Health Care Policy & Rural America

The 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.
• A 2007 study by the South Carolina Rural Health Research Center showed that nationally rural children aged 10 to 17 have obesity rates nearly 15 percent higher than urban children, and that nearly a third of rural children aged 10 to 17 are overweight or obese (again, a higher rate than urban children).
• The 2007 South Carolina study also found that nationally rural children are at higher risk or comparable risk to urban children in weight-related health behaviors found to be statistically significant 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).
• National studies have also found that adult obesity is more prevalent in rural adults and that rural adults are less physically active than urban adults.
• 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 – thus, most at risk of bad health outcomes – are those 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.

Health Care in Rural America

Health Care in Rural America is a two-part series from the Center's August and September 2004 newsletters. Part I looks at the health care status of rural Americans, and Part II discusses possible solutions.

Health care in rural communities has many aspects – access to physicians, dentists, nurses, and mental health services; the financial circumstances of rural hospitals; federal rules concerning Medicare reimbursement rates and the impact on rural hospitals and healthcare professionals; and the consequences of all of these on the health of rural people.

While each aspect is important, this brief focuses instead on issues related to health insurance coverage, health care costs of rural people, and solutions to reform the health care system.

The Center has always believed that guiding principles are fundamental to any public policy effort. We offer a set of principles that should guide any proposed health care solution or reform proposal. Similar principles were suggested by the National Academy of Sciences’ Institute of Medicine Committee on the Consequences of Uninsurance.

• Universal – because of the long-term health and societal consequences of being uninsured and underinsured, health care coverage should be available to everyone.
• Continuous – gaps or interruptions in coverage lead to inadequate care and worse health outcomes. This is particularly important for rural people since rural residents lack health insurance for longer periods; any solution must have a long-term focus to assist rural people.
• Affordable to individuals and families – the primary reason given by businesses, employers, and people for lacking health insurance benefits is cost; the affordability challenge is even greater for low- and moderate-income individuals and families.
• Affordable and sustainable for society – any reform proposal must be cost-effective and efficient, both to the society as a whole and to individuals and families.
• Enhance health and well-being – coverage should include those services that provide for long-term health.

View the report here, or download a PDF of the it here.