Significance of Health Care Policy to Rural America

Rural America presents a unique set of challenges for health care reform. 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.

The demographics and socio-economic conditions of rural America are also fundamental challenges to health care issues. Consider:

  • Rural Americans are older and have lower incomes compared to the rest of the nation. The median age of rural Americans is 40 compared to 36 for urban residents. Median household income of rural residents is only 77 percent of non-rural households. This demonstrates greater need in rural communities, and confirms why rural residents – particularly those in remote rural areas – are more dependent on public forms of health insurance and health care.
  • Rural children are the Americans most need in need of health care system reform. For the most recent year for which data is available, 32 percent of rural children are covered by State Children’s Health Insurance Programs (SCHIP), compared to 26 percent of non-rural children. Nearly half of children in rural areas live in low-income families (again, a higher rate than non-rural children), and 44 of the 50 counties with the highest percentage of uninsured children are rural counties.
  • Nationally rural children aged 10 to 17 have obesity rates nearly 15 percent higher than urban children and nearly a third of rural children aged 10 to 17 are overweight or obese (again, a higher rate than urban children), according to a 2007 study by the South Carolina Rural Health Research Center.
  • Nationally rural children are at higher or comparable risk to urban children in weight-related health behaviors that are determinants of being overweight and obese, namely electronic entertainment media usage (higher rates than urban children), after school activity participation and inactive mothers (with rural and urban children having nearly equal rates in the final two). This was also a finding in the 2007 South Carolina study.
  • Adult obesity is more prevalent in rural adults and rural adults are less physically active than urban adults, according to national studies.
  • Some parts of rural America are characterized by “bookend” generations. In our research of the socio-economic conditions of the Midwest and Great Plains, we found that rural areas have higher percentages of their population in two age cohorts when compared to non-rural areas – children under 18 and adults over 65. These age cohorts are, in general, most in need of health care and more likely to be recipients of public health insurance and health care services.
  • The population sub-groups most at risk of being uninsured are most likely to live in rural areas. According to recent Nebraska-based research by the Nebraska Center for Rural Health Research, the population sub-groups most at risk of being uninsured are Hispanics, low-income individuals and families, small business employers and employees and the self-employed. Each comprises a significant (and in the case of Hispanics, a growing) segment of the rural population.

It is vital that the unique health reform challenges of rural areas are carefully articulated to policymakers. Reform can either address these unique challenges and provide an opportunity for healthier people and more sustainable communities, or exacerbate the current situation.

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