As implementation of the Affordable Care Act continues, and more specific provisions go into effect with every passing day, health care experts and pundits are getting more comfortable predicting what the post-reform landscape might look like 5, 10 or 20 years out. Some observers project the ACA's value-based purchasing provisions will stimulate wholesale cultural change from the board room to the ED; others see reform and alignment creating a generation of empowered, enlightened physician leaders driving quality improvement.

Beyond the world of health care, though, the ACA will have an enormous effect on the rest of the American economy. Last week, I came across a report from the Center For Rural Affairs that hopes the ripple effects of additional coverage will encourage overall rural investment and population growth. The new report estimates that of the 15 million young Americans between 19 and 29 who are currently uninsured, 12 million will receive access to coverage through the ACA. Of those 12 million, roughly 600,000 will be young adults under 26 who will become eligible for their parents' coverage, the center estimates. And officials hope that gaining insurance coverage without having to leave home will promote long-term economic growth in rural areas, where the temptation to leave for opportunities elsewhere, usually referred to as the "brain drain," has long been a barrier to growth.

"Access to affordable, quality health insurance means more young adults can stay, return or relocate to rural communities," Alyssa Charney, a spokesperson for the Center for Rural Affairs, said in a press release.

Those optimistic projections come as the Obama administration launches a major initiative to encourage rural investment and growth in the health care sector and elsewhere; in June, the administration established the White House Rural Council, with directives to coordinate federal engagement with rural stakeholders. A score of federal agencies are involved in the initiative, including HHS. Specifically, the health care outreach of the new council includes plans to "improve access to quality health care through expansion of health technology systems."

To be sure, rural providers have plenty to worry about and consider as more of the ACA comes online, as my colleague Matthew Weinstock wrote about back in April while analyzing, among other things, an American Hospital Association report that lays out the manifold implications of reform for rural providers.

And rural providers still have their hands full with challenging financial realities; in June, AHRQ reported that low-income adults under 65 accounted for 56 percent of the 8 million visits to rural hospital EDs in 2008. Of those visits, roughly 44 percent were either paid for through Medicaid or were billed to uninsured patients.

Nonetheless, the wave of prognostications about the ACA reinforces the enormous role health care plays in American life.  The ACA might not single-handedly reverse the rural brain drain, but that conversation is a reminder that its impact extends well beyond the coverage and reimbursement provisions most health care experts have focused on.