Thursday, Nov. 15, was National Rural Health Day.

Rural America is a wonderful place to live and work, which is why nearly 60 million people make their homes there. That’s why the nation honors the health of rural America every third Thursday of November. As we do so, each of us should pause to remember the unique healthcare challenges and the crucial state and federal healthcare decisions rural America faces in the coming weeks and months.

First, each state must decide whether they will establish their own health insurance “Exchange” or marketplace. Exchanges allow individuals – from self-employed farmers and ranchers to small business owners and employees – to share risk with much larger groups and thereby reduce premiums. And for individuals earning up to four times the federal poverty level – over $90,000 for a family of four – the exchanges will provide access to premium assistance subsidies for health insurance. We must ensure, however, that they serve all consumers, urban and rural alike.

And in coming months, every state will choose whether or not to participate in the expansion of Medicaid eligibility to all adults below 138 percent of the federal poverty level, as provided in the Affordable Care Act. Tens of thousands of health care jobs, lower insurance premiums for the currently insured and access to affordable healthcare coverage for hundreds of thousands of rural Americans, many of whom lack coverage today, make this another vitally important decision for rural communities.

John Crabtree

Center for Rural Affairs