Research on Health Care for Rural People

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

Affordable Care Act

Medicaid Expansion as a Rural Issue: Rural & Urban State Expansion Decisions (December 2013)
This report looks at the differences between rural and urban states in their decision on expanding the Medicaid program as provided for in the Affordable Care Act. More rural states appear to be less likely to expand Medicaid. Thus a significant number of low-income, working rural residents are left in a "coverage gap." They earn too much to qualify for Medicaid, but not enough to qualify for health insurance marketplace premium tax credits.

Seniors and the Affordable Care Act (Oct 2013)
The Affordable Care Act provides a variety of benefits to seniors without imposing additional health insurance coverage obligations. Benefit areas include enhanced wellness, preventive care, referrals to specialists, and prescription drug payments. See the provisions and what they mean in our report.

Making Health Isurance Affordable: Assistance to Individuals and Families (Aug 2013)
The Affordable Care Act has a system of tax credit assistance and automatic measures to subsidize the cost of health insurance and make it more affordable for individuals and families. In this report, find out how they work and why they are so important to rural individuals and families.

New Medicaid Initiative in Nebraska: Rural Implications (Sept 2012)
Examines the fiscal and economic impacts of the state’s potential participation in the expansion of Medicaid as provided for in the Affordable Care Act. Significant implications for Nebraska’s small towns and rural residents underlie the decision of whether the state will participate in expanding Medicaid coverage.

The Affordable Care Act: Real Help for Real Rural People (April 2012)
This report documents how many Americans have used or benefited from provisions of the Affordable Care Act. It also estimates the number of rural residents and families that have used or benefited from them.

Medicaid and Rural America (February 2012)
Medicaid protects long-term care for millions of seniors, assists people with disabilities live independently, and provides health coverage that ensures children can see a doctor when they get sick. Medicaid is critical for rural people, and it's vital for the rural health care infrastructure and for rural communities.

Health Reform: What's in It? Series

Affordable Care Act: What's In It? Prevention and Public Health (August 2011)
Chronic diseases and conditions such as heart disease, cancer, strokes and diabetes are responsible for 7 of 10 American deaths each year and 75% of the nation’s health spending. Rural residents experience these diseases in greater numbers and have greater rates of engaging in behaviors that can lead to chronic conditions and poor health.

Principles for a Nebraska Health Insurance Exchange: Governance & Oversight (August 2011)
An outline of principles for effective governance and oversight of Nebraska’s new health insurance marketplace - the Nebraska Health Insurance Exchange. The exchange will serve as a one-stop-shop where individuals and businesses can shop for affordable, high-quality health care coverage or enroll in public benefits. Eight organizations released the paper.

Affordable Care Act, What’s in it? Rural Young Adults (June 2011)
The Patient Protection and Affordable Care Act includes significant benefits for young adults in rural communities. With increased access to health insurance, young adults will be able to choose the places they live and the work they pursue, without limitations of how or where to find health insurance. This report examines provisions of the law that benefit young people and the rural places they call home.

Principles for a Nebraska Health Insurance Exchange (June 2011)
The health insurance exchange is a central feature of the Affordable Care Act, and will serve as a one-stop-shop where individuals and businesses can find affordable coverage in a competitive marketplace. Nine Nebraska organizations co-sponsored this report outlining principles for an effective, high-quality health insurance exchange that ensures quality, affordable health care will be available to all Nebraskans.

Affordable Care Act, What’s in It? Health Insurance Exchanges that Work for Rural (March 2011)
One of the primary features of the Patient Protection and Affordable Care Act law is the creation of health insurance exchanges. An Exchange is an insurance marketplace with the goal to help individuals and small businesses access affordable and quality health insurance. This report examines important rural issues and considerations in health insurance Exchanges.

Health Care Reform: What’s in It for Rural Individuals and Families (September 2010)
The Patient Protection and Affordable Care Act (PPACA) the federal health reform law, contains many provisions reforming health insurance. Several popular reforms took effect on September 23, 2010. This report discusses these and their consequences for rural people.

Health Care Reform: What’s in It for Rural Communities and Rural Medical Care? (July 2010)
Making people healthier is the ultimate goal of health care reform, but it can't be done without access to medical services. This paper summarizes access provisions in the new law directly targeted to rural communities and rural medical care.

Health Care Reform: What's in it for Small Business? (May 2010)
Small businesses dominate the rural economy. In fact, they dominate the American economy in terms of the number of business firms. So it’s important to know, understand, and accurately portray the effects of the newly adopted health care reform law, on small businesses.

Health Care Reform: What Does it Mean for Sole Proprietors?
A fact sheet that clarifies which health reform provisions apply to sole proprietors.


Health Care Reform Testimony

Comments on Health Insurance Exchange Provisions in the new health reform law. They were submitted to the Centers for Medicare and Medicaid Services at the Department of Health and Human Services by Jon Bailey, Director of the Rural Research & Analysis Program at the Center for Rural Affairs.

Comments on Health Insurance Exchanges and improved access to health care providers in rural areas. The testimony was provided be Melissa Florell, a mother, nurse, Yale graduate and farmer from outside of Kearney.


Health Care Reform and Rural America Series

The following reports were created to investigate the condition of health and health care in rural America, identify the main issues that effective reform should address, and create a basis for evaluating how any proposed health reform legislation would impact rural America.

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.

Why Health Reform Can't Wait: The Benefits of Health Reform for Rural America (February 2010)
This report examines the Congressional health reform proposals and their potential affect on rural residents, families, businesses, as well as the rural consequence of health reform inaction.

What will health care reform mean for me?
Looks at what legislative proposals include.

Fact Sheet: Health Care and Rural America (opens pdf)


Investigating the Condition of Rural Health & Health Care


In 1994, the Center for Rural Affairs convened a task force of rural health professionals, farmers, small business owners, religious leaders and other rural residents to study rural health care access. This report laid the foundation for the Center's focus on health care reform as essential for the growth and prosperity of rural communities.

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.

Survey Shows Iowa and Nebraska Small Business Supports Health Care Reform
Hear John Arensmeyer, founder and CEO of Small Business Majority, and Jon Bailey, Rural Research and Analysis Director for the Center for Rural Affairs, take questions on a media conference call.

Mr. Bailey Goes to Washington
The Center for Rural Affairs unveils report at White House meeting on May 4, 2009. This blog post discusses the meaning of the event.

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
This article 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.