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Rural photo contest!

Rural Lens: 2013 NRHA and RAC Photo Contest
The National Rural Health Association (NRHA) and the Rural Assistance Center (RAC) are proud to present the Rural Lens photo contest. The contest is as an effort to capture rural life across the nation through photographs. Enter to have your image featured in Rural Roads magazine and future NRHA and RAC materials and sites. Photos will be accepted through January 6, 2014 in three categories: community outreach, people and landscape.

Florida leads enrollment in


Nearly 14,500 Floridians have signed up for the Affordable Care Act in November, more than any other state, according to figures released Wednesday. 

The enrollment figures are considerably higher than the 3,500 in October when technical issues with prevented most people from enrolling. In the last two months, nearly 18,000 Floridians have registered. 

Nationwide, 394,682 people have signed up for private insurance coverage as of Nov. 30, according to the Health and Human Services Department. Officials had originally projected 1.2 million enrollments by the end of November. 

Source: The Associated Press

ACA Battleground: Florida


Florida, a diverse political swing-state, is used to being a battleground for presidential elections, but this year the state has become ground zero in the nation's battle over  the Affordable Care Act. 

Florida, the fourth-most populous state in the nation, has the second-highest rate of the uninsured, nearly 25 percent, just behind Texas.  

“Florida is ground zero for Obamacare,” said John Anzalone, President Obama’s Florida pollster. “If you take a look at all of Florida’s natural constituencies, you have seniors… You have minority communities, including Hispanics.”

“And you have areas of the state, like Fort Myers, that were heavily impacted by the recession,” he said. “Also, Miami-Dade is a heckuva lot different than the Tampa area. And then you have North Florida, which is really Southern.”

The travel schedule of the Obama administration’s top health official, Kathleen Sebelius, attests to Florida’s importance. She has made five stops in Florida since June. 

Republicans Sen. Marco Rubio and Gov. Rick Scott have been the most public figures against the act. 

Check out this article from The Miami Herald and Kaiser Health News to read how the fight over the ACA has played out in Florida.  

Register today for the FRHA Educational Summit, Nov. 20-22 in Gainesville, to hear from an expert panel how the ACA will effect rural Floridians. 



ACA Multimedia

Wrapping up FRHA’s week of consumer information on the Affordable Care Act, FRHA has rounded up some of the best multimedia resources to make sure you and the clients you serve are informed and prepared when health care reform laws take effect. 

The YouToons Get Ready for Obamacare: Health Insurance Changes Coming Your Way Under the Affordable Care Act- From nonprofit Kaiser Family Foundation, cute animations explain the way Americans will get health coverage and what it will cost when the majors parts of the ACA go into effect. A Spanish version is also available here.

Health Care Finder USA- This App for iTunes and Android from the Young Invincibles, geared toward young people, helps you discover your healthcare options and find local healthcare services. The "Find a Doctor" section helps you find both free and paid healthcare options - results are shown on a map or as a list.

Subsidy Calculator- Also from Kaiser Family Foundation, use this tool to enter different income levels, ages, and family sizes to get an estimate of your eligibility for subsidies and how much you could spend on health insurance.

The Affordable Care Act Explained- These 13, 30-second audio clips explain in simple terms how residents can benefit from the ACA and how to comply with the new law. The webpages also have links for more information on each of the topics. They can be downloaded or you can request a hard copy for free.

Health Coverage Under the Affordable Care Act flowchart- The Journal of the American Medical Association provides a step-by-step guide through the options and requirements for health coverage under the Affordable Care Act beginning in 2014, including coverage through an employer, coverage through a health insurance exchange, and coverage through Medicaid. See the chart here.

Health Reform Quiz- Test your knowledge of the ACA with the Kaiser Family Foundation’s 10-question quiz. Get social by sharing your results and encouraging others that take it too.

