One in six of all Americans—46 million people—live in rural areas. A significant gap in health exists between rural and urban Americans, with rural Americans more likely to die from conditions such as heart disease, cancer, and opioid overdoses. In addition, access to care has been under threat, as exemplified by the closure of over 100 rural hospitals across the country over the last decade. Urban areas also have nine times the amount of specialists per 100,000 people that rural areas have.

Moreover, racial disparities also contribute to lower access to care. While 15 percent of white rural adults were unable to see a doctor because of financial reasons, 25 percent of Black rural adults and 23 percent of Hispanic rural adults were unable to do so. Native Americans are also 3.2 times more likely to die of diabetes and have a life expectancy 5.5 years shorter than the rest of the US population.

Challenges facing rural health are even more concerning in light of the COVID-19 pandemic. Populations of rural counties in the United States have a 15 percent increased risk of developing severe COVID-19 symptoms while also having 10 percent fewer acute care beds per 100,000 people.

Opportunities for innovation we are pursuing include improved community-based care and telehealth, value-based care-reimbursement models that preserve access and align incentives for rural payers and providers, and deployment of readiness assessments and action plans for addressing behavioral health and social determinants of health in rural areas. We are also supporting efforts to help rural communities get the care they need during the immediate COVID-19 crisis and its aftermath.

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