Angel Romero-Keister opened Cravings Café in Lyons, Nebraska. Her husband and their son have health insurance, Angel does not. Additional premiums prevented them from purchasing coverage for her. (Photo by Casey Francis)

After August’s rancorous health care debate, it seems time to return to the question, “What would it look like if rural really mattered?”

Making health care coverage affordable for the rural self-employed should be a driving force in the reform debate. Over half the jobs in rural America are tied to small businesses or self-employment – on family farms, ranches and Main Street businesses. As a result, rural people who own or work for those businesses are twice as likely to be underinsured as urban Americans.

Angel Romero-Keister opened Cravings Café in Lyons, Nebraska, last year. Her husband and their son have health insurance, Angel does not. They could not afford the additional premiums to include her. A so-called “pre-existing condition” made purchasing coverage for Angel on the individual market virtually impossible. She has become a vocal advocate for reform. She has helped organize local and statewide events in Nebraska and has traveled with other small business owners to Washington, D.C. to lobby Congress for strong health care reform legislation.

Likewise, Larry Harbour, an entrepreneur from Broken Bow, Nebraska, has spoken out for health care reform. Larry’s story was reported by National Public Radio’s Howard Berkes in June. Larry opened LB Custom Chrome and Detail to good success, but he knows the cost of individual health insurance for him and his wife – as much as $12,000 to $20,000 in annual premiums – is a serious economic threat to their business. But they also risk financial devastation if they remain uninsured. As Larry told Howard Berkes, “If anything were to happen to my wife and I, the business is sunk … . Every day, we wonder when it’s going to happen – if something’s going to happen, are we able to afford that?

Angel and Larry, like so many other self-employed rural Americans, have taken great financial risks to start their businesses in our rural communities. We hold them up as examples of rural America’s drive and entrepreneurial spirit, and rightly so. They have done what we asked of them. They’ve taken a leap of faith, staked a claim in their communities, and worked tirelessly to make good on that commitment.

If rural America mattered, we would not allow a dysfunctional health insurance system to kill off the entrepreneurial dreams of rural America’s family farmers, ranchers and Main Street business owners. And we would see broad agreement about what reform can and should do – starting with instilling competition in health insurance markets by creating a national health insurance exchange buttressed by a public health insurance plan.

That should be where our vision for health care reform begins, for Larry and Angel’s sake and for the future of rural America, which is so intertwined with their entrepreneurial dreams.

Contact: John Crabtree, johnc@cfra.org or 402.687.2103 x 1010