National Rural Health Association

NRHA's 2017 Rural Health Policy Institute

Organizational History

NRHA past presidents

NRHA Rural Health Awards

Past Legislative Award winners

The following is a brief history of the formation and growth of NRHA from its humble beginnings into the vibrant and influential organization of more than 20,000 members today.


  • National Rural Primary Care Association (NRPCA) is founded and based in Waterville, Maine.
  • September 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 in the future begins publication of the American Journal of Rural Health.


  • April 1982—5th Annual Conference on Rural Primary Care, "Strategies for Success," is held on April 4-6, 1982, in Jackson, Miss.
    • Research contributed papers sessions are offered for the first time.
    • 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; 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 in the following ways.
    • The association name becomes the National Rural Health Care Association (NRHCA).
    • Establishment of increased member involvement through regional and constituency group representatives on the Board of Directors
    • Establishment of Executive Committee, Nomination Committee and other standing committees.
    • Establishment of Annual Policy Forum 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's agenda setting conference held in December 1987. They were:
    √ 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 approve 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 develops and distributes the 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 ORHP 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 1st Annual Rural Minority Health Conference in Long Beach, Calif.


  • NRHA goes online with email and the creation of NRHA'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. The initiative, A Community Approach to Rural Health Policy Development, outlines 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 establishment 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 to foster increased national, state and local awareness and resources to 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 StateRural Health Association members as affiliate members within NRHA.
  • TheMedicare Payment Advisory Committee releases its Rural Report toCongress, 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 the 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, Missouri, 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, Colorado 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 "Rural 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 web site.
  • NRHA launches re-designed 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 was established.
  • NRHA Connect, the Association’s online member social networking tool was launched.
  • HHS Secretary Kathleen Sabelius speaks at the Policy Institute.
  • NRHA Holds “March on Washington” on behalf of rural hospitals.
  • The National Rural Health Foundation is launched to support leadership development.

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