In late July, in the heart of Appalachia, thousands crowded onto a southwest Virginia fairground for the annual Wise County free medical clinic led by Remote Area Medical, a volunteer medical relief corps based out of Tennessee. During the clinic's three days of operations, more than 14,000 rural Southern families, most with little or no insurance, spent hours in line to receive free health care from hundreds of professional doctors, nurses, dentists, and other health care workers.
Individuals living in rural areas are more likely to be uninsured than those in urban areas (24 percent versus 18 percent), although they are 50 percent more likely to have Medicaid coverage. Two-thirds of the uninsured are low- income families, and 30 percent are children. Even those lower income individuals who are working often lack health insurance due to the structure of employment in rural areas--specifically, smaller employers, lower wages, and greater prevalence of self-employment.
The Nebraska-based Center for Rural Affairs and the Washington, D.C.-based Center for Community Change recently released a report entitled, "Sweet the Bitter Drought: Why Rural America Needs Health Care Reform," which details the importance of health care reform to rural people and rural communities.
...the health care reform debate has suffered greatly from a false dichotomy that ailing urban poor folks are the main beneficiaries of reform, while the hardy rural middle class is healthy and well-served by the current system. The truth is that rural people and rural communities are faced with many of the same health care challenges confronting the rest of the nation--exploding heath care costs, large numbers of uninsured and underinsured, and an overextended health care infrastructure.
Rural Americans are more likely to be underinsured, less likely to have choices in private insurance coverage, and in dire need of the medical services and technology that public health care investment has brought to big cities. The majority of rural Americans are suffering silently in our broken health care system and want change now.
James from Union City, Tennessee, put it best: "We're not screaming, we're pleading."
The report identifies several health care issues that make health care reform a critical one for rural communities. Rural communities have: an aging, sicker, more at-risk population with less access to preventive health care; a lack of health and wellness resources and centers; a highly-stressed health care delivery system; higher rates of chronic illness (arthritis, asthma, heart disease, diabetes, hypertension and mental disorders); a shortage of practicing physicians, dentists, pharmacists, registered nurses, and emergency medical personnel; and riskier professions (farming and industry).
Since the late 1990s, rural areas have witnessed a significant decline in manufacturing jobs and a rise in service sector employment, losing jobs with higher rates of employer-sponsored health insurance while gaining jobs with much lower rates of such coverage. The lack of employer-sponsored health insurance is particularly acute for low-skilled jobs, which are more common in rural areas.
Of the 100 congressional districts with the highest percentage rates of uninsured people, 53 are represented either by Republican lawmakers who are fighting the overhaul, or by conservative Blue Dog Democrats who have slowed down and diluted the overhaul proposals.
One leader of the Blue Dog effort is Rep. Mike Ross of Arkansas, the coalition's chief health care negotiator. His 4th Congressional District covers southern Arkansas, a rural area with a high poverty rate. In his district, more than one out of five residents under age 65 lacks health insurance. That's 30 percent higher than the national average.
As Facing South reported, Ross claims his opposition to health reform efforts is because "an overwhelming number" of his constituents don't want it. This is a sentiment echoed by other conservative politicians from rural states and districts who claim that rural voters oppose health care reform. But studies continue to show that rural areas have the highest proportion of both uninsured and underinsured, and would benefit the most from comprehensive health care reform that includes a public option.
"Rural people have much to gain from inclusion of a public health insurance plan option in health care reform legislation, possibly more than any other group in the nation," said Jon Bailey, Director of the Center for Rural Affairs.