The Future of the Rural Economy — October 2005
http://www.rupri.org/ruralHealth/presentations/mueller082505.pdf

Preparing for Medicare Part D: An Opportunity for State Offices of Rural Health and State Rural Health Associations — August 2005
http://www.rupri.org/healthpolicy/

The Future of Rural Health: The MMA As a Change Agent — August 2005
Keith J. Mueller, PhD. Presented to the All Programs Meeting of the Federal Office of Rural Health Policy.
http://www.rupri.org/ruralHealth/presentations/mueller082505.pdf

Effective Rural Governance: What Is It? Does It Matter? — June 2005
Nancy Stark, Director, RUPRI Rural Governance Initiative
http://www.rupri.org/ruralPolicy/publications/RGI_in_pdf.pdf

A Rural Framework for Rural/Urban Discussion: A "Systems" Approach to Regional
Innovation — February 2005
Presented to the National Association of Regional Councils Washington Policy Conference by Charles W. Fluharty, RUPRI Director.
http://www.rupri.org/ruralPolicy/presentations/NARC020605.pdf

Changing Rural Policy for Changing Times — February 2005
Presented to the National Rural Network by Mark Drabenstott, Center for the Study of Rural America, Federal Reserve Bank of Kansas City.
http://www.rupri.org/ruralPolicy/presentations/DrabenstottNRN.pdf

Impacts of the Medicare Modernization Act on Rural Health Programs and Constituencies — February 2005
Presented to Congressional staff by the RUPRI Rural Health.
http://www.rupri.org/ruralHealth/presentations/briefing021105.pdf

HIV/AIDS in Rural America: Disproportionate Impact on Minority
and Multicultural Populations — July 2004
Human Immunodeficiency Virus (HIV) is an infection which can lead to Acquired Immune Deficiency Syndrome (AIDS).  There are currently an estimated 800,000 to 900,000 people living with AIDS or PLWA in the United States, with an estimated 40,000 new infections each year.  In 2001, 7.6 percent of reported AIDS cases were from rural areas (i.e., non-Metropolitan Statistical Areas), a rise from the 6 percent overall figure since the epidemic's start.
Download the full issue paper in PDF format

Rural Veterans: A Special Concern for Rural Health Advocates — July 2004
Since the founding of our country, rural Americans have always responded when our nation has gone to war. In the American Revolution, rural Americans left their homes and their families to protect their families and their lands.  During the American Civil War, rural Americans again responded to preserve their way of life, and to protect their families.  However during the Civil War, the United States government instituted the military draft.  Again motivated by tradition and values, rural Americans responded in order to maintain value structures reflective of volunteerism, care of home, a sense of place, for economic concerns, and certainly through patriotism.
Download the entire policy brief in PDF format

Federal Medicaid Reform: A Rural Perspective — April 2004
Rural citizens in the United States have less access to the full range of essential public health services than their urban counterparts.  Many rural and frontier areas have no local county or city public health agency, and those public health departments that do serve rural areas have few (if any) staff with formal public health training.  Although the rural population has many indicators of poor health status that beg for public health prevention programs, the low incomes and small tax bases in rural areas provide insufficient funds to local public health departments to address these needs.
Download the entire policy brief in PDF format

Health Insurance Access in Rural America — March 2004
Living in rural America increases the risk of being uninsured.  This is primarily because the rural economy tends to be dominated by smaller employers and the self-employed, and because rural residents are more likely to work for low-wage employers.  Both small and low-wage employers are less likely to offer health insurance. 
www.nrharural.org/dc/policybriefs/insurance.pdf

Federal Medicaid Reform: A Rural Perspective — March 2004
Many economic factors have contributed to a fiscal crisis for state Medicaid plans.  The economic recession, the ongoing effects of September 11, 2001, and the war in Iraq have combined to cause many state economies to change from budget surpluses to substantial budget deficits.  
Read Full Brief

Rural Health Professions — January 2004
Title VII of the Public Health Service Act Reauthorization — The rural population of the U.S. is about 20 percent, or 61 million people. In 1999, less than 9 percent of physicians practiced in nonmetropolitan counties (Rural Health in the United States, Thomas Ricketts, III, ed.). In recent years, distribution and shortages of non-physician providers including nurses, dentists, pharmacists, radiology and laboratory technicians and mental health professionals have also become more apparent. It has been estimated that in urban areas, the average provider to population ratio is 58/100,000 compared to 35/100,000 in rural areas. Recruitment and retention of nurses, lab technicians, radiology technicians and other health professionals is an ongoing problem for rural areas that compete with urban areas to maintain an adequate workforce. In addition, maldistribution of health care professionals is projected to become greater as nationwide shortages increase.
www.nrharural.org/dc/policybriefs/HlthPrfsns.pdf

