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"There are the protected and the unprotected," Peggy Noonan wrote in a 2016 op-ed. "The protected make public policy. The unprotected live in it. The unprotected are starting to push back, powerfully. The protected are the accomplished, the secure, the successful--those who have power or access to it. ... They are protected from the world they have created."

In the wake of covid-19, Noonan's words almost seem prophetic. We can see this clearly in Arkansas, where 54 of our 75 counties are considered rural. People who live in rural areas statistically have lower life expectancies, higher infant mortality rates, a lower health literacy rate and higher chronic disease rates. In a word, many are unprotected.

A pandemic makes these systemic problems even worse. Our health-care system will not return to its original capacity overnight, particularly our rural health system. In April, 1.4 million health-care workers were either furloughed or laid off. In the past decade, 128 rural hospitals closed, including 19 in 2019, the single highest year recorded. According to a 2020 Kaiser Family Foundation poll, 48 percent of Americans have reported delaying health-care services, and about 75 percent of doctors don't believe patient visits will rebound until at least July.

U.S. government officials made the right choice in requesting that hospitals suspend elective procedures in order to conserve personal protective equipment (PPE) and protect surge capacity. However, the long-term result of that decision and people's continued fear of going to hospitals has led to a large delay in regular and chronic care.

Many rural hospitals and health-care clinics operate almost entirely on elective procedures and have suffered significant financial losses, but those most affected are the actual patients that are missing out on services. The Coronavirus Aid, Relief and Economic Security (CARES) Act allocated more than $100 billion to hospitals and created policies that benefit both providers and patients but, metaphorically speaking, we can't just keep pulling people out of a river. We need to go upstream and figure out where and why they're falling in.

I recommend several solutions. First, we must expand telehealth options. Giving patients the ability to talk to a doctor via video call often eliminates the need for a face-to-face visit, something that's particularly helpful for patients that can't risk exposure to viruses at a doctor's office.

Letting federally qualified health centers and rural health centers furnish services, making it easier for patients to operate from home, allowing more audio-only options (as opposed to requiring video, which is often difficult in rural areas with spotty service) and increasing payment rates to incentivize physician usage are all programs that hospitals tested and found to be successful during covid-19, but they will expire once the pandemic is over. We should keep them going permanently, promoting telehealth to an ongoing reality.

U.S. Surgeon General Jerome Adams has shown a continued commitment to telehealth during his tenure, and this recognition on a national level will only increase funding and awareness for rural health needs.

Second, we can expand alternative care sites. During covid-19, the Centers for Medicare and Medicaid Services (CMS) established a Hospitals without Walls initiative, allowing hospitals to provide health-care services in areas that they wouldn't typically use, such as hotels or community facilities.

The policy also allows for ambulatory surgical centers to provide expanded services for patients without risking covid-19 exposure at a hospital. The VA tested a similar model by allowing veterans to undergo elective procedures at non-VA facilities. While originally established to protect against surge capacity, officials have now realized that these programs have a greater purpose by allowing non-coronavirus care to be given in coronavirus-free sites.

CMS also set up a program called the Emergency Triage, Treat and Transport Model, which gives greater flexibility to emergency medical services teams to provide treatment and release care for patients in their own homes, instead of requiring costly transportation to the hospital.

This list isn't exhaustive, but it gives us a look into some of the ways health-care experts have modified existing systems to respond to the covid-19 crisis. Arkansas had a much less severe outbreak, so we never needed to implement these programs like other states did, but even when we contain the virus' spread and return to a new normal, we should learn from these emergency measures. Many of them can continue serving rural patients in need of nontraditional care.

Rural health clinics are continuing to provide critical emergency care to communities across the state, and it's time Congress supported them in every possible way. Whether you are protected, living in a crowded New York City suburb, or unprotected, living on a farm in southwest Arkansas, you should have equal access to quality medical care. I hope to take the lessons we've learned from covid-19 and use them to make our health-care system stronger and better than ever.


U.S. Rep. Bruce Westerman represents Arkansas' 4th District.


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