By Kristina Hubbard
As farmers, ranchers and other rural Americans discuss the ongoing health care debate, questions about the Senate's recently unveiled bill are arising. One question is recurring across rural America. "Will my state opt-out of the public health insurance option, if given the choice?"
The question refers to the Community Health Insurance Option - the Senate bill's proposed public option - that would be offered through state-run exchanges and be open to individuals, small businesses and people who are uninsured. States would also be allowed to opt out of offering the public option.
Rural Americans typically have fewer health insurance options, making it that much more important to have a public health insurance option that ensures competition and access to affordable care. It is nearly as important for that option to exist in a national exchange, as written in the health care bill passed in the House. With two health insurance companies governing the majority of Montana's plans, for example, the difference in choices offered through a state-run exchange versus a national exchange is huge.
The question above brings to light another important point: states will have a vital role in shaping programs after this landmark legislation is passed. These decisions could include whether to have a public option, how to expand Medicaid benefits, and how to enforce regulations on insurance companies. In a way, health care reform has just begun.
Kristina Hubbard is a health care organizer for the Center for Rural Affairs and resides in Missoula, Mont.