In the health care reform debate, as with many other political conversations, the unique situation faced by rural communities is often overlooked. In fact I’ve been rather disheartened by the vitriolic, disrespectful, and divisive nature of  public discourse, and had, rather embarrassingly, tuned the whole thing out. The recent announcement by Anthem Blue Cross that they intend to raise premiums by as much as 39% for all California customers reignited my interest in the reform discussion. Though this sort of increase has a significant impact on all employers, I would venture that it affects rural communities to an even greater degree.

In fact, any potential change or lack of change in the way health care is provided in this country will have a larger impact on rural communities than urban, which is why I feel it’s our duty as rural ambassadors to understand the broader implications of the debate. My hope with this post is to illuminate a couple of the issues that most interest me, and spark some civil conversation about other considerations.

Rural communities tend to be dominated by small businesses, and higher rates of self-employment. For small businesses who want to offer workers health insurance, their small size means higher premium costs spread across fewer employees. The NFIB (National Federation of Independent Business) estimates that the self-employed for example, pay an additional 15.3 percent tax on their premiums. For many, it’s a choice between offering employees insurance, or having no employees at all. Factoring in the prevalence of higher risk occupations such as farming, mining, logging, and fishing, which carry even higher premiums, many families are unable to find affordable insurance. The rural west is especially prone to this phenomenon; uninsured rates in the rural northeast are 12, while in the rural west they are 18.2.

A story on National Public Radio presented a good example of this;

Larry Harbour is celebrated in Nebraska as a model entrepreneur. But the 33-year-old owner of LB Custom Chrome and Detail in rural Broken Bow, Nebraska, is an illness or injury away from losing his business. Harbour has a son and daughter who are covered by a state health insurance plan for children. He and his wife searched for their own coverage, but found premiums would cost from $12,000 to $20,000 a year, plus a $2,000 deductible.

"If anything were to happen to my wife and I, the business is sunk," Harbour said, standing in the shop he built from scratch. "It's like playing Russian roulette. Every day, we wonder when it's going to happen — if something's going to happen, are we able to afford it?"

Concerns over loss of employer provided health care is one of the greatest obstacles to entrepreneurship in this country. It’s not hard to understand the reluctance would-be entrepreneurs feel when considering leaving a secure job to join or start a new business. The reliance on employer provided health care also makes it difficult for startups to recruit employees who would help their venture grow. Therefore, access to affordable health insurance directly affects the continued economic vitality and resiliency of rural communities, as entrepreneurs and small business owners are our economic backbone.

High rates of uninsured also translate to less access to service. The lack of health insurance predicts lower utilization of health care and preventative services, which means fewer dollars going into the health economy, which directly contributes to the shortage of doctors and service providers. According to the National Rural Health Association only about ten percent of physicians practice in rural America despite the fact that nearly one-fourth of the population lives in these areas.
 

There are some who suggest our health care ‘crisis’ is all about improving personal choice, and changing our national food policy. The fact that Americans spend almost 20 cents of every dollar managing disease — diabetes, allergies, asthma, cancer, obesity — and only 10 cents of every dollar on food is not lost on me. As much as I’d like to see more support for growing vibrant food systems that encourage good nutrition and healthy rural economies, I don’t think a new farm bill will provide a solution.

Accidents happen, tractors roll over, cancer is found, and, thankfully, babies keep coming in to the world. The reality of the complicated and unpredictable nature of life requires us to have a health care system that promotes health through a variety of means, and provides adequate support to those who are in need of medical care without ruining them financially. I’m not certain on what the solution is, and it's hard to make informed decisions when we as a country have had a chance to hear each other out in a civil and respectful manner. I do hope that rural citizens can reflect on the unique needs of our communities, and bring thoughtful ideas and input into the discussion.

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