About NRHA

NRHA Organizational History

The following is a brief history of the formation and growth of NRHA into a vibrant and influential organization of thousands of members, advocates, and rural health stakeholders.
  • National Rural Primary Care Association (NRPCA) is founded and based in Waterville, Maine.
  • Sept. 18, 1978—Articles of incorporation are signed in the state of California.
  • The American Rural Health Association (ARHA) is formed. The association’s goal is to "become a definitive source of information on rural health." ARHA plans publication of a bimonthly newsletter, “Rural Health Communications,” and begins publication of the American Journal of Rural Health.
  • April 1982—5th Annual Conference on Rural Primary Care, "Strategies for Success," is held April 4-6, 1982, in Jackson, Miss.
  • The first meeting of state offices of rural health is held in conjunction with the conference.
  • NRPCA offices are relocated from Waterville, Maine, to Kansas City, Mo.
  • August 1983—Robert Van Hook is named as executive director and begins operations of the Kansas City, Mo., national office.
  • NRPCA membership hits 230.
  • The Board of Directors approves major bylaws changes that restructure the association.
  • The association becomes the National Rural Health Care Association (NRHCA).
  • Increased member involvement is established through regional and constituency group representatives on the Board of Directors.
  • Executive Committee, Nomination Committee and other standing committees are established.
  • Annual Policy Forum is established as a mechanism for direct member involvement in policy making and an opportunity for the association to produce clear-cut policy statements on important issues.
  • NRHCA and American Small and Rural Hospital Association (ASRHA) boards of directors vote unanimously to merge the two associations, retaining the NRHCA name. ASRHA members are folded into the NRHCA Hospital Constituency Group.
  • NRHCA and the American Rural Health Association (ARHA) boards of directors pass resolutions to develop and implement a plan to consolidate the two associations on terms that are acceptable to both within two years.
  • The NRHCA and the ARHA merge to form the National Rural Health Association (NRHA), creating a "new unified voice for rural health."
  • Six issues are selected as focus areas for the rural health research agenda established by NRHA in December 1987:
    • rural hospitals;
    • primary care and emergency medical systems;
    • elderly and long-term care;
    • maternal, child and adolescent health;
    • the rural poor and uninsured; and
    • alternative health care delivery systems;

  • NRHA's Board of Directors approves development of a grassroots legislative response group, NRHA's Legislative Action Network.
  • NRHA and NACHC's Joint Task Force on Rural Health releases a study that reveals inadequate funding for community health centers due to increased operating expenses of 14 percent, while federal funding increased by only 11 percent.
  • NRHA's Board of Directors approves the association’s seventh constituency group, the Frontier Constituency.
  • NRHA sponsors its first Legislative Action Network conference in Washington, D.C., to introduce NRHA members to the federal legislative process and advocacy.
  • National Health Care Reform—NRHA focuses on national health care reform by developing and distributing an issue paper, “Necessary Components of any National Health Plan,” outlining its position on components needed in a reformed national health plan to meet the needs of rural Americans. The eight components presented in the issue paper were:
    • universal access to health care;
    • national direction and funding;
    • state and local self-determination;
    • community development;
    • consumer choice;
    • financing incentives;
    • education and training; and
    • quality and efficiency.

