Rural residents pay a higher percentage of their income for their health insurance than their city cousins, yet they are less likely to blame insurance companies for recent increases in health premiums.

While there is little consensus on preferred reforms for the health care system, there is wide consensus that consumers should have more choice among health insurance plans.

Those were among the key findings of a just-released survey commissioned by Communicating for Agriculture and the Self-employed (CA) and conducted by Strategic Research Group, Minneapolis. CA is a national non-profit association that provides benefits and services for more than 100,000 independent businesses and their families. CA's national headquarters is in the rural community of Fergus Falls, MN.

Households across the U.S. were randomly surveyed. There were 300 rural households (in communities of less than 50,000 and more than 50 miles from a large city of 250,000 or more); 300 suburban households (communities adjacent to a city of 250,000 or more); and 300 urban households (residents of cities of 250,000 or more). Respondents were divided into three geographic groupings, and a grouping that was split by Republican-Independent-Democrat. The surveys were completed during the week of April 7 to 14. The overall margin of error is about 4%. The margin of error for each of the cells (groupings) is about 8%.

"The survey results would appear to confirm there is a sharp divergence of opinion on how to best improve health care access and keep costs affordable. We are a long, long way from a national solution on who and what is to blame and how to fix it," said Wayne Nelson CA president.

"However, there appears to be strong belief in the need for choice and a range of health insurance options available to consumers. And there is wide support for the idea of using tax credits to help those who can't afford health insurance, a concept now gaining more favor in Washington," he said.

The survey found:

--Seventy one percent of respondents said their health insurance premiums had recently increased, and 14% said they had recently dropped their health insurance because of higher costs.

But survey respondents differed on whom they blame for the cost increases and on what solutions they would favor to reform health insurance.

--When asked who is most to blame for rising health care costs, suburban and urban respondents tended to blame insurance companies most, while rural residents blamed doctors and hospitals for increasing costs.

--Rural residents were more likely to pay for their own health insurance, and paid a greater percentage of their income to get it. Suburban residents, while claiming the highest income of the three groups, also claimed to pay the least amount of their household income for health insurance.

--Only 11% of Democrats thought government rules and regulations were driving up health care costs, compared to 15% of Republicans and--surprisingly--26% of independents.

--Overall, 89% of respondents, almost equally among all groups, favor of giving consumers more choice choosing the type of health plans they can buy, including plans that would reduce the level of coverage to make them less costly.

--Seventy three percent of respondents said they support giving tax credits for people who can't afford insurance to address the rising level of Americans without health insurance protection.

--Rural residents were the strongest critics of a plan to replace the current health care delivery system with a government-run plan, like in Canada. Republicans also opposed this concept. Democrats and suburbanites were most likely to favor this plan, as were women.

--There is a little awareness of the health care proposals of the Presidential candidates, with 85% overall saying they did not know enough about them to have an opinion and 9% admitting they didn't know the candidates had health care proposals. The results were virtually the same among Republicans, Democrats and independents.

"Some of the results were surprising," Observed Jeff Smedsrud, Strategic Research Group. "We did not anticipate the insurance companies to be viewed as the culprit. In reality, the companies pass rising medical costs, such as high prescription drug costs, and many of them have been losing money recently. But consumers do not see it as such This should serve as a wake-up call for the insurance side of the health care industry. Unless they begin to effectively tell their side of the story, they face the likelihood of greater scrutiny by the American people, Congress and regulators. Insurance companies have faced greater regulation over the past 10 years, and analysts now point out it has not lowered costs for consumers. It has raised costs and contributed to the rising number of uninsured."

"The results tell us several things, said Nelson. "First of all, when Congress considers reforms it is clear that one-size-doesn't-fit-all. The impact of rising health care costs hit people in different locations in unique ways. Congress should especially consider that if you live in a rural area, you are more likely to pay for your health insurance and may be more likely to pay a greater percentage of your household income for your health premiums."

"Second, it suggests that there is overwhelming support to give the consumers greater say in how they design and pay for their health insurance plans. In this Internet -age of individual empowerment, consumers believe they can choose for themselves and they don't want 'Big Brother' to pick their health plans for them.

"And last, it reminds us that the growing number of uninsured Americans is a direct result of the rising costs of health care. Access to health insurance may be a problem for some, but the major reason more and more Americans are uninsured is that they cannot afford the coverage. And the costs increase are not entirely caused by the insurance industry--the causes are often the very factors--rising drug costs and greater government intervention--that consumers are not eager to blame," Nelson said.

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