Marketplace Application Process- This video from the federal Health Insurance Marketplace,, introduces an interactive online application process.  Using an example of a single man from Arizona, images of computer screens from the application unfold while a narrator explains the content of each screen. The program concludes with a printable summary of the application and an explanation of what benefits will be received. Find more videos at

Protect from Marketplace fraud

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With only 12 days until open enrollment begins on the Health Insurance Marketplace, Washington has geared up efforts to protect consumers by preventing and detecting potential fraud.

“Today, we are sending a clear message that we will not tolerate anyone seeking to defraud consumers in the Health Insurance Marketplace,” said Kathleen Sebelius, Health and Human Services secretary in a press release Wednesday.  “We have strong security safeguards in the Marketplace to protect people’s personal information against fraud and we will work with our partners to aggressively prosecute bad actors, just as we have been doing in Medicare, Medicaid and the Children’s Health Insurance Program.”

Federal officials acknowledged the potential for scams with any new government program, but stressed federally-paid enrollment advisors, called navigators, do not represent a significant risk and that Medicare has used such guides for years without problems or controversy.

Some lawmakers say they’re worried the online marketplace may put citizens’ privacy at risk.

"Exchange applicants will have to hand over Social Security numbers, birth dates, employment information, tax returns and much more," said state Rep. Matt Hudson, R-Naples, before a House Subcommittee meeting in Washington, D.C.. "All the information needed for identity theft."

State Sen. Eleanor Sobel, D-Hollywood said she’s worried for a different reason. Many Floridians don’t even know the Marketplace exists or how to use it, she said, citing restrictions placed by Gov. Rick Scott administration that prevents local health departments from allowing navigators into their offices.

"This is a desperate attempt to prevent access to those who need health insurance the most," she said.

The Obama administration announced Sept. 18th a comprehensive, interagency initiative to prevent, protect against and, if necessary, prosecute consumer fraud and privacy violations in the Marketplace.

Steps have been initiated to prevent and respond to individuals attempting to take advantage of the public during health care implementation.  These measures include:

  • Reporting fraud mechanism: A new feature of the Marketplace Call Center (1-800-318-2596) will now enable individuals to report fraud simply by calling the 1800 number. Call Center operators have been trained to take a fraud complaint, and refer them to FTC’s Consumer Sentinel Network.   
  • Creating new pathways: offers easy access to connect consumers to FTC’s Complaint Assistant.
  • Establishing a routing system for complaints through a centralized database: Routing complaints through FTC’s Consumer Sentinel Network will ensure federal, state and local law enforcement have access to consumer complaints and can analyze and refer those complaints as appropriate. 
  • Protecting personal data: Building on the certification of the Health Insurance Marketplace’s data hub on Sept. 6, 2013 as in compliance with the stringent security, privacy and data flow standards developed by the National Institute of Standards and Technology - the gold standard for information and independent security controls assessment - the interagency officials have also established a rapid response mechanism that will be employed in the unlikely event of a data security breach.
  • Empowering consumers with information: Building on a proactive effort to inform consumers about potential fraud and privacy threats, the federal government is releasing new educational materials to empower consumers and assisters who are helping consumers navigate the Marketplaces. They include online tip sheets like Protect Yourself from Fraud in the Health Insurance Marketplace and Tips for Assisters to Help Consumers Navigate the Marketplace. The materials remind consumers that there is assistance, at no cost to them, available to navigate the Marketplace and that they should be suspicious of persons who ask for a fee before providing assistance.

Resources to protect yourself against fraud

  1. Suspect a Health Care Scam? Here’s What to Do- Tips from the Federal Trade Commission, the nation’s consumer protection agency, on lines scammers may use and how to figure out what’s real.
  2. Protect Yourself from Fraud in the Health Insurance Marketplace- a tip sheet from helping consumers know what to expect and when to be suspicious.
  3. Tips for Assisters to Help Consumers Navigate the Marketplace- a tip sheet for navigators to engage their communities and safely enroll the uninsured.
  4. Information on Navigators and Registering- Guideline from Florida’ Chief Financial Officer on training navigators should complete and what they are prohibited from doing.
  5. Securing the Health Insurance Marketplace- Information on security measures from the Centers for Medicare & Medicaid Services.

