Access to healthcare services is critical to good health, yet rural residents face a variety of access barriers. A 1993 National Academies report, Access to Healthcare in America, defined access as “the timely use of personal health services to achieve the best possible health outcomes.” A 2014 RUPRI Health Panel report on rural healthcare access summarizes additional definitions of access with examples of measures that can be used to determine access.
Ideally, residents should be able to conveniently and confidently access services such as primary care, dental care, behavioral health, emergency care, and public health services. In 2012, Healthy People 2020 identified that access to healthcare is important for:
Rural residents often encounter barriers to healthcare that limit their ability to obtain the care they need. Access to healthcare implies that healthcare services are available and obtainable in a timely manner. Yet rural residents often encounter barriers to healthcare access. Even when an adequate supply of healthcare services exists in the community, there are other factors that may impede healthcare access. For instance, to have healthcare access, rural residents must also have:
This guide provides an overview of healthcare access in rural America, including discussion of the importance and benefits of healthcare access and the barriers that rural residents experience. The guide includes information regarding:
For information on access to public health services in rural communities, see the Rural Public Health Agencies topic guide.
Immigrants in the United States and their families are forgoing essential welfare benefits like public housing, food stamps and Medicare over fear of persecution, a new study has found. One in seven immigrants avoided public benefit programs in 2018 out of concern they would risk their future green card status, the Urban Institute found.Last week, President Donald Trump proposed changing the nation’s legal immigration system to limit green cards given to migrants who rely on welfare benefits or who are not financially independent. Instead, the president said he would prioritize well-off citizen-seekers with job offers or job creation ideas.
Data revealed Thursday at MadREP’s “State of the Madison Region Economy” event highlighted significant challenges facing the seven counties outside Dane while also breaking down research reports on the region’s target economic sectors: agriculture, food and beverage; advanced manufacturing; health care; information communications technology; and bioscience.“Our rural areas are significantly under-performing compared to Dane County,” said MadREP President Paul Jadin, who presented the region’s next five-year economic development strategy.There are many reasons for that, not the least of which is the lack of robust broadband connections in parts of those counties, a farm economy that is suffering in some sectors – and a mix of opportunity and social factors that have contributed to rural out-migration in America for a century or more.Some of the friction in Wisconsin is cultural and political. Local officials in parts of the state often see cities such as Madison and Milwaukee as wealthy enemies, even if so much of the state’s economy depends on healthy urban centers. City officials, on the other hand, are sometimes accused of land grabs to build municipal tax bases.
In a story May 16 about school meals programs in Oregon, The Associated Press reported erroneously the number of public school students in Oregon. There are about 580,000 students, not 400,000. A corrected version of the story is below:Oregon OKs largest expansion of federal free lunch program. Oregon is spending $40 million to dramatically expand the federal free breakfast and lunch program, ensuring that more than 60 percent of its 58,000 public school students will be included, the only statewide effort in the country
Shelterforce is right on the money in their article, “Pushing Opportunity Zones to Fulfill Their Promise.” The piece urges urban leaders across the country to set guiding principles to make sure this new tax incentive, called the “most significant community development program to pass in a generation,” leads to equitable development and not displacement of low-income residents and people of color. Opportunity Zones were created by the federal tax overhaul in 2017 to entice private investors to underserved areas by eliminating capital gains taxes owed on prior investments if reinvested in Opportunity Zone communities for at least a decade. The new program has already attracted $28 billion in investment capacity.But many rural communities, like many urban neighborhoods, need outside investment to create jobs, build affordable housing, provide critical services, and incent broadband and renewable energy infrastructure. So why are rural communities barely targeted in the Opportunity Zone marketplace? According to the experts, the deals are too small, the risk is too high, the real estate doesn’t appreciate so as to produce capital gains, and investors don’t know rural places and players.At least six states, however, are testing strategies that can crack the code for rural. Three states, Kentucky, Alabama, and Texas, are seeking to sweeten the deal for investments in rural Opportunity Zones through proposed legislation enabling state tax credits on top of the federal ones. Just signed into law in the State of Washington is a new tax preference for state taxpayers who contribute to a Rural Development and Opportunity Zone Fund, for a total of $65 million/year. But perhaps most useful are Virginia’s, Oregon’s, and Alabama’s efforts to respond to the persistent challenge of limited development capacity in rural places—lack of local expertise to move qualified deals forward and connect them with state and national capital sources.