  • NRHA members elect constituency representatives to the newly established Rural Health Policy Board through a special mail election.
  • Several NRHA members, including NRHA President Denise Denton, serve on the Clinton Administration’s Health Reform Task Force.
  • Illinois, Washington and Alabama state rural health associations become the first state affiliates of the newly formed NRHA State Association Council (formed by the bylaws structure revisions ratified by NRHA members in 1992).
  • NRHA holds its first invitational Rural Minority Health Conference.
  • NRHA conducts its first annual rural hospital symposium in Prairie du Chien, Wis.
  • NRHA enters into a three-year cooperative agreement ($530,000) with the Federal Office of Rural Health Policy that replaces small (average $25,000) contracts.
  • NRHA's Board of Trustees approves creation of the association’s eighth constituency group, the Rural Health Clinics Constituency.
  • NRHA conducts the Annual Rural Minority Health Conference in Long Beach, Calif.
  • NRHA goes online with email and the creation of the association’s website.
  • NRHA members ratify a bylaws amendment to create the State Office Council, which parallels the State Association Council to provide representation in the association for state offices of rural health.
  • The Board of Trustees approves a new initiative developed by President Tim Size, “A Community Approach to Rural Health Policy Development,” outlining a set of activities by NRHA to enhance community involvement in developing rural health policy related to health, education and economy.
  • August 1997—NRHA holds Southeastern Conference on Rural HIV/AIDS, "Issues in Prevention and Treatment," in Atlanta, Ga.; attendance tops 300, making it the largest meeting ever held by the association other than the annual national conference.
  • Universal Services Fund is established through the Telecommunications Competition and Deregulation Act of 1996.
  • The National Rural HIV/AIDS Initiative is launched in collaboration with the Office of National AIDS Policy to address the growing impact of the HIV/AIDS epidemic in rural and frontier America, as well as foster increased national, state and local awareness and resources for education, prevention and treatment efforts in rural communities.
  • The 15-member National Rural HIV/AIDS Task Force convenes for the first time in Albuquerque, N.M.
  • The House Rural Health Care Coalition and the Senate Rural Caucus introduce the “Rural Health Care Improvement Act of 2001.”
  • NRHA Board of Trustees approves a new membership policy establishing state rural health association members as affiliate members within NRHA.
  • The Medicare Payment Advisory Committee releases its Rural Report to Congress outlining recommendations for improving rural health care.
  • NRHA launches the first annual National Critical Access Hospital Conference, with more than 100 attendees.
  • Membership in the association exceeds 5,000.
  • NRHA launches the first annual National Rural Health Clinic Conference.
  • NRHA leads national efforts to include more than $20 billion in increased federal spending on rural health within the Medicare Modernization Act.
  • Membership in the association exceeds 7,000.
  • NRHA testifies before the House Appropriations Committee on behalf of rural health funding.
  • In a collaborative effort with NOSORH and the National Association of State EMS Directors, NRHA publishes “Rural/Frontier EMS Agenda for the Future.”
  • NRHA releases the publication “Hope in the Face of Challenge,” a book commissioned by NRHA and written by Tom Rowley. It profiles success stories in rural health from around the country.
  • NRHA begins a new national rural health quality initiative to promote “Quality through Collaboration.”
  • Membership in the association exceeds 10,000.
  • NRHA purchases a building in Kansas City, Mo., as the new home for its administrative offices.
  • The organization eliminates retained deficit and posts the first retained fund balance as an organization since 1985.
  • NRHA successfully leads the effort to restore funding for rural health programs, including rural research and funding for area health education centers.
  • NRHA launches the first annual National Rural Health Quality Conference in Kansas City, Mo., with more than 100 participants.
  • NRHA leads a national coalition to re-authorize the Conrad-30 program.
  • The Board of Trustees establishes NRHA Services Corporation, a for-profit entity to advance the common mission of the association.
  • NRHA holds the first annual Rural Clinicians Conference in Denver, Colo., with more than 100 participants.
  • NRHA membership exceeds 17,000.
  • NRHA testifies before the House Ways and Means Committee on the Medicare Advantage program in rural America.
  • NRHA testifies before the House Veterans Committee on rural veteran issues.
  • NRHA testifies before the House Agricultural Committee on the topic of rural development.
  • NRHA launches the Rural Health Fellows national rural health leadership program.
  • NRHA testifies before the House Ways and Means Committee on the Medicare Advantage program in rural America.
  • NRHA testifies before the House Appropriations Committee on rural health funding.
  • NRHA testifies before the Senate Health, Education, Labor and Pensions Committee on rural workforce.
  • NRHA launches re-designed website and Rural Roads magazine.
  • NRHA begins collaborative work with the Veterans Administration under a new grant agreement.
  • NRHA membership exceeds 20,000.
  • NRHA launches Medication Use in Rural America Conference in Kansas City, Mo.
  • NRHA begins collaborative work with the Health and Human Services Office of Minority Health under a new grant agreement.
  • NRHA begins a new health information technology initiative under a grant from the Leona Helmsley Foundation.
  • NRHA launches its new online career center.
  • NRHA completes a nationwide survey of rural hospitals' health information technology readiness.
  • Through a new HHS grant, NRHA launches the Rural Training Track Technical Assistance Demonstration Program.
  • NRHA successfully includes key rural health provisions in the Accountable Care Act.
  • NRHA participates on HHS Health Professional Shortage Area/Medically Underserved Area (HPSA/MUA) Negotiated Rulemaking Committee.
  • NRHA fights against Medicare cuts to rural hospitals during federal debt reduction discussions.
  • The White House Council on Rural is established.
  • NRHA Connect, the association’s online member social networking tool, is launched.
  • HHS Secretary Kathleen Sabelius speaks at the Rural Health Policy Institute.
  • NRHA Holds “March on Washington” on behalf of rural hospitals.
  • The National Rural Health Foundation is launched to support leadership development.

