Below you can find a round up of reports on rural health care reform published by the Center for Rural Affairs and allied organizations.

The Center for Rural Affairs history in health policy began in 1994 with a task force of rural health professionals, farmers, small business owners, religious leaders and other rural residents studying rural health care access. The task force found that the self-employed and working poor, disproportionately represented in rural areas, are not well served by the current health care system. It recommended a greater role for non-physician health professionals, expanded regional health care planning and public health services in Nebraska, and reforms to health care networks to meet the unique circumstances of remote rural areas. This report laid the foundation for the Center's focus on health care reform as essential for the growth and prosperity of rural communities.

Since then, the Center for Rural Affairs has greatly increased the breadth and depth of its examination into health policy from a variety of rural interests. The following reports were created to investigate the condition of health and health care in rural America, identify the main issues that effective reform must address, and create a basis for evaluating how any proposed health reform legislation will impact rural America.

2009 Health Care Reform and Rural America Series

Nutrition, Physical Activity, and Obesity in Rural America(January 2009)
The first of a series on health care issues in rural America, this report discusses the alarming fact that, in terms of diet, exercise, and weight, rural Americans are less healthy now than they use to be. The growing problem of obesity in rural areas is both a health, economic, and social problem.  Potential solutions include working to change unhealthy social habits, making safe bike routes for all community members, and working to build a healthier food system.

Top 10 Rural Issues for Health Care Reform (March 2009)
This is the second report issued in a series on health care issues in rural America.  It highlights the 10 most important issues for successful rural health care reform.  Any proposed legislation should be assessed according to this list to estimate its potential effectiveness and value for rural America.  Among the top issues are affordable, meaningful coverage for small business and the self-employed, workforce provider shortages, and access to preventative care.

Causes and Consequences of the Rural Uninsured and Underinsured (May 2009)
The third report on health care issues in rural America looks at the prevalence and impact of uninsurance and underinsurance in rural America. The report concludes that insufficient or nonexistent health care coverage is a problem that affects families, economies, and entire communities.

Mental Health: Overlooked and Disregarded in Rural America (May 2009)
This is the fourth report on health care issues in rural America.  It examines the prevalence of mental health problems in rural areas and the barriers to adequate mental health services that health reform legislation must address.

Why Rural America Needs a Public Health Insurance Plan Option (July 2009)
The inclusion of a public health insurance plan in health care reform legislation as an option for individuals, families and businesses promises to be one of the most controversial and crucial decisions made by Congress. With the myriad health care challenges facing rural people and rural communities, the decision on whether to include a public health insurance plan option has significant potential consequences for rural America. Rural America has much to gain or lose from the public health insurance plan decision.

Rural Health Care Workforce: Opportunities to Improve Care Delivery(August 2009)
Health care reform presents rural communities with opportunities to greatly improve access and overall health of rural America. This report examines the critical shortage of primary care providers in rural America, the importance of nurse practitioners as rural primary care providers, opportunities for rural nursing, and ultimately, how health care reform presents opportunities for nurses to improve access to and quality of health care for rural residents.

Healthy Communities--Healthy People (September 2009)
This report examines what rural people, families, businesses and communities can do to reverse trends showing rural people, on average, eat less nutritious food, get less physical activity, and are more often obese than their urban counterparts. Federal policy can assist rural Americans to create healthier lifestyles by funding community initiatives to create, improve, or maintain an infrastructure that encourages preventative behaviors like eating right and exercising. However, many rural communities lack the resources for full-time staff to seek out federal grants, and, as a result, miss out on public funding because they are unaware of opportunities.

Sweet the Bitter Drought (September 2009)
The economic infrastructure of our nation relies on rural Americans having a healthy existence to ensure the balance needed for a strong nation as a whole. This report presents  facts of how rural communities are struggling in the current health care system. If reform doesn't address the needs of rural America, the nation as a whole will feel the effects.

Investigating the Condition of Rural Health & Health Care

Health Care in Rural America
This 2005 policy brief focuses on health insurance coverage, health care costs of rural people, and potential models for health care system reform.  This is the first report issued by the Center for Rural Affairs to present the various reform models that could come into play in the health care reform debate that has now arrived at the forefront of the federal agenda.

Life Expectancies for Rural Women Declining
This 2008 newsletter article discusses two studies which suggest that the life expectancy of women living in rural areas is not increasing in toe with the life expectancy of women living in urban areas. Although the first study addresses differences in life expectancy between urban and rural women indirectly, the second study finds evidence that in nearly 1,000 mostly-rural counties, the life expectancy for women did not increase for the first time since 1918.

