"Crop insurance reform" turned out to be doing away with a public option, subsidizing insurance companies and handing farmers high costs and high deductibles. Is health insurance reform headed this way?

With a solid "Yes" to primary care for everyone, and a reluctant "No" to most everything else, one community meets the national health care crisis.

Kaiser Health News reporters tell us that U.S. Senators continue to push for higher Medicare payments to rural hospitals in their states even as they decry budget deficits and an expensive health care reform bill. Eric Pianin and Mary Agnes Cary write that several senators want to help local hospitals become declared "critical access" facilities, a designation that allows these hospitals to collect higher payments from Medicare. Meanwhile, KHN reports, the "same senators are among those pushing hardest to hold the line on the cost of health care reform."

Senators Wyden (Oregon), Brownback (Kansas), Pryor (Arkansas) and Conrad (North Dakota) are among those seeking special designation of rural hospitals as "critical access" facilities. Congress created this designation in 1997 to help ensure care in isolated parts of the country. The original law said hospitals farther than 35 miles from other health facilities could be declared "critical access" and then collect 101% of their costs from Medicare rather than the usual 95% of allowable costs. The 35 mile limit was routinely waived, however, and the number of "critical access" hospitals grew to over 1,200 when Congress eliminated all waivers to the 35-mile rule in 2006.

"Now lawmakers from rural states want to ease the rules, partly by making it easier for hospitals to qualify for "critical access" status even if they are less than 35 miles from another facility," the reporters write. "Supporters note that the hospitals, besides providing emergency and limited inpatient treatment, are often the mainstays of small-town economies."

We see this over and again: An assertion that people in rural America have less insurance than those living in the cities. This statement of "fact" appears in reports and in speeches. Most recently, U.S. Secretary of Agriculture Tom Vilsack said that "there are significantly higher number of uninsured people as a percentage of population in rural communities." 

Is Vilsack right? Well, no, he isn't. The Yonder analyzed the most recent Census figures and found that the percentage of people under the age of 65 without health insurance is HIGHER in URBAN America than it is in rural.  For some reason the exact opposite is reported time and again. Most recently, the Center for Community Change issued a report finding (according to a summary) that "rural areas have the highest proportion of both uninsured and under-insured." Folks that just ain't so — at least the latest official data comes to the exact OPPOSITE conclusion. Surely too many people are without a way to pay for health care, but it's not a problem that's any worse in rural America than it is in the cities. 

Why would Secretary Vilsack be so far off base? All he has to do is go down the hall to his Economic Research Service which released a report on rural health care in the last month. The ERS found that rural people have health problems — higher rates of mortality, disability and chronic disease than in the cities. But the ERS also found, like the Yonder, that metro and non metro rates of health insurance coverage are the same.