Last week’s cancer report from the Centers for Disease Control suggested that progress is being made. The death rate from all cancers nationally continues to decline.

But there is an important geographical disparity to those gains: Rural America is worse off than urban areas in both death rate from cancers of all types and in new cases.

The cancer report details a key reason life expectancy is declining for rural Americans, who are more likely to die from the top five causes of death, including cancer, than their urban counterparts.

Various reports over the years have highlighted greater risk factors among rural Americans, who are more likely to use tobacco, drink excessively and be obese. All these things contribute to higher incidences of, and deaths from, cancer.

But another factor is particularly relevant as Congress considers if and how to replace the Affordable Care Act, popularly known as “Obamacare”: Rural Americans are less likely to have health insurance coverage and must travel farther to obtain medical care.

The University of North Carolina reports that nearly 80 rural hospitals have closed since 2010; many more operate in the red and are thus at risk of failure.

It’s a deadly equation: Lack of coverage plus distance adds up to little preventative care. Couple that with risky behavior, and the result is markedly worse health.

The Affordable Care Act’s coverage mandates started in 2014. More Americans have health coverage now than before the ACA was passed, but it’s uncertain how much that has affected the statistics cited by the CDC. It is likely that more rural Americans have had such cancer screening as colonoscopies since the ACA was passed, but that has probably not shown yet in cancer mortality rates, and may even result in an increase in diagnoses.

But the CDC report underlines the rural issue of access to health care. We have seen little reason to believe that either the bill passed by the House earlier this year or the measure being massaged by the Senate will improve that situation. But the drive to “repeal and replace” Obamacare is in some cases not motivated by a desire to improve health care in the United States.

— Mankato Free Press, July 11