Child Health Care Rankings Highlight Several Rural States
This 2008 newsletter article discusses the three dimensions of health care - access, quality, and equity - and how well states fare on delivering care to children. That two states with predominantly rural populations were the only states to rank in the top quartile for all dimensions of care suggests that these states can provide models of how to deliver on all facets of health care in a cost-effective manner.

Related Reports from the Access Project

2007 Health Insurance Survey of Farm And Ranch Operators
A series of four reports examining health care costs and their consequences for farmers and ranchers in the Great Plains.  The reports highlight the impact of unaffordable coverage and medical debt on rural residents and their families, rural businesses, and rural economies in general.  
        Overview of Findings
        How Farmers and Ranchers Get Health Insurance and What They Spend for Health Care
        Who Experiences Financial Hardship Because of Health Care Costs?
        The Cost of Dental Care and the Impact of Dental Insurance Coverage

Identifying the Main Issues Effective Reform Must Address

Health Care Challenges for Small And Micro Businesses
This 2005 issue brief identified health insurance as an economic development issue hurting rural communities. Because of the nature of the rural economy, the rural workforce is more likely than its urban counterpart to be uninsured, underinsured, and burdened with medical debt. The inability of many rural employers to provide comprehensive health benefits has also hindered their inability to compete with urban employers for the most skilled, educated workers. Health care reform must address the affordability of coverage for small businesses and the self-employed.

Rural Elderly And Health Care Reform
This 2009 weekly column looks at the health care reform concerns of the aging population. It suggests that reform legislation strengthen long-term care services and help address rural health care worker shortages by enhancing Medicare funding of telemedicine and other health care information technology that enables seniors to receive care in their own home or community setting.

Related Report from the Access Project

The Illusion of Coverage: How Health Insurance Fails People When They Get Sick
This report looks at the primary reasons why even those with insurance get into medical debt.  Health care reform legislation must address these causes - unaffordable premiums or deductibles, caps on coverage, uncovered services, out-of-network fees, complex billing processes, and a lack of meaningful choice in plans, among others.

Creating A Basis For Evaluating How Any Proposed Legislation Will Impact Rural America

Fixing the Broken Health Care System
This 2008 newsletter article addresses meaningful health care system reform legislation in broad strokes.  The three key principles are (1) quality affordable health care for all Americans, (2) choice, competition, and quality and (3) preventative care and personal responsibility.

Rural America Presents Unique Set of Health Care Challenges
This newsletter article advices that health care reform legislation be based on guiding principles like sustainability, affordability, and universality.

The Rural Health Care Provider Shortage: How Nurses Can Make a Difference [coming in June 2009]
This paper explores how nurses can positively impact the rural health care provider shortage through improved utilization and developing rural care delivery models that build on the strengths of the profession.

Related Reports from the Robert Wood Johnson Foundation

Nursing's Prescription for a Reform Health System: Use Exemplary Nursing Initiatives to Expand Access, Improve Quality, Reduce Costs, and Promote Prevention
This report outlines the central role for nurses to play in ensuring that health care reform results in greater access to affordable, preventative care.  Especially in rural, underserved areas, nurses already play a critical role.  However, they have the potential to do even more.  Health care reform legislation should be evaluated on the basis of how well it makes use of one of our greatest health care resources - nurses.

Health Insurance Exchanges: Organizing Health Insurance Marketplaces to Promote Health Reform Goals
The establishment of a health insurance exchange market has been promoted by a number of influential health policy leaders.  This report provides an explanation for how such a market should be set up, and what benefits such a market should deliver - benefits that would go far in improving the health and quality of coverage experienced by rural residents.

Beyond Health Care: New Directions to a Healthier America
This report points out that while individual responsibility plays a major role in determining health outcomes, the environment in which we live, work, and play also contributes significantly to the quality of life we are able to enjoy.  The report provides recommendations for improving social and environmental factors that contribute to unhealthy behaviors. Any proposed reform should be evaluated according to how well it addresses both individual and community causes of ill-health. 

Related Report from the Institute for America's Future

Healthy Competition: How to Structure Public Health Insurance Plain Choice to Ensure Risk-Sharing, Cost Control, and Quality Improvement
A public health insurance option has the potential to break down many of the barriers preventing rural Americans from accessing affordable, meaningful coverage.  But, of course, such a plan must be constructed properly if it is to provide the changes rural America needs.  This paper outlines how to structure a public health insurance plan in a way that is in keeping with the values and guiding principles for reform advocated by the Center for Rural Affairs.