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RURAL HEALTH

The Access Project’s Rural Health initiatives are designed to better understand the unique issues faced by rural residents and their providers. These problems result from a lack of comprehensive affordable coverage for rural citizens. Through research and community engagement, The Access Project is gathering information that we hope will be used to inform local, state and national discussions on rural healthcare issues. 

The Access Project’s work is national in scope and is not specifically focused on rural issue. However since we began in 1998 we have consistently focused some of our work on rural issues. Starting in 2000, we conducted a community access monitoring survey focusing on dozens of hospitals and clinics, including a number of rural providers.

More recently we have leveraged a range of strategic relationships with rural leaders and rural health experts to pursue a deepening of our rural health work. This work, done in conjunction with the Center for Rural Health at the University of North Dakota, the Farmers’ Union, the National Organization of State Offices of Rural Health and many state offices of rural health, has generated information on rural health access and health insurance coverage issues. 

For more information on our rural health work, please contact Mark Rukavina at rukavina@accessproject.org.


Featured Work

The Access Project's Work Featured in New Report Released by Health and Human Services Secretary Kathleen Sebelius

Health and Human Services Secretary Kathleen Sebelius released a new report, Hard Times in the Heartland: Health Care in Rural America, outlining the health care challenges facing rural communities. The report was developed by HHS staff from across the department and comes on the same day Director of the White House Office of Health Reform Nancy-Ann DeParle, HRSA Administrator Mary Wakefield, and Representative Mike Ross will hold a meeting with Americans from rural communities as part of the ongoing series of White House Health Care Stakeholder Discussions. The report is available at www.HealthReform.gov.

Hard Times in the Heartland indicates that nearly 50 million people in rural America face challenges accessing health care. Not only do these Americans face higher rates of poverty, they report more health problems, are more likely to be uninsured, and have less access to a primary health care provider than do Americans living in urban areas. Go to http://healthreform.gov/reports/hardtimes/ to read the full report.
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Great Plains: 2007 Health Insurance Survey of Farm and Ranch Families

The Access Project, in collaboration with the Center for Rural Health at the University Of North Dakota School Of Medicine and Brandeis University conducted a health care survey of farm and ranch families in Iowa, Minnesota, Missouri, Montana, Nebraska, North Dakota, and South Dakota. The purpose of the survey is to gather information about farmers’ health insurance coverage issues. This information will be shared with state and federal policy makers to help inform them on how to best improve access to affordable health insurance for farmers. The survey gathered information about health care and health insurance issues for farm families focusing on the cost of health insurance premiums, deductibles and co-payments and other out-of-pocket expenses and any outstanding medical bills.

A series of Issue Briefs and state specific fact sheets were produced examining the survey findings. Read more about them or download them below

STATE SPECIFIC FACT SHEETS
These fact sheets provide information about how farmers and ranchers in each state are faring compared to farmers and ranchers in the surveyed states as a whole.

CORRECTION: Some of the original data about the percentage of people with outstanding medical bills were incorrect.  The figures have been corrected in these online versions.

Iowa:Health Insurance, Health Care Costs, and Access to Care Minnesota: Health Insurance, Health Care Costs, and Access to Care Missouri: Health Insurance, Health Care Costs, and Access to Care Montana: Health Insurance, Health Care Costs, and Access to Care Nebraska: Health Insurance, Health Care Costs, and Access to Care North Dakota: Health Insurance, Health Care Costs, and Access to Care South Dakota: Health Insurance, Health Care Costs, and Access to Care
Iowa
 Minnesota Missouri Montana
Nebraska
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South Dakota

ISSUE BRIEFS
These briefs examine the survey findings of all respondents, and in greater depth.

Issue Brief No. 6: Who Has Medical Debt and What Are the Consequences? (release date 10/7/09) examines the characteristics of farmers and ranchers who had medical debt and the impact of the debt on their financial situation and ability to access care. The brief also documents the amount of debt people are carrying and the additional out-of-pocket costs borne by people with medical debt . Read more...

Issue Brief No. 5: Who Is Uninsured? (release date 6/24/09) examines the characteristics of uninsured family farmers and ranchers and the impact of lack of insurance on their financial situation and ability to access health care. Read more or access the report and conference call...

Issue Brief No. 4: The Costs of Dental care and the Impact of Dental Insurance Coverage(release date 4/29/09) presents data on the amounts spent out-of-pocket by family farmers and ranchers for dental care, the percentage who have dental insurance, and the percentage who have debt resulting from obtaining dental services. It also looks at the impact of having dental insurance on the overall costs of dental care, on access to care, and on the likelihood that people will experience financial hardship because of health care costs. Read more or access the report and conference call...

