WASHINGTON – According to a new report from the Department of Health and Human Services, rural Americans pay for nearly half of their healthcare costs out of their own pocket, and one out of every five farmers is in medical debt.

Released Tuesday by HHS Secretary Kathleen Sebelius and Sen. Kay Hagan (D-N.C.) the report, titled "More Choices, Better Coverage: Health Insurance Reform and Rural America," details the healthcare inequities faced by rural Americans.

According to the report, one in five uninsured Americans – 8.5 million people – lives in a rural area.

In 2005, there were 55 primary care physicians per 100,000 residents in rural areas, compared to 72 per 100,000 in urban areas. As a result, the study found, nearly 50 million rural Americans lack access to a primary care provider because of shortages in their communities, and 12 million seniors live in areas where they do not have adequate access to a primary care provider.

"Americans who live in rural communities have a harder time finding the doctor they need and getting the care they deserve and their health suffers," Sebelius said. "Americans in rural communities also face some of the nation's highest rates of obesity and high blood pressure and they struggle to get affordable healthcare. Reform will improve access to high quality care in rural communities and help give all Americans the stable, secure care they need."

Hagan said rural areas in North Carolina have a 33 percent higher mortality rate from diabetes and a 60 percent higher mortality rate from heart disease. "Healthcare reform will improve the quality, accessibility and affordability of healthcare for people across rural America," she added.

The health reform package under consideration on Capitol Hill would create a health insurance exchange program designed to allow families to shop for health insurance coverage that is right for them, Hagan said.

She said healthcare quality will improve through the development of national standards and the coverage of preventive screenings for chronic diseases. Reform will also provide scholarships, grants and loan repayments to compel providers to practice in underserved areas so that all Americans can have access to healthcare, she said.