Rural people have less access to health networks and health care providers, greater rates of disability and chronic diseases and higher use rates of all public health care programs. And largely as a result of higher rates of self-employment and small business employment, rural Americans have lower rates of employer-provided benefits and are more likely to be underinsured or uninsured for longer periods of time. The 50 million people in rural America are most in need of health care system reform and have much to contribute to any reform debate.

Health care is also a major barrier to rural economic development that creates genuine opportunity and reduces poverty. Microenterprise and small business development is the most effective path in many communities for low and moderate income rural people to pull themselves out of poverty. But if small entrepreneurs cannot gain affordable access to health care for themselves or their employees, that path out of poverty is blocked. Any hope of building genuine economic opportunity for struggling rural Americans through entrepreneurship must be accompanied by reforming the health care system in a way that benefits both small business owners and their employees.

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