Issue Brief No. 3: Who Experiences Financial Hardship Because of Health Care Costs (release date 9/16/08) shows that while nine in ten farm and ranch operators have health insurance, nearly one-quarter (23%) report that insurance premiums and other out-of-pocket health care costs are causing financial difficulties for themselves and their families. These families report spending an alarming 42 percent of their income on health care coverage and medical costs. In addition, more than four in 10 farmers and ranchers (44%) report spending at least 10 percent of their annual income on health insurance premiums, prescriptions and other out-of-pocket medical costs. Farm and ranch operators are especially hard hit because they are often forced to buy insurance on the individual, nongroup market, where insurance costs more and often covers less. Read more or download the report...

For more information on the report, including a Photo Essay of Farm and Ranch Families telling their stories, please go to the Robert Wood Johnson Foundation website at www.rwjf.org.

Issue Brief No. 2 (release date 12/18/07) examines how farm and ranch operators get health insurance coverage and the amount of their overall healthcare costs including insurance premiums and money spent out-of-pocket for medical services, treatments, products or prescription drugs. It highlights the inadequacies of relying on the private, non-group market to provide affordable, comprehensive insurance coverage to farm and ranch operators. Read more or access the report and conference call.

Issue Brief No. 1 (release date 9/6/07) provides information on insurance status, source of health insurance, health care access, and medical debt for these families. It urges policymakers to carefully consider proposals that will ease the burden of health care costs for rural residents and small business operators.  Read more or access the report and conference call.

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California: 2008 Health Insurance Survey of Farm and Ranch Operators

Issue Brief No. 1 (released in May 2008) provides an overview of the survey findings. The survey found that despite high rates of insurance coverage, farm and ranch families in the state spent, on average, more than $8,500 on healthcare premiums and other out-of-pocket expenses annually, and more than one in ten had debt resulting from medical or dental bills. People purchasing health insurance on the individual market had significantly higher expenses than those getting coverage through employment. To cover expenses, many used up savings or had to take out loans against their farm or ranch or add to their credit card debt. The report highlights the necessity of developing proposals that will ease the burden of health care costs for self-employed rural residents and small business operators. Read more or dowload the report...

Issue Brief No. 2 (release date 11/20/08) shows that while nine in ten respondents have health insurance, one in five report that insurance premiums and other out-of-pocket health care costs are causing financial difficulties for themselves and their families. These families report spending 37 percent of their income on health care coverage and medical costs. In addition, nearly one third of farmers and ranchers report spending at least 10 percent of their annual income on health insurance premiums, prescriptions and other out-of-pocket medical costs. Farm and ranch operators are especially hard hit because they are often forced to buy insurance on the individual, non-group market, where insurance costs more and often covers less. Read more or download the report...

For a Photo Essay of Farm and Ranch Families telling their stories, please go to the California Endowment website at www.tce.org.

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Iowa
In conjunction with the release of the report, Iowa for Health Care, the Access Project and the Iowa Farmers Union traveled over 650 miles around the state to nine different cities to bring the specific health care cost and access concerns of Iowa family farmers to the attention of Iowa voters.You can watch the press conference by clicking on the video below.

A report detailing the Iowa specific data was also released. It examines how Iowa farm and ranch operators get health insurance coverage and the amount of their overall healthcare costs. Costs include insurance premiums and money spent out-of-pocket for medical services, treatments, and products.


Kansas
Heartache in the Heartland: Kansans Speak About the Burden of Medical Debt
Heartache in the Heartland is based on a focus group discussion conducted in February of 2005 in Emporia, a city of 26,000 in eastern Kansas.  It explores the barriers to heath care that result from having inadequate insurance as well as the sources and consequences of unpaid medical bills.

Losing Ground: Eroding Health Insurance Coverage Leaves Kansas Farmers with Medical Debt (18 p., ©2006)
The Access Project partnered with the Kansas Farmers Union to examine medical debt among the farming population.

Playing By The Rules But Losing: How Medical Debt Threatens Kansans' Healthcare Access and Financial Security (30 p., ©2006)

Losing Ground: Eroding Health Insurance Coverage Leaves Kansas Farmers with Medical Debt (18 p., ©2006)
The Access Project partnered with the Kansas Farmers Union to examine medical debt among the farming population.


Missouri
Health Care In the Heartland

Living In The Red: Medical Debt and Housing Security in Missouri (24 p., ©2007)
This report tells the personal stories that bring life to the statistics on medical debt. Seven Missouri residents from across the state share their personal experiences telling how medical debt affects their access to health care, as well as their families’ financial and emotional stability.