This report describes the relative availability of health care resources, level of health insurance coverage, and cost of providing health services in the Appalachian Region compared with the rest of the United States, using a county-level index developed by PDA, Inc, and the Cecil G. Sheps Center for Health Services Research of the University of North Carolina at Chapel Hill. The Healthcare Cost Coverage and Access Index (HCCA) shows the status of Appalachian counties relative to one another, to other counties in Appalachian states, and to the rest of the counties in the United States. The report describes these county comparisons at the level of the HCCA summary index and each individual component index. It also tests relationships of the index and its components to county health status, economic status, and persistent poverty, and explores medical bankruptcy and the impact of health reform on state budgets.