Today, the U.S. Department of Health and Human Services released an analysis of how the Affordable Care Act has benefited rural America. The findings, which examine independent studies and other data, show that health coverage in rural counties increased by 8.0 percentage points between late 2013 and early 2015, and the share of rural Americans unable to afford needed care dropped by almost six percentage points.
“The Affordable Care Act has helped millions of people in rural areas access quality, affordable health coverage,” said Secretary Sylvia M. Burwell. “As someone from rural America, I know how important these gains in coverage and access to care are to communities like my hometown of Hinton, West Virginia.”
Despite being disproportionately likely to live in states that have not expanded Medicaid, rural Americans have seen coverage gains under the Affordable Act on par with residents of cities because they have benefited from the Health Insurance Marketplace and tax credits that keep coverage affordable, from other coverage reforms such as the elimination of exclusions based on pre-existing conditions.
The new analysis documents the success of the Health Insurance Marketplace in particular in expanding coverage and access to care in rural areas. In the HealthCare.gov states alone, 1.7 million rural Americans purchased coverage through the Marketplace for 2016, comprising nearly 1 in 5 plan selections. This represents an 11 percent increase from 2015, greater than the overall increase in Marketplace enrollment. The Affordable Care Act also helped ensure that Marketplace plans remained affordable for rural households. For the almost 9 in 10 rural consumers who are eligible for premium tax credits, the average premium increased only 4 percent, or $5 per month, between 2015 and 2016, despite headlines suggesting double-digit increases.
Rural Americans, like residents of metropolitan areas, have also experienced improved access to care as the ACA’s major coverage provisions took effect. For example, among rural individuals, the share without access to a personal physician dropped 3.4 percentage points, and the share unable to afford needed care dropped 5.9 percentage points.
Even more progress could be made in improving coverage and access to care for rural communities if the remaining 19 states choose to expand. Nearly two-thirds of the rural uninsured (versus 51 percent of uninsured residents of non-metropolitan areas) live in states that have not yet expanded Medicaid at the end of 2015.