  • NRHA brings national attention to the growing rural hospital closure crisis.
  • NRHA successfully fights for extension of many critical rural provider payments (and opposed sequestration cuts).
  • NRHA leads a national response opposing the HHS Office of the Inspector General recommendations on critical access hospital “necessary provider” allowances.
  • In collaboration with the White House Rural Council, NRHA holds the first national philanthropy meeting on public/private collaborations.
  • NRHA convenes rural primary care issue group meeting in collaboration with the Federal Office of Rural Health Policy.
  • NRHA reconstitutes the Minority and Multicultural Council as the Health Equity Council and announces plans to conduct the National Rural Health Equity Conference.
  • NRHA supports the Senate’s adopted resolution (S. Res. 588), which recognizes access to hospitals and other rural health care providers for patients as essential to the survival and success of rural communities.
  • NRHA successfully promotes legislation extending the enforcement moratorium for physician supervision requirements at CAHs and small rural PPS facilities. 
  • NRHA releases national report showing approximately 700 rural hospitals at risk of closure.
  • NRHA works with Congress to see the introduction of H.R. 3225, the Save Rural Hospital Act, legislation designed to halt the onslaught of rural hospital closures.
  • NRHA addresses a national rally at the U.S. Capitol to demand action by Congress on the rural hospital closure crisis.
  • NRHA launches partnership with the Verizon Foundation and the Appalachian Regional Commission to pilot the Rural Community Health Worker Training Program to improve A1c levels amongst diabetic patients utilizing technology to support healthy lifestyles.
  • NRHA fights for federal legislation to help combat the opioid epidemic in rural America and obtains key provisions in the Senate legislation.

  • The Centers for Medicare and Medicaid Services establishes the CMS Rural Council. NRHA provides policy recommendations and guidance to the new entity which seeks to remove regulatory barriers for improving rural access and quality of care.
  • NRHA launches re-designed website, Rural Health Voices blog and print and digital versions of Rural Roads magazine.
  • In partnership with iVantage Analytics, NRHA releases a national report showing that 1 in 3 rural hospitals are at risk for closing. The report, “2016 Rural Relevance: Vulnerability to Value Study,” indicated that 673 rural hospitals were at risk of closure.

  • NRHA launches the National Rural Oral Health Initiative.
  • NRHA joins collaborative partnership with the National Institutes of Health All of Us Research Program - a precision medicine initiative that aims to gather data from one million or more people in the United States to accelerate research and improve health. This collaboration would assist with sharing the information to rural stakeholders to expand the data collection and evaluate disparities.
  • NRHA Participates in the White House Summit on the topic of “Addressing the Rural Opioid Crisis.”
  • NRHA President testifies on how federal investments in rural health care help ensure that rural health care thrives leading to healthy communities and sustainable their communities.

  • NRHA establishes a partnership with USDA to ensure direct technical assistance to rural hospitals.
  • NRHA receives funding from the National Cancer Institute to examine disparities in cancer care, and assist with assessment of current research efforts for rural communities.
  • NRHA successfully advocates for relief for rural communities struggling to meet the needs of those with substance use disorders through the 21st Century Cures Act.

  • NRHA hosts the World Rural Health Conference in Albuquerque, N.M., welcoming attendees from around the globe.
  • NRHA hosts the association’s 42nd Annual Rural Health Conference in Atlanta, Ga., with more than 1200 attendees.
  • NRHA launches the National Rural Community Health Initiative to support and spotlight the critical role of the 330A grant programs.
  • NRHA collaborates with key partners to participate in the forum, "A Conversation on Maternal Health Care in Rural Communities: Charting a Path to Improved Access, Quality and Outcomes," to share promising practices and help to identify areas of opportunity to improve access to maternal health services and achieve health equity within rural communities.

  • NRHA launches the Rural COVID Technical Assistance Center.
  • In response to the global COVID pandemic, NRHA transitions all educational events to an online virtual platform.
  • NRHA leads advocacy efforts to secure $11 billion in COVID relief funding for rural providers through the HHS COVID-19 Provider Relief Fund.
  • NRHA releases statement condemning systemic racism and its detrimental effects on the physical and mental health on rural individuals and communities.
  • NRHA launches the Rural Action Alliance, a national coalition of health care providers and facilities who provide high-quality, evidence-based care to millions of Americans, particularly to those living and working in rural and underserved areas. 

  • In partnership with the CDC, NRHA establishes the Rural Vaccine Confidence Initiative, a COVID vaccine communication and education campaign.
  • NRHA leads advocacy efforts to secure $10 billion in COVID relief funding for rural provider efforts including the rural Health Care Heroes Sustainability Fund, emergency grants for rural health care, and COVID-19 rural response.
  • NRHA more than triples its grant revenue through longstanding and new partnerships to increase support for rural communities impacted by the pandemic.
  • NRHA creates a new logo, rebranding all print and digital elements, including migrating the association website and email addresses to the new domain RuralHealth.US.
  • NRHA's Board of Directors approves the transition of the association’s Frontier Constituency Group to a special interest group.
  • NRHA leads advocacy efforts in the Infrastructure Investment and Jobs Act with $65 billion for broadband connectivity buildout and significant intent for rural.