Stop back by the FRHA blog Saturday for more health care exchange information.

Learn how the Affordable Care Act impacts rural Florida and the nation by registering for the FRHA 20th Annual Educational Summit held in Gainesville Nov. 20-22. Click here for check out the agenda and learn more.


Scholarships available for NRHA conference

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The National Rural Health Association's Rural Multiracial and Multicultural Health Conference is one of the only meetings in the nation to focus on rural multiracial and multicultural health issues, this event offers attendees the opportunity to meet with peers and experts who share unique concerns and interests.

This conference is designed for those who are dedicated to bringing quality health care and health care services to this underserved and often under-represented portion of the rural population. This year's conference is taking place December 4-5 in San Antonio, TX.

The National Rural Health Association has scholarship funds available for students and community members with a critical need for financial support with conference expenses. Scholarships will be awarded on a first come, first serve basis. Please click here for a scholarship application. Once completed, please send to Gaby Boscan at

For more information, visit the conference website.  

Get informed, Oct. 1st is rolling in

Despite actions by Florida lawmakers apparently designed to undercut the implementation of the Affordable Care Act, Floridians can begin purchasing insurance on the health care exchange October 1.

It is up to consumers, in Florida and across the country, to select the right insurance for themselves and their families by cutting through the political hype and making an informed decision. This week FRHA will focus on resources consumers can use to make the right selection.  

Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, spent time in Florida this week to spread the word about open enrollment and criticize the hardship Florida officials have placed on citizens looking to take advantage of the new law, sometimes called Obamacare.

“Florida has done some pretty unbelievable things,” she said.

Among those moves has been the State Department of Health’s decision to ban trained health “navigators” from county health departments; refusing to set up or advertise health care exchanges where the uninsured can purchase insurance beginning Oct. 1; refusing to accept federal money to expand Medicaid in Florida, leaving about 1.1 million Florida residents without any coverage; and suspending the power of the state Insurance Commission to review rates for the next two years.

Florida’s failure to extend Medicaid coverage will have serious consequences for nearly 1 million Flordians falling in the unintended coverage gap by not earning enough to quality for tax credits available through the exchange, but earning too much to qualify for Medicaid. The state’s refusal to expand Medicaid could also be detrimental to hospitals that treat large numbers of uninsured patients.

However nearly 2 million Floridians will be eligible to enroll in the exchange and receive a tax credit.

Resources: the federally-run health insurance marketplace for residents in states not running their own marketplace. or call 1-800-318-2596.

Email and/or text updates from

FAQ: What You Need to Know About the New Online Marketplace- Nonprofit news organization Kaiser Health News answers common questions about the exchanges.

Less Help for Uninsured in Many States as Obama Health Care Markets Open in a Divided Nation- Associated Press article on how your coverage will be effected by where you live.

Stop back by the FRHA blog Thursday for more places to turn to health care exchange information.

Learn how the Affordable Care Act impacts rural Florida and the nation by registering for the FRHA 20th Annual Educational Summit held in Gainesville Nov. 20-22. Click here for check out the agenda and learn more.


Medicaid Expansion is a Rural Issue


Rural residents in twenty-two states, including Florida, will be hurt by their state’s refusal to expand Medicaid coverage.

“Not expanding Medicaid ... is a rural issue,” said Tim McBride, a health economist with the Rural Policy Research Institute’s Center for Rural Health Policy Analysis.

When researchers look at rural residents who could be covered by expanding Medicaid, more than half live in states that have opted out. In comparison, more than half of the urban residents eligible for coverage under the expansion live in states that are going forward with it, he said.

To see where states stand on Medicaid Expansion, click here.

Rural hospitals and their patients are likely to be affected because expansion is being paid, in part, by cutting reimbursement rates. That means hospitals in states that have opted out won’t get any of the federal expansion money but will still see rate cuts, McBride said.

“I don’t see an upside to not expanding,” McBride said. “The truth is, this will be really important money for rural hospitals, rural health providers, rural communities.”

However, changes to health care should help rural residents overall, he said, because they are less likely to have employer-provided insurance and more likely to be uninsured or rely on government-funded insurance than those in cities.