Companies have relocated thousand of jobs to Colorado since the Great Recession, many drawn by the state’s job growth incentive tax credit program (JGITC), which provides a state tax credit based on payroll taxes paid. But most of those positions have landed in metro Denver or now and then in nearby cities like Fort Collins or Colorado Springs. That Front Range concentration has frustrated economic development officials to no end. The Hickenlooper administration rolled out even more targeted and generous incentive programs to convince employers to go rural. The state devoted outreach and resources to help overlooked areas boost their attractiveness. And employers have continued to keep their distance.Starting next year, when companies apply for a JGITC award from the state, they can count remote workers based in rural areas toward that award, not just those in the primary Colorado location. If they have 15 or more remote workers in a rural area, employers can receive another $5,000 per worker beyond the JGITC award. For fewer than 15, the award drops to $2,500 a hire, unless those remote workers are on the Ute Mountain or Southern Ute reservations.
Smart and effective community development financial institutions are investing in the success of rural America. The results contradict arguments that America should write off everyone who lives outside large cities. Rural America isn’t going to hell in a handbasket. There’s more strength and possibility in rural areas than today’s popular narrative would have us think. I’ve spent much of my career on and around rural development issues, and I believe we can’t just write off 14 percent of the country’s population and 85 percent of its land mass, throw up our hands, and tell people to buy a bus ticket out or be doomed. There is a power to place. We need people in rural America.Modern American agriculture leads the world in food, fuel, and fiber innovations—there’s a strength here that as a nation we need to encourage. some of the most forceful, creative, and capable community development practitioners—community development financial institutions (CDFIs)—are fighting in and for highly distressed rural areas. They are proving the fight can be won.CDFIs have proven experience and the conviction that decent housing, clean drinking water, and life enriching community facilities and opportunities can happen in even the remotest and poorest areas. We’re not grappling with the mysteries of cancer. We know how to solve problems in rural infrastructure, housing, banking, small business, and healthcare. The solution is capital, resources, and perseverance.
Two sweeping health-care bills that would prevent patients from getting hit with surprise emergency room bills and protect Nevadans with pre-existing conditions were signed into law by Gov. Steve Sisolak. The move brings Sisolak one step closer to fulfilling the health-care agenda he touted on the campaign trail, including standing up to President Donald Trump on protections for people with pre-existing conditions and ending surprise emergency room bills. But it also represents the culmination of years of work — and for surprise billing, decades — on issues Democratic lawmakers had championed at the Legislature but were unable to bring to fruition under a Republican governor. The surprise billing compromise, AB469, is the byproduct of an interim working group tasked by Assembly Speaker Jason Frierson with figuring out how to ensure that patients aren’t caught in the middle of a debate between their insurance company and their provider after receiving out-of-network emergency care. The final bill they settled on holds patients harmless by requiring them to only pay whatever copay, coinsurance or deductible they would have been responsible for at an in-network facility for emergency care.
Tramping over a charred mountainside here one foggy morning, Matt Champa glowed with satisfaction. “Deer and elk will love this,” said the U.S. Forest Service “burn boss,” gesturing to a cluster of blackened trees that eventually will fall and create more space for forage plants. Champa and his team set fire to this area last month, part of the 1,900-acre Pingree Hill prescribed burn on the Arapaho and Roosevelt National Forests and Pawnee National Grassland to improve wildlife habitat and create space that firefighters could use to defend nearby residents and the Cache la Poudre River from a wildfire.The Forest Service and its partners hope over the next decade to carry out a series of such prescribed burns in Northern Colorado to protect communities and the river, which supplies water to about 300,000 people.Public and private landowners across the West are increasingly using prescribed fire to reduce wildfire danger. Over 3 million acres were treated with prescribed fire in Western states in 2017, up from the roughly 2 million in 2011, according to a survey by the National Association of State Foresters and the Coalition of Prescribed Fire Councils Inc.
The population numbers since 2010 look bad for most rural Iowa counties: Pocahontas, down 7.8%; Sac, down 6.1%; Audubon, down 10%; Cass, down 7.3%; Adams, down 9.5%. A small sampling of isolated rural counties. They may have peaked in population in 1940 or before. The sad news is: Nothing is on the horizon to turn it around.This according to Iowa State University research economist Dave Swenson, who studies regional trade dynamics and population. “They’re not within driving distance of a market center,” he explains, as is much of the Great Plains. Too far from Omaha or even Sioux City. All the good job growth in Iowa occurred in Des Moines, Cedar Rapids, Dubuque, Iowa City and Ames. That is where the population is headed, not to Atlantic or Wall Lake. His colleagues in Extension are doing a Shrink Smart program that helps communities transition into maturity. It strikes us as hospice for rural America — give us an IV drip to keep the sewer and water systems in repair, and give us a hospital nearby and a nursing home, and let nature sort of take its course.