Rural Health
Research Gateway

Timothy D. McBride, MS, PhD

RUPRI Center for Rural Health Policy Analysis

Phone: 314.935.4356
Email: tmcbride@wustl.edu
X: @mcbridetd
LinkedIn: Timothy on LinkedIn

Public Health
Washington University in St. Louis
One Brookings Drive
St. Louis, MO 63130

Current Projects - (3)

  • Changes in Rural Health Insurance Coverage, 2020-2023
    This project uses secondary data sources to characterize changes in health insurance coverage during the public health emergency (2020-2023) for rural and urban people according to demographic, employment, and geographic characteristics, and to describe how changes in federal policies impacted coverage. Researchers also assess the potential impact of maintaining more robust marketplace subsidies on rural and urban coverage rates once the "unwinding" of continuous Medicaid enrollment is complete.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health reform, Healthcare financing, Medicaid and CHIP, Medicare, Medicare Advantage (MA), Private health insurance, Rural statistics and demographics, Uninsured and underinsured
  • Differences in Rural and Urban Hospital Cost Structures: Evidence and Implications
    The project will compare fixed-to-variable cost ratios in U.S. rural and urban hospitals. We hypothesize that rural hospitals will realize proportionally greater fixed costs than urban hospitals, suggesting important hospital payment system implications.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health reform, Healthcare financing, Medicare
  • Rural-Urban Differences in Medicare Advantage Plan Quality Scores
    This project updates previous RUPRI Center publications focused on rural-urban differences in access to, and enrollment in, Medicare Advantage plans with four- and five-star quality ratings.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health services, Healthcare financing, Medicare, Medicare Advantage (MA)

Completed Projects - (20)

