Health care reform has dominated lawmakers’ agenda and saturated the news this past year. With an uneven spatial distribution of health care resources and insurance options varied by occupation, national health care reform is likely to have differing impacts. These articles highlight continued uncertainty about the impacts of reform for health insurance, costs, and access for farmers and rural residents.

Since at least 1992, federal policy has been aimed toward fostering competition among health insurance plans. A review of evidence from the Federal Employees Health Benefits Program, and experiences with Medicare managed care, indicate that competitive insurance markets should not be expected to function in all rural places.

Employment based health insurance has been on the decline in the United States, especially in rural areas. Without reform, employment based coverage is likely to continue to decline in rural areas. With reform, the final form of employer tax credits compared to the terms of alternative options, such as exchanges, will determine coverage types for rural residents.

Farm persons have less geographic access to health resources and they are also less likely to receive insurance through employer sponsored programs. Consequently, health care reform which promises to provide greater access to insurance could lead to greater coverage and lower costs for some farm persons.

Cooperatives have received attention in the health insurance reform discussions. We review the nature of cooperatives and focus on the Farmers’ Health Cooperative of Wisconsin. Cooperatives, if properly executed, could be a solution to the health access question facing farmers and other Americans, but they are not a “magic bullet”.

Health insurance coverage and health promotion provisions are among the most controversial aspects of national health care reform. This article addresses those issues in the context of rural America, specifically as they relate to health outcomes for children in low-income families.

Small rural hospitals play a unique, if limited, role in the health care economy. Health care reform has the potential to contribute to a continuation of the improvement in the financial soundness and viability of small rural hospitals.

Recent reform legislation restricts physician financial ownership of health care system facilities. Research suggests physician ownership can increase patient costs due to overprescribing testing procedures. We examine the correlation between per capita Medicare costs and two types of physician ownership contracts with hospitals and find evidence that suggests cost and physician ownership are positively related in urban markets, but not in rural.

Nonmetro per capita transfer payments are higher and have been rising faster than metro since 1978. The majority of this increase is due to the rising cost of medical care, especially Medicare, and points to the need to control health care costs in general, and the government’s share in particular.