The approach to covering the uninsured presented in the Patient Protection and Affordable Coverage Act (as amended on December 19, 2009 by the Senate Majority Leader's Manager's Amendment), when fully implemented, would reduce the number of uninsured to 2.9 million persons in rural areas, leading to a coverage rate of 94.1% (Table 1). This legislation would lead to a slightly higher coverage rate for rural than for urban persons (94.1% compared to 93.4%), largely because a lower proportion of rural persons are non-citizens who would not be covered under any of the proposed reform approaches but also because the reform proposal reaches more low-income persons who are more represented among the rural uninsured. These estimates also reflect the recently added provisions of slightly more generous subsidies for small employers. 

 

The tables in the report present state-by-state estimates of the effects of the legislation on overall health insurance coverage rates (for all persons, rural and urban persons), as well as estimates of how the previously uninsured would get covered under the provisions of the legislation. The results show significant variation in how the legislation would impact ultimate coverage rates, and how individuals would be covered under the legislation, mostly resulting from the initial characteristics of a state and their uninsured persons. 

 

The subsidies, tax credits, and public program expansions are particularly important to rural persons (Table 1). A higher proportion of rural adults (33% as compared to 29.7%) would obtain coverage through Medicaid (largely because their income falls below 133% of the federal poverty line), while a smaller proportion (23.2% as compared to 24.5%) would be children that obtain coverage either through public programs (Medicaid or CHIP) or through private insurance obtained by their parents (through the exchange). A slightly lower proportion of the previously uninsured in rural areas (43.8%, compared to 45.8% in urban areas) would obtain insurance through the Health Insurance Exchange.

 

 

Contact information: Timothy D. McBride, PhD, is a professor and associate dean for Public Health in the Brown School and a faculty scholar in the Institute for Public Health at Washington University in St. Louis. He currently serves as a Faculty Research Associate for the Rural Policy Research Center (RUPRI) Rural Health Policy Analysis Center. He can be reached by electronic mail at tmcbride@wustl.edu , or by phone at (314)935-4356. 

 

This report was supported by funding provided by the Robert Wood Johnson Foundation. The views expressed are those of the authors and should not be attributed to the Robert Wood Johnson Foundation or its trustees.