  • An Empirical Study of Health Insurance Firm Participation over Time in Rural Counties
    We examined changes in firm participation in multiple health insurance markets (FEHBP, MA, HIMs) over time in rural counties. We had hypothesized that participation would be related inversely to population density, because it becomes more difficult to spread risk, and network formation becomes more challenging when primary and specialty care becomes less available.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Medicare Advantage (MA), Private health insurance
  • An Insurance Profile of Rural America: A Chartbook
    This chartbook describes current conditions and recent trends in rural health insurance by drawing from census data and other sources. Tables and maps, accompanied by bulleted policy takeaways, compare rural and urban coverage sources, the degree of competition among issuers, and the share of the population who are underinsured.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topic: Uninsured and underinsured
  • Analysis of Medicare Advantage Quality in Rural Areas: Historically and Moving Forward
    This project examines the role that geography and demographics play in the success and quality of different types of MA plans in particular regions of the country.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Medicare, Medicare Advantage (MA)
  • Analysis of Trends in Characteristics of Rural Beneficiaries Enrolling in Medicare Advantage Plans
    This study compared characteristics of rural and urban beneficiaries enrolling in Medicare Advantage (MA) plans, including their age, health status, income, and race/ethnicity. We analyzed the consequences of increasing use, promoted by policy choices, of a market-based approach in the Medicare program.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Medicare Advantage (MA), Rural statistics and demographics
  • Do Communities Make a Difference in Access? A National Study
    This project will examine the effect of community-level resources on an individual's access to healthcare, particularly whether urban and rural individuals' access to healthcare differs, given community differences.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topic: Health services
  • Effects of Changing Medicare Advantage Landscape on Rural Enrollees
    The goal of this project is to assess the impact of changes in Medicare payment policy on the availability of choices for rural Medicare beneficiaries. The objectives are quantify the impact of payment policy on the number of competing plans in strata of rural counties and the effects of using quality star ratings on choices in rural counties.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Medicare, Medicare Advantage (MA)
  • Estimating the Medicare+Choice Threshold Payment Rate
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Healthcare financing, Medicare
  • Expanding Rural Health Insurance Coverage: How Do Insurance Reform Strategies Stack Up?
    This purpose of this study is to inform policymakers about the current state of health insurance coverage in rural America, and to assess how specific reform strategies may differentially affect rural residents. Using a combination of analytic strategies, we will provide policymakers and rural health advocates with the necessary tools to develop reform strategies that meet the needs of rural residents.
    Research centers: Maine Rural Health Research Center, RUPRI Center for Rural Health Policy Analysis
    Topics: Health reform, Private health insurance, Uninsured and underinsured
  • Health Insurance Marketplaces, Medicaid, and Uncompensated Care: The Rural Impact
    This project provides an in-depth analysis of Health Insurance Marketplace (HIM) plan design, specifically measuring the availability and prevalence of high-deductible plans in rural as compared to urban areas.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health disparities and health equity, Healthcare access, Medicaid and CHIP, Uninsured and underinsured
  • How will Plan Offerings and Premiums Change in Rural and Urban Areas in the Second Year of Health Insurance Marketplaces?
    This project analyzes changes in Health Insurance Marketplaces plan and premium data between 2014 and 2015 by geographic region.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topic: Private health insurance
  • Impact of Medicare Advantage Plan Concentration on Choices and Competition in Rural Areas
    This project focuses on the analysis of Medicare Advantage (MA) plan choices for rural beneficiaries and what the concentration of plan choices in rural areas may mean in the context of how rural beneficiaries are making their choices. Using measures of concentration from the economics literature, this project will explore the relationship between market concentration in MA plans and the generosity of MA plans, and how it varies by the location of residence of Medicare beneficiaries.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Medicare, Medicare Advantage (MA)
  • Implementation of the Medicare Prescription Drug Benefit: What is Available to Rural Beneficiaries?
    This study will focus on the impact of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 on rural beneficiaries, based on actual prescription drug plan contracts, comparing the impact of the legislation on rural beneficiaries to their urban counterparts.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Legislation and regulation, Medicare Part D
  • Rural and Urban Sources of Insurance Coverage: the Role of Public and Private Coverage over Time
    We estimated the percent of rural residents obtaining insurance coverage under each of the major options available to them using multiple data sets and a methodology that accounts for multiple sources of coverage. We compared rural and urban coverage sources and changes in coverage over time.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health reform, Healthcare financing, Uninsured and underinsured
  • Rural Premiums, Issuer Participation, and Enrollment in Health Insurance Marketplaces: An Updated Analysis
    The project described variations in Health Insurance Marketplace plan design and availability, total and net-of-subsidy premium trends, and enrollment over time between rural and urban areas and identified associations between these factors and several key policy differences and changes, controlling for economic and demographic variation.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health disparities and health equity, Health reform, Healthcare access, Private health insurance, Rural statistics and demographics, Uninsured and underinsured
  • State Policy Issues That May Impact HIMs' Success in Rural Places: A Regional Analysis
    Goals of this project include gathering detailed data and providing analysis and policy recommendations on issues relating to network adequacy and service areas for HIMs, with additional investigation of other state-level policy variables (such as the Medicaid expansion decision) which may have a confounding or moderating effect on the relationship between network adequacy and enrollees' choices and premiums.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health information technology, Legislation and regulation, Medicaid and CHIP, Private health insurance, Telehealth
  • The Geographic Expansion of Medicaid MCOs
    This project characterized the counties into which Medicaid Managed Care Organizations (MCOs) expanded in 2012-18, focusing on population and provider density, sociodemographics, and health indicators. We assessed the extent to which MCO geographic expansion occurred in compliance with previous network adequacy standards and evaluated how well MCOs were performing in rural areas.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topic: Medicaid and CHIP
  • Trends in Medicare Advantage Quality and Enrollment: The Effects of Quality Based Payment Incentives on Rural People and Places
    This research will analyze the quality of Medicare Advantage (MA) plans offered to rural MA beneficiaries currently, in relation to urban beneficiaries, and how it has evolved over the past four years. In addition, the effect of quality-based payment incentives will be measured by: 1) changes that have been made to improve the quality of existing plans in rural areas or to encourage the entry of high quality plans into rural areas, and 2) the movement of plans' entry and exit into the MA market by plan type and rural/urban location.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Medicare, Medicare Advantage (MA)
  • Uninsurance and Welfare Reform in Rural America
    This project used widely accepted databases to examine the recent history of uninsurance rates in the U.S., focusing on the low-income population that could be eligible for welfare. Additionally, the project concentrated on how welfare reform has impacted the health insurance coverage of welfare recipients and other low-income persons over the period when welfare reform was phased in.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Poverty, Uninsured and underinsured
  • Why Are Health Care Costs Increasing and Is There a Rural Differential in National Data?
    This project will determine whether growth in health insurance premiums and out-of-pocket spending differs in rural areas as compared to urban areas.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topic: Private health insurance
  • Will Health Insurance Marketplaces Deliver Affordable Options in Rural America
    This project analyzes early Health Insurance Marketplaces plan and premium data by geographic region, controlling for state policy decisions, to assess the degree to which affordable health insurance will be available through individual and/or small business marketplaces.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health reform, Private health insurance