Rural Graduate Medical Education — June 2003
Approximately 20% of the U.S. population resides in rural areas, while less than 9% of U.S. physicians practice in rural areas.  Family practice doctors are the most common rural physicians.  All other specialties, including other generalist specialties, are more likely to settle in urban areas.  The more specialized a physician is, the less likely practice in a rural area will occur.  www.nrharural.org/dc/policybriefs/RurGradMedEdu.pdf

Reforming the Universal Service Fund — May 2003
The 1996 Federal Telecommunications Act provided funding to assist certain rural not-for-profit health care providers with telecommunications services necessary for the provision of health care.  The program, called the Universal Service Fund, can finance up to $400 million annually, so that rural health care providers pay no more than their urban counterparts for the same or similar telecommunications services.  To date, more than 1,600 rural health care providers have received Universal Services funding to reduce the cost of their telecommunication services. 
www.nrharural.org/dc/policybriefs/UniversalSvcs.pdf

Federal Medicaid Reform: A Rural Perspective — May 2003
Many economic factors have contributed to a fiscal crisis for state Medicaid plans.  The economic recession, the ongoing effects of September 11, 2001, and the war in Iraq have combined to cause many state economies to change from budget surpluses to substantial budget deficits.  In addition, many states are constitutionally required to operate under a balanced budget.  With limited additional help from the federal government on the horizon, many states are considering cutting Medicaid programs by reducing the number of eligible beneficiaries, the number and nature of covered services, and/or the reimbursement levels for providers.  President Bush and many members of Congress have expressed the need for federal reform of Medicaid.  Given many rural areas' disproportionate reliance on Medicaid, any reform measures must take into account the unique needs of rural and frontier areas.
www.nrharural.org/dc/policybriefs/MedicaidReform.pdf

Professional Liability Reform — April 2003
Large jury awards, large settlements, and other financial losses to medical insurance companies are triggering rapid increases in the costs of liability insurance premiums.  More than half of all jury awards are more than $1 million dollars, and the average has increased to 3.5 million.  As insurance becomes unaffordable or unavailable for rural providers, doctors are being forced to leave their practices and drop vital services.  In rural and underserved communities, where access to quality care is already in jeopardy, rising liability costs are creating a crisis situation.
www.nrharural.org/dc/policybriefs/LiabilityReformPolicyBrief.pdf

Strengthening the Role of International Medical Graduates in Providing Access to Health Care for Rural America — March 2003
The J-1 visa allows foreign medical graduates (FMGs) to pursue graduate medical education in the U.S.  Upon completion of their residencies, international medical graduates (IMGs) on the J-1 visa are required to return to their country of origin or last country of residence for at least two years before seeking a different immigration status.  Until recently, the U.S. Department of Agriculture (USDA) requested waivers for physicians who agree to serve in a rural Health Professional Shortage Area (HPSA) not otherwise "fully served."  But as of February 27, 2002, the USDA terminated its involvement in sponsoring foreign research scientists and recommending waivers of the home residency requirement for foreign physicians.
www.nrharural.org/dc/policybriefs/J-1PolicyBrief.pdf

Health Care Workforce Distribution and Shortage Issues in Rural America — March 2003
The health care labor shortage in the United States has been widely documented and is expected to last through 2050.  Almost half of the health care workforce will be 45 years old or older by 2008.  By 2010, 40% of all registered nurses will be 50 years old or older, and the U.S. will need 1.7 million nurses but only 635,000 will be available.  The National Rural Health Association (NRHA) believes that it is essential for rural health areas to have an adequate and able workforce to deliver needed health care services.
www.nrharural.org/dc/policybriefs/WorkforceBrief.pdf

Access to Automatic External Defibrillation — February 2003
The enactment of the Rural Access to Emergency Devices Act in 2001 has the potential for saving large numbers of lives throughout rural America.  This Federal program authorized up to $25 million in federal funds to help rural communities purchase the latest in cardiac arrest technology — automatic external defibrillators (AEDs).  In Fiscal Year 2002, $12.5 million was appropriated to the Federal Office of Rural Health Policy for this program.  Automatic external defibrillators are portable, laptop-sized devices that analyze heart rhythms and deliver a shock to a heart when necessary.  The National Rural Health Association supports prudent access to external defibrillation devices and proper training in the use of these devices.
www.nrharural.org/dc/policybriefs/AEDBrief.pdf

Back to Health Policy & Legislative Issues