Health care reform a winner for rural America


If you want to see just how badly broken America’s health care system is come to the country.

Be careful during your visit, however, because rural America — where just nine percent of the nation’s doctors serve 17 percent of its citizens scattered across 80 percent of its geography — is not an ideal place to find medical care.

It’s an even worse place to get medical insurance, according to the April 2009 report issued by the Center for Rural Affairs (CRA) in Lyons, Neb.

A face

In fact, if you want to put a face on the need for Congress and the White House to reform the nation’s health care system look no further than the weathered ones of farmers and ranchers.

The reasons for reform are evident, said Jon Bailey, director of rural research and analysis at CRA. Bailey co-authored the report with colleague Julia Hudson and Joe Blankenau, a professor of politics at Wayne State College.

First, he noted, rural Americans need health care insurance more than urban counterparts because their demographic — older, poorer and less educated — means greater use of the health care system.

Growing problem

Insurance to cover that need, though, is a growing problem in rural America.

“Overall, 72 percent of the urban non-elderly have insurance through employers,” explained the CRA report. It’s 61 percent for rural non-elderly.

Most of the fall-off can be traced to jobs. Rural America is dominated by small business and “people working for small business are twice as likely to be uninsured,” said the CRA report.

Moreover, rural business is usually low-wage business, the key reason why many locate in rural areas. And a big key to that low wage is not providing health insurance.

“Workers making about $7 per hour are three times more likely to be uninsured” than workers in higher-wage jobs, claimed the report.

The biggie

Then there’s the biggie: self-employment. “About 33 percent of rural residents are self-employed, a much higher rate than the roughly 21 percent of self-employed urban residents.”

Self-employment, especially in rural America, is an elemental factor in “greater health insurance vulnerability.”

These reasons, and more, mean most rural Americans have either no insurance, inadequate or less comprehensive insurance or more costly health insurance than urban Americans.

In fact, noted the report, while only eight percent of all Americans have individual policies, “33 percent of all farmers and ranchers” rely on such policies.


More importantly, Bailey explained in a May 19 telephone interview, “Health insurance coverage and cost is an ‘anything goes, wild west show,’ across rural America.” There’s little regulation, little competition and fewer options for this more vulnerable group, he said.

But health care reform, Congress and the administration’s key legislative goal this year, might not fix the problem, said Bailey.

“Everyone agrees health care costs need to be reined in; few agree on how to do it,” he noted.

Biggest issue

The biggest issue is designing a way for the current market to contain rampant costs (up 78 percent between 2001 and 2007) or establishing “a public health insurance option,” Bailey explained, “to increase competition.”

He favors the latter, he said, because it will provide more insurance options that are more competitively-priced for rural Americans as well as at least maintain, and maybe even increase, health care choices throughout farm and ranch country.

He’s right

Bailey is right. Relying on health insurance companies to fix health insurance is like relying bankers to fix banks. A government-backed alternative — there still will be private providers — will ensure a reform program actually reforms today’s limping system.

Then again we can continue to pay more for less until we qualify for better, cheaper care under Medicaid and Medicare.

Oh, that’s a government-backed option, too, isn’t it?


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Alan Guebert was raised on an 800-acre, 100-cow southern Illinois dairy farm. After graduation from the University of Illinois in 1980, he served as a writer and editor at Professional Farmers of America, Successful Farming magazine and Farm Journal magazine. His syndicated agricultural column, The Farm and Food File, began in June, 1993, and now appears weekly in more than 70 publications throughout the U.S. and Canada. He and spouse Catherine, a social worker, have two adult children.


  1. Thanks for the heads up! Those who believe health care is an individual right support a universal health care system with the argument that every citizen deserves to have access to the right care at the right time and that a government’s responsibility is to protect its citizens, sometimes even from themselves.

    Cobb County

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