A Public Health Crisis In Rural America

Since the turn of the century, we’ve seen an interesting and troubling new trend — one that I don’t think anyone else predicted beforehand. And it’s only received mainstream attention in the past year or two. I’m talking about the simultaneous rise in mortality rates and decline of access to medical care throughout the rural United States, problems that have been exacerbated by the opioid crisis. I was reminded of this situation by some recent headlines from our Weekly News Wire articles: Premature Death Rates Rise In 20% Of Rural Counties Over The Past Decade and Methadone Accounted For 23% Of Prescription Opioid Overdose Deaths In 2014.

What do we mean when we talk about rural America? The U.S. Census Bureau has two classifications of urban areas: urbanized areas (UAs) that are home to 50,000 people or more, and urban clusters that have somewhere between 2,500 and 50,000 residents. Any people living outside of those two zones are considered to be rural. In the 2010 Census, they accounted for 19.3% of the total population, which works out to approximately 60 million Americans (see Defining Rural at the U.S. Census Bureau).

While it makes up less than one-fifth of the people, rural America accounts for a vast majority of the U.S. landmass, as seen in the map of the 48 contiguous states below.


As you can imagine, delivering health care services to isolated populations across such vast spaces is a challenge. Due to a combination of travel difficulties and a shortage of rural mental health professionals, rural residents often experience difficulty in accessing services (see About Rural Health Care). But geography isn’t the only challenge for rural health care access.

Historically, Americans living in these areas have had higher uninsured rates and lower rates of commercial insurance coverage than their urban counterparts. That improved somewhat after passage of the Patient Protection and Affordable Care Act (PPACA), but even as recently as 2014, 7.3 million rural Americans were uninsured, according to research from the Kaiser Family Foundation (KFF). And more rural Americans live in non-Medicaid-expansion states, further limiting access (see The Affordable Care Act and Insurance Coverage in Rural Areas). What’s more, states with vast rural areas saw disproportionately large increases in premiums for plans on the health insurance exchange last year (see Map: Here’s where Obamacare premiums are rising).

To recap: We have a situation in which rural Americans are affected by rising premature death rates, due in large part to overdoses on opioid-based substances, yet have less access to health care and addiction treatment than their urban counterparts. The situation seems grim, but fortunately, we’ve seen a few bright spots recently. States are developing new programs to bring attention and assistance to this underserved population, including:

  • The Rural Health Learning Collaborative, a recently announced program developed by the National Governors Association, is exploring new ways to deliver treatment in rural areas, including telemedicine and youth and adult services. Participating states are Kentucky, Michigan, Nevada, New York, North Carolina, North Dakota, and Pennsylvania (see North Dakota Selected for Rural Health Care Collaborative).
  • A new bill in the Colorado state legislature that would provide temporary financial support to residents who live in regions with the highest insurance premiums, spend 15% or more of their income on those premiums, and meet other earnings criteria. Though its impacted isn’t necessarily limited to rural Coloradans, State Representative Diane Mitch Bush, D-Steamboat Springs, described it as “short-term relief for people who are suffering from pretty extreme inequities between rural and urban Colorado.” House Bill 17-1235 reportedly has bipartisan support in the state Senate, which is expected to vote on the legislation sometime in the coming weeks (see Rural health care relief bill that could aid Roaring Fork Valley residents advances to state Senate).
  • The Rural Wisconsin Initiative, a new bill resulting from a collaboration between state legislators and the Wisconsin Hospital Association that aims to create new programs in health care, economic development, education, and more. If it passes, the legislation would generate hundreds of thousands of dollars in new funding for training, career opportunities, and wellness programs in rural health (see Legislators Creating Incentives for Rural Clinicians in Wisconsin).
  • The newest version of the Healthy Indiana Plan (HIP), a relatively recent implementation by that state’s Medicaid organization. Among other things, HIP sought to cut the state’s insured population, particularly in rural regions. Additionally, the program has helped usher in new solutions such as telemedicine and delivery of care in community-based settings that are aimed specifically at the rural population (see HIP a vital component for rural Hoosiers’ health).

OPEN MINDS is continually tracking new developments and adding new resources in rural health and related topics. For a look at recent opportunities related to rural health, see these requests for proposals (RFPs) on our site:

And for even more info on RFPs, winning bids, and contracts in rural health and other areas in health & human service, check out the OPEN MINDS Government Contract & RFP Database online, available for free to all Elite- and Premium-level members. Not a member? Subscribe today.

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