Rural communities throughout the United States lack sufficient access to quality health care services. Scholars suggest that these deficiencies persist despite a national consensus regarding the need for improved medical care; although bipartisan coalitions in the US House and Senate propose and support rural health care policy initiatives, Congress rarely enacts effective legislation. Existing research focuses on deficiency solutions and policy proposals, but few studies address the politics of rural health care reform. This study attempts to fill this gap. It examines legislative inertia through an analysis of two cases: the Emergency Health Personnel Act (EHPA) of 1970 and Health Care Access and Rural Equity (H-CARE) Act of 2007. The former legislation was successful; the latter failed. An analysis of these proposals finds that a combination of factors – including executive leadership, urban-centrism, and diverse policy proposals – contribute to successful or failed legislation.
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