BY JOHN CRABTREE

Last week I visited Ottumwa for the first time in a few years. I was reminded that it is a proud community with business, industry and considerable history, grand old downtown buildings — none more so than the grand facade of the Courier, a newspaper with over a century and a half of history as well. Like most communities throughout rural America, Ottumwa’s economy and its downtown are in need of continued revitalization.

Entrepreneurship and small business development are strategies with a proven track record for revitalizing communities in rural America. In these economic times, there are a number of obstacles that entrepreneurs must overcome to start a small business. But first and foremost among those obstacles is the cost of adequate health care coverage.

As health insurance premiums and out-of-pocket medical expenses rise, more small business owners in Ottumwa and surrounding communities will drop unaffordable coverage for themselves and their employees. This trend threatens the wellbeing and quality of life of Ottumwa and Wapello County residents. And economic development efforts will continue to be hampered by the risk that entrepreneurs face in leaving employment with health care benefits to start up their own business, forcing them to navigate the turbulent market for individual health care coverage alone.

Fortunately, a debate over health care reform has begun in earnest. Residents of Ottumwa and Wapello County have an opportunity to be a part of that debate this week. On Wednesday, April 15, the Center for Rural Affairs, Iowa Citizen Action Network and Iowa Farmers Union will host a health care forum at the Ottumwa Public Library, from 5-6 p.m.

For Ottumwa, Wapello County and all of rural America, health care reform is not only a matter of justice, but crucial to economic revitalization and the creation of economic opportunity. The economy in and around Ottumwa is based on self-employment, owner-operated farms and small business to a far greater extent than in urban centers. As a result, the people of Wapello County are more likely to be under-insured, more dependent on the individual insurance market and paying more for less coverage.

Rural Americans face unique challenges in our current health care system. And any health care reform legislation will need to address these challenges if Congress and the White House hope to fulfill the promise of making the health care system fair and equitable to all. One important starting point would be the creation of a public health insurance plan that provides individuals, families and businesses the option of choosing such a plan over private insurance. In particular, small business employers and employees and the self-employed would benefit from having the choice between a public health insurance plan and private insurance.

The strengths of a public health insurance plan are what many rural people and small businesses need — stability and affordability — while also providing more affordable health insurance access to vulnerable populations such as low and moderate income families and the self-employed.

John Crabtree is Development and Outreach Officer for the Center for Rural Affairs