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	Show Introduction Introduction Throughout rural America, there are nearly 50 million people who face challenges in accessing health care. The past several decades have consistently shown higher rates of poverty, mortality, uninsurance, and limited access to a primary health care provider in rural areas. With the recent economic downturn, there is potential for an increase in many of the health disparities and access concerns that are already elevated in rural communities. Hard Times in the Heartland provides insight into the current state of health care in rural areas and the critical need for health care reform.
	Sources Produced by Meena Seshamani, MD, PhD Joan Van Nostrand, PhD Jenna Kennedy, BA Carrie Cochran, MPA Analysis and support provided by the Rural Health Research Centers Report Production by the HHS Web Communications and New Media Division ¹ DeNavas-Walt, C., Proctor, B. D., and Smith, J. C. (2008.) U.S. Census Bureau. “Current Population Reports, P60-235, Income, Poverty, and Health Insurance Coverage in the United States: 2007.” Washington, DC: U.S. Government Printing Office. ² Ziller, E. C., Coburn, A. F., & Yousefian, A. E. “Out-of-pocket health spending and the rural underinsured.” Health Affairs, Nov/Dec 2006; 25(6), 1688-1699. See also “Helping the Bottom Line: Health Reform and Small Business” (2009). U.S. Department of Health and Human Services. http://www.healthreform.gov/reports/helpbottomline/ ³ Drabenstott, Mark and Moore, Sean. (March 2009). “Rural America in Deep Downturn: A RUPRI Rural Economic Update.” RUPRI Center for Regional Competitiveness: Kansas City, MO. ⁴ The Access Project. (Sept. 2007). “Issue Brief: 2007 Health Insurance Survey of Farm and Ranch Operators.” http://www.accessproject.org/adobe/issue_brief_no_1.pdf ⁵ Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2006. ⁶ Ziller, E. C., Coburn, A. F., & Yousefian, A. E. “Out-of-pocket health spending and the rural underinsured.” Health Affairs, Nov/Dec 2006; 25(6), 1688-1699. ⁷ Ziller, E. C., Coburn, A. F., & Yousefian, A. E. “Out-of-pocket health spending and the rural underinsured.” Health Affairs, Nov/Dec 2006; 25(6), 1688-1699. ⁸ The Access Project. (Sept. 2007). “Issue Brief: 2007 Health Insurance Survey of Farm and Ranch Operators.” http://www.accessproject.org/adobe/issue_brief_no_1.pdf ⁹Dohogne, Aaron. (Sept. 2008). “Survey recommends remedies for farmers' high insurance rates.” The Missourian. http://www.columbiamissourian.com/stories/2008/09/26/missouri-farmers-paying-more-individual-healthcare-insurance/ ¹⁰ Bennett, K. J., Olatosi, B., & Probst, J.C. (2008). “Health Disparities: A Rural – Urban Chartbook.” South Carolina Rural Health Research Center. ¹¹ Fordyce MA, Chen FM, Doescher MP, Hart LG. (2007). 2005 physician supply and distribution in rural areas of the United States. Final Report #116. Seattle, WA: WWAMI Rural Health Research Center, University of Washington. ¹² Fordyce MA, Chen FM, Doescher MP, Hart LG. (2007). 2005 physician supply and distribution in rural areas of the United States. Final Report #116. Seattle, WA: WWAMI Rural Health Research Center, University of Washington. ¹³ Agency for Healthcare Research and Quality, 2006 Medical Expenditure Panel Survey. Calculations By Maine Rural Health Research Center. ¹⁴ WWAMI Rural Health Research Center. Aging of the rural generalist workforce. Seattle, WA: WWAMI Rural Health Research Center, University of Washington; in press. ¹⁵ Health Care in Urban and Rural Areas, Combined Years 2004-2006. Update of Content in MEPS Chartbook No. 13. Agency for Health Care Policy and Research, Rockville, MD. http://www.ahrq.gov/data/meps/chbook13up.htm ¹⁶ Bennett, K. J., Olatosi, B., & Probst, J.C. (2008). “Health Disparities: A Rural – Urban Chartbook.” South Carolina Rural Health Research Center. ¹⁷ Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2006. ¹⁸ Bennett, K. J., Olatosi, B., & Probst, J.C. (2008). “Health Disparities: A Rural – Urban Chartbook.” South Carolina Rural Health Research Center. ¹⁹ Bennett, K. J., Olatosi, B., & Probst, J.C. (2008). “Health Disparities: A Rural – Urban Chartbook.” South Carolina Rural Health Research Center. ²⁰ Pleis JR, Lethbridge-Çejku M. Summary health statistics for U.S. adults: National Health Interview Survey, 2006. National Center for Health Statistics. Vital Health Stat 10(235). 2007.