Learn how the Affordable Care Act impacts rural Florida and the nation by registering for the FRHA 20th Annual Educational Summit held in Gainesville Nov. 20-22. Click here for check out the agenda and learn more.

Source: The Associated Press



Navigators, mandates and exchanges


October 1st is marching towards us ever more quickly, sure to bring a flurry of new confusion and debate over the Affordable Care Act. October 1st is the magic moment when anyone in the general public will be able to start shopping for health insurance in the new “exchange” health insurance marketplace. The exchanges will feature new health insurance plans that are intended to cover at least 3 out of 5 currently uninsured people with affordable coverage.

What affordable means is relative, of course, but subsidies will be available for those who make too much for Medicaid coverage, but for whom health insurance premiums would represent an undue burden (an income of less than $45,960 for an individual). Coverage through the new exchanges will start as early as January 1, 2014.

For all the uncertainty and mystery surrounding the new plans and what exactly they will look like, it does appear that health insurance coverage will be affordable to the general public like never before. At least, it better be, since the nearly 4 million Floridians without coverage will be under a mandate, the “individual mandate”, to obtain insurance, or suffer a penalty. Proof of coverage will be required on 2014 US tax returns. Individuals not able to show proof will incur a $95 (adult) fee the first year, which rises significantly with each subsequent year.

There are two good ways the general public will be introduced to the exchanges over the next several months. First, a non-profit group called Enroll America is canvassing low income, low coverage neighborhoods as we speak to introduce people to their options. Second, federally funded “navigators” will begin their public education work beginning October 1st, as well. Navigators will receive a minimum of 20 hours training, testing, finger printing and confidentiality instruction to help individuals understand the ins and outs of each plan, according to their personal circumstances.

Learn more about the Affordable Care Act and its implications at the Florida Rural Health Association Annual Summit, November 20-23 in Gainesville Florida.  Click here to register today!


Neglecting Floridians' real-life needs



Despite the Florida and nationwide launch of the new health exchanges pending on October 1st, the Republican-led legislative majority continues to oppose such measures related to the Affordable Care Act. If you’re reading this blog, you probably already know that the new exchanges are health insurance pools designed to open affordable insurance options to a wider range of individuals than who currently have the ability to participate in an insurance plan. And, because they are the keystone elements of President Obama’s Affordable Care Act, political leaders across the nation continue to sway public opinion and public policy to affect the success of the exchanges.  Obviously in support of Affordable Care Act provisions, House Democratic leader Perry Thurston (D – Fort Lauderdale) had this to say about his colleagues leading the state:

“…leaders who say they want to improve Florida’s business competitiveness and image can make great headway by reducing this state’s abysmally high number of uninsured… legislative leaders are harming Floridians by refusing to accept millions of available dollars to help people obtain health insurance. As more residents become aware of their failure to act, I believe they will pay a political price for neglecting Floridians’ real-life needs.”

But there are others as vehemently opposed to his comments.  As a resident, still possibly lost in the quagmire of political cross-fire, what can you do to ‘clear up the mud’ and make sense of the extremely complex and ever-changing information?

First, stay tuned to this blog.  FRHA will continue to post updates on these, and other relevant rural health issues as we count down to the launch of the exchanges and our annual membership summit in November.

Second, make plans to attend the 2013 FRHA Annual Summit in Gainesville, Florida, November 20-22.  There, you will hear from an expert panel on the Affordable Care Act and its impacts on rural Florida.  Special guest speaker State Surgeon General and Secretary of Health John H. Armstrong will also provide a state of the state’s health address that will be sure to be enlightening.  You can learn more about the summit or register for it now here:

Third, take a moment to peruse these excellent news resources for their expertise in all things related to the Affordable Care Act, including up to the minute breaking news.  They each have electronic news letters that will keep you informed about this important issue, helping you climb out of the quagmire, to make up your own mind about health insurance exchanges and other important rural health news.

The Kaiser Family Foundation

Florida Chain

Health News Florida