Rural residents benefit most from enhanced ACA subsidies, and have highest risk of losing coverage without them

"Rural residents were the most likely to benefit from enhanced subsidies for Affordable Care Act coverage and face the greatest danger of losing coverage if those benefits expire after this year, a new study finds," Robert King reports for Fierce Healthcare. "The study, released by the Robert Wood Johnson Foundation Tuesday, comes as healthcare groups are making a major effort to get Congress to renew the boosted subsidies. ACA enrollment grew to a record-setting 14.5 million people this year, thanks in part to the higher subsidies."

This year's federal poverty threshold for a single person is $13,590, but people whose earnings put them over 400% of the poverty line ($54,360 for an individual) may still have a hard time affording decent health care. Through the ACA, such people have qualified, for the first time, for enhanced subsidies on their insurance premiums. If the tax credits that fund those subsidies are allowed to expire, "Rural residents will have few if any policies to choose from that are both affordable and comprehensive," said Kathy Hempstead, a RWJF senior policy adviser.

Rural residents generally pay higher premiums than their suburban and urban peers for a number of reasons, according to Urban Institute researchers working in collaboration with RWJF. They compared average premiums for benchmark plans on ACA exchanges and found that they were higher in rural areas than in urban areas in 34 states, averaging about 10% more, and "18 of them had average rural premiums more than 10% higher than the average urban premium. In addition, 12 of those states had rural premiums more than 20% of their urban counterparts," King reports. Illinois had the largest disparity, with rural residents paying an average of $217 more for their monthly premiums than their urban counterparts.

Health-care provider and insurance groups wrote an open letter to Congress this week urging them to make the enhanced subsidies permanent, King reports. "Our country continues to work through the economic and public health implications of Covid over the past two years, including rising inflation which is forcing families to pay more at the grocery store and gas pump," said the letter. "We cannot add to these burdens by putting the healthcare of 14.5 million current marketplace enrollees, and millions of future enrollees at risk."