This brief uses the Medical Expenditure Panel Survey (MEPS) to compare the health insurance coverage of rural and urban residents in 1997 and 2005 to assess how uninsured rates and sources of coverage have changed since SCHIP was enacted. The authors also discuss the characteristics of the rural uninsured and the implications for health insurance reform. Rural is defined as living in a non-metropolitan county, as designated by the Office of Management and Budget (OMB). All presented results are statistically significant at p. = .05.

Findings: Between 1997 and 2005, the uninsured rate among rural children declined more dramatically than among urban children, following increases in public health insurance. Public health insurance growth among rural adults was much more modest and uninsured rates remained the same. Nearly 60% of the rural uninsured have family incomes below 200% of the federal poverty level suggesting the potential for expanding public coverage. For those with higher incomes, policy strategies to strengthen private coverage will need to account for the unique employment and insurance market characteristics of rural areas.