The upcoming vote on health care reform is of historic proportions. The issue has vexed American leaders since Teddy Roosevelt called for universal health insurance in 1912, followed by Presidents Truman, Nixon, Clinton and now Obama. Even the hard-nosed Truman, who stared down the murderous dictator Joseph Stalin, met his match in the opposition to health reform.

On Nov. 3, farmer and Center for Rural Affairs board member Jim Knopik arrived in Washington, D.C. to tell Senator Ben Nelson (D-NE) of his support for health care reform in person. Knopik joined over 100 other small business owners and self-employed people who traveled to Washington to make their support known to their members of Congress.

Researchers from the Harvard Medical School have found that about 45,000 deaths of working age adults per year in the U.S. are associated with a lack of health insurance. For the study’s base year, the number of deaths associated with being uninsured were higher than those for HIV/AIDS, breast cancer, prostate cancer, leukemia, Parkinson’s disease, hypertension heart disease, liver diseases, kidney disease, and homicide, and nearly the same as motor vehicle accidents.

Access is the opposite side of the health insurance coverage coverage coin. The importance of access cannot be ignored, particularly in rural communities. The greatest health insurance in the world is less valuable without access to medical services. An Oklahoma State University report puts a different spin on rural access. It looks at the economic effect of primary care physicians and primary care services in rural communities, making the need for more rural health care providers an economic development cause.

On Nov. 3, Ohio voters approved a constitutional amendment, known as Issue 2, with 63 percent voting in favor. Issue 2 creates a 13-member panel to define animal care standards for Ohio’s livestock sector. The board would include the Ohio Department of Agriculture director, two farmers appointed by the Speaker of the House and the President of the Senate, and 10 members appointed by the governor.

USDA recently awarded 29 grants for the Beginning Farmer and Rancher Development Program. This new competitive grants program is designed to support collaborative networks and partnerships that provide beginning farmers and ranchers with education, training and mentoring. First-round recipients include organizations doing inspiring work with beginning farmers and ranchers.

Last month we discussed the challenges rural grocery stores face and ways to meet those challenges so that food retail in small towns remains open and accessible. This month, we highlight some of the federal programs that can be used to support, expand, and update rural grocery stores to help them compete in today’s marketplace.

Montana: Like many states, Montana faces a critical shortage of primary care physicians. As Missoulian State Bureau’s Mike Dennison reported, private family doctors are leaving their profession because of financial concerns or are retiring, and fewer medical students are willing to take their places.

Absentee ownership of Main Street buildings and homes can present challenges for rural communities: empty storefronts; badly maintained buildings; rents that are too high; poor energy efficiency and high utility costs; homes with overgrown lawns, etc.

The Nebraska Legislature went into special session in November to cut spending in response to declining revenues. The Governor’s proposal included cuts to state agencies and also targeted three critical programs.

A microenterprise is defined as a business with five or fewer employees. In the U.S., microenterprises represent 87 percent of all small businesses. These are not one-size-fits-all kinds of businesses, and the organizations that exist to serve them are not either.

As a very interesting and challenging year for rural America ends, the Center for Rural Affairs is more active than ever. We are addressing the large challenges. Making healthcare relevant to rural people, helping people start businesses, and advocating for better structure in American economic life are just a few of the areas we are working on. We could not do it without you. Your help in making a difference on these topics and so much more is essential.

This month the Center for Rural Affairs welcomes two new interns – Angel Romero Kiester and Adele Phillips.