfano County and see how bad it is, see what we're living with," said Tenorio, who suffered a neck injury in 1979 and hasn't worked since 1996.

In rural America, many like Tenorio are too poor to afford basic care. People who can afford doctors often can't find them. The lack of health care in small towns like Walsenburg is a problem Congress is just beginning to address.

Many folks in Huerfano County, population 7,900, depend on a low-cost outreach clinic for care. There's no eye doctor, no full-time dentist. The clinic relies on nurse practitioners, midwives and medical assistants to provide basic exams, but most sick patients are referred to a bigger town about 30 minutes away.

"I don't have any way to get up there to the doctor," said Tenorio, who doesn't drive. "Sometimes I can't even get out of bed because of the pain."

The 25 percent of Americans who live in rural areas are poorer, older, fatter and sicker than their city neighbors. They live farther from doctors and have a harder time getting to appointments, many depending on neighbors or church volunteers if public transportation doesn't exist.

Small towns often lack specialists and rely on family physicians. But even incentives such as covering student debt for new doctors haven't worked. Many small towns look to nurse practitioners for general care or seek foreign doctors using J-1 visa waivers.

According to the Washington, D.C.-based National Rural Health Association, only about 10 percent of U.S. physicians practice in rural areas. The problem: Medical students know they can make more money, and work shorter hours, in a specialty practice in a city.