Obamacare’s big challenge: Lack of doctors

GREENVILLE, MISSISSIPPI (Real Money) -- Nestled in between the Mississippi and Yazoo Rivers is a sweltering locale known as the Delta, where cotton was once king and the blues still swing.

Once home to music greats like Robert Johnson and B.B. King, this fertile Mississippi plain now sports a patchwork of dilapidated, boarded-up houses that punctuate the state’s economic troubles, where more than a quarter of the population lacks health insurance.

"Unfortunately, a lot of people who need insurance don't have it,” said Steve Kolbus, a harmonica-toting blues man who lives in the western Delta town of Clarksdale.

“I actually happen to be one of them."

The 51-year-old Indiana native, whose slight drawl and deliberative gaze tend to make him a crowd favorite, earns about $18,000 per year.

Playing at “juke joints,” selling CDs and washing windows, he moved to the Delta more than 16 years ago to start a restaurant with the hopes of also being discovered like McKinley Morganfield, a.k.a. “Muddy Waters,” and other blues legends from across the region.

“It’s a hard place to live,” said Kolbus, finishing a set with his band at the Ground Zero Blues Club, where actor and Clarksdale native Morgan Freeman is part owner.

Kolbus, who suffers from heart disease and relies on a pair of coronary stents to keep his arteries open, no longer sees a specialist or even a family doctor.  

“Can’t afford it,” he said.

But under the Affordable Care Act, he now qualifies for federal insurance subsidies that would halve his monthly premiums for a health plan that he can purchase on new marketplaces that roll out in October.

If he gave up smoking, Kolbus could shave off thousands more due to the law’s tobacco surcharge, according to the Kaiser Family Foundation subsidy calculator.

But in places like Mississippi, which has the fewest active family physicians per capita in the nation, finding a doctor is often as much of a challenge as getting insured. 

The Magnolia State averages one primary care physician for every 1,700 people, according to the Association of American Medical Colleges. The national average is one per 1,260.

And that ratio gets worse in the Delta. 

"In the Delta, you're looking at areas without a lot of transportation,” said Therese Hanna, Executive Director at Center for Mississippi Health Policy. “And you don't have a large number of providers, in particular, specialists."

In 2011, just one primary care doctor was registered in neighboring Sharkey County, which is home to roughly 5,000 residents, according to the state health agency and U.S. Census data.

In Humphreys County, where more than 9,000 people live, there were two.

Analysts say Mississippi -- which ranks worst in the nation in obesity, infant mortality and faces comparatively low education levels -- has a tough time luring in new doctors and nurse practitioners, just as its baby boom-era clinicians start to retire. 

“It’s quite honestly hard to attract a young, highly educated professional to move to a rural and underserved area of a state with significant health issues,” said James Turner, D.O., Dean at William Carey College of Osteopathic Medicine in Hattiesburg, Mississippi.

That’s especially true when the money is better elsewhere, and “they could be in Boston, or Atlanta or New Orleans,” he said. 

Sister Anne Brooks, who has worked as a physician in the Delta for roughly three decades, points to the lack of financial incentives as at least part of problem. Brooks, both a doctor and a nun, runs a medical clinic in the rural town of Tutwiler, treating local residents often free-of-charge.

Many of her patients are uninsured and don’t earn enough to make payments.

“If 74% of my patients can’t pay me, how am I going to earn enough money to pay the salary of another doctor?” she asked rhetorically. 

The state’s unemployment rate is currently 8.5%, compared to the national rate of 7.4%, while those who are employed earn a median hourly wage of about $13 an hour. More than 16% of the state’s population lives below the federal poverty line, according to U.S. Census Data.

The region has also been plagued by depopulation as residents search for better opportunities in cities like Jackson, the state’s capital, and other metropolitan areas.  

Since 1940, the region's population has dropped, with notable declines in poor, rural towns in the Delta. In Greenville alone, nearly a fifth of the residents have left in the past decade.

"When I was here in '67, we had probably around 10 or 12 factories,” said 71-year-old Charles Shute, a long-time Greenville resident. “Now we've got around two."

But as the U.S. economy rebounds, industry analysts say new opportunities could reverse manufacturing losses in places like Mississippi. 

Firms like Multicraft, an electronics-supplier, recently moved some of its Mexico-based operations to the central Mississippi town of Pelahatchie. Last month, the automaker Nissan announced plans to build a new assembly operation in Canton, investing $50 million in the project and creating 400 supplier jobs.

And as the Affordable Care Act rolls out this fall, even some of the law’s staunchest opponents are looking to use “Obamacare” to create new incentives for insurance networks and health care providers in under-served areas.  

“I don’t like the act. I would not have voted for it [and] I would repeal in the morning… but it is the act,” said Insurance Commissioner Mike Chaney, who helped entice the insurance company Humana to take part in new federal exchanges in the Delta, just as other insurers turned away. 

“If you do not have the benefits of health care and proper medical care, you’re not going to have economic growth with your state,” said Chaney, who added that he hoped to resolve issues like reduced federal payments to hospitals as the new exchanges roll out this fall.   

The federal government’s aim is to enroll 7 million people in these online marketplaces, with about 2.7 million of them being young and healthy adults to offset the costs of the old and sick.  If that happens, federal and state officials say it could encourage more health care providers to work in underserved areas like the Delta.  

"Specifically in the preventative care side,” said Chaney. “You will see more primary care physicians. And doctors can at least rest assured that they will be able to have most of their patients have insurance.”

And yet many residents remain unaware that they could qualify for federal subsidies to help pay for health coverage, jeopardizing the law’s design to help lower America’s uninsured population and reduce costs.

"That's first I've heard about that," said Kolbus.  

(Original package aired Tuesday, August 20th. If your cable provider doesn't offer Al Jazeera America, you can request here.)