Editor’s Note: This article first appeared in the Billings (Montana) Gazette and is reprinted here with permission.

Several of America’s founding fathers had agrarian ties – they knew what it meant to plant, harvest and produce a product to meet both the needs for physical sustenance and the framework of the greatest democracy in the world. Fast forward to the 21st century, the framers would be impressed to see that their democratic vision has prevailed and agrarian roots have expanded, establishing the U.S. as a super-power in food, fiber and fuel production.

This feat has not come easily. Many rural communities across America are still recovering from the effects of the recent recession,. With well-funded special interests in Washington, D.C., stacked against them, the going is even tougher than it should be.

The next president will play a role in drafting and implementing a Farm Bill, along with deciding critical new policies on everything from biotech to animal health, trade and commodity prices. Policy areas not typically thought of as “rural,” sometimes play an even bigger role. One such issue, health care continues to affect the lives of every single man, woman and child in our communities.

Health care has long been an issue of seemingly unbalanced odds in rural regions as economic factors and basic geographical restraints have made access to reliable and affordable health care a luxury. In examining sparsely populated markets, large corporations too often see an opportunity to squeeze consumers without having to answer to any competition. One recently released analysis found that in the coming year, a greater number of rural residents will only be able to choose from one insurance plan on Affordable Care Act exchanges. This lack of available options, and thus competition, places all of the power into the hands of insurers ultimately looking to maximize their profits while passing more costs onto the consumer.

To justify these moves, insurance companies are turning to reports from an organization called the Institute for Clinical and Economic Review, which analyzes the costs of new medical treatments approved by the Food and Drug Administration, generally finding the price too high. This, in turn, allows insurance companies and other middlemen to put policies in place that effectively limit access to prescription drugs – like requiring doctors to get prior approval, one patient at a time, before prescribing medicines. Patients are then forced to either pick up the whole cost out of pocket, which can cost thousands of dollars, or forego treatment entirely. Doctors, patient advocacy groups and others have all raised concerns about this particular group’s funding.

Essentially, insurance companies are now picking winners and losers in the health care arena. By deciding who does and does not get access to certain treatments and medications, insurers and the organizations advising them are taking the fate of many rural Americans into their own hands.

Given the geographical isolation and availability of services, there is a strong connection between a rural community’s health care facilities and its residents. Our hospitals and our doctors are now faced with providing treatment plans that are dictated by the insurance companies, based on “expertise” from a detached entity operating without public oversight. Personalized treatment plans and care have been reduced to profit margins.

We cannot allow well-funded special interests to dictate this most basic of services. Treatment based on sound advice and consultation from one’s local medical provider must be the guidance behind any treatment plan, not profit margins. Our forefathers would not have placed a mathematical value on the lives of rural Americans. Further, they would not have allowed for-profit corporations to take advantage of our communities’ access to health care and compromise a basic right of all Americans.

Last year, Arkansas passed legislation to require greater transparency behind the decisions insurers make that affect prescription drug coverage for patients. It’s a perfect example of rural America once again pushing back against unjust practices, something other states should emulate. As consumers reject special interest meddling in their health care, a sense of security in communities and regions across the country will be reinstated.

Linda Newman her family ranch in north central Montana in the Missouri River Breaks. She is president of Women Involved in Farm Economics.

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