About 1.4 million rural Americans purchased health care last year through the federally managed marketplace, about 10 percent more than in 2015, says a study by the RUPRI Center for Rural Health Policy at the University of Iowa. That represents 40 percent of the potential market outside metropolitan areas. Michigan, North Carolina and Wisconsin had non-metro enrollment rates above 50 percent.
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.)
"The study compared 2015 and 2016 data from the 36 states with non-metro counties whose individual insurance marketplace is managed through the federal system," Tim Marema 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."
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.)
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."
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