Researchers found that about rural areas in about half the states, mostly in the Midwest, had higher enrollment growth. (RUPRI graphic: 2015-16 Health Insurance Marketplace enrollment rates as a percent of the potential market, by metropolitan and expansion status.)
reports for the Daily Yonder. "The states that weren’t part of the study either managed their own marketplaces or had no non-metro counties."
Overall, metro areas had a higher rate of enrollment, 48 percent, but the gap has narrowed, says the study. Researchers found that "six of the eight states with the highest differentials (states in which metropolitan enrollment substantially outpaced non-metropolitan enrollment) were non-expansion states: Florida, Georgia, Kansas, Mississippi, Oklahoma, and Texas all showed large enrollment differences, as did Pennsylvania and Arizona in the Medicaid expansion group."
Marema writes, "Though a lower percentage of potential market purchased insurance in states that didn’t expand Medicaid, those states had a greater year-to-year increase in enrollment. That may be because private insurance was the only option for more residents in those states that didn’t expand Medicaid."
"The study noted that counties that had a concentration of residents who lived at 100 to 200 percent of the poverty income (defined as $24,300 for a family of four and $11,880 for individuals) had better enrollment rates than other counties," he writes. "The scholars theorized that was because lower-income residents are eligible for greater subsidies to help them pay for their insurance, so the insurance was a better deal."