Publications - (91)

2024

2023

  • Policy Implications of Fixed-to-Total-Cost Ratio Variation Across Rural and Urban Hospitals
    Journal Article
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2023
    This article utilizes hospital cost report data to estimate the relationship between adjusted volume and total costs of patient care. These results are used to estimate fixed-to-total-cost ratios for all nonfederal, short-term acute care hospitals in the U.S. These ratios were then stratified by rurality and Critical Access Hospital status.

2022

  • An Insurance Profile of Rural America: Chartbook
    Chartbook
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2022
    Over the past decade, health insurance coverage has changed in major ways in rural areas with shifts towards public and publicly subsidized coverage among the nonelderly – Medicaid, Marketplace plans – and a shift towards Medicare Advantage among those eligible for Medicare. This chartbook describes these trends in detail.
  • Health Insurance Marketplaces: Issuer Participation Trends in Non-Metropolitan Places, 2014-22
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
    Date: 08/2022
    Since the 2014 implementation of Health Insurance Marketplaces (HIMs), considerable changes have been observed in the number of insurance companies offering plans across the United States. This policy brief describes changes in HIM plan issuers over the 2014-2022 period with an emphasis on variation across metropolitan and non-metropolitan places.
  • Meeting the Behavioral Health Needs of Farm Families in Times of Economic Distress
    Policy Brief
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 02/2022
    Economic fluctuations and periods of distress in farming cannot be eliminated, however, their impact on communities and individuals can be mitigated. Strategies for meeting the behavioral health needs of farm families by supporting community-based services, and expanding behavioral health services in rural contexts are highlighted in this work.
  • High-Performing Rural Health System
    Policy Brief
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 01/2022
    This document updates the RUPRI Health Panel's framework, for a high-performing rural health system, originally published in 2011. It offers a revised vision statement and updates the high-performing rural health system pillars (access, affordability, community health, and quality) and describes an underlying base of equity considerations.

2021

2020

  • Considerations for Defining Rural Places in Health Policies and Programs
    Report
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 05/2020
    Rural definitions in statute and policy are used to direct resources to underserved people. But changes in population behavior and census processes have led to concern about historic methods of defining rural. This paper identifies key questions, reviews rural definitions, and discusses options for reconsidering rural definitions.

2019

2018

  • Assessing the Unintended Consequences of Health Policy on Rural Populations and Places
    Report
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 12/2018
    This paper explores the unintended consequences of health policy through an analysis of policy actions that have affected, or had the potential to affect, rural people, places, and/or providers in ways counteractive to policy intent.
  • Health Insurance Marketplaces: Issuer Participation and Premium Trends in Rural Places, 2018
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2018
    This brief assesses changes from 2014 to 2018 in average Health Insurance Marketplace plan participation and pre-subsidy premiums in rural and urban places. Insurance carriers reduced participation across both, while the gap between average premiums in expansion and non-expansion states is widening at a similar rate in rural and urban counties.
  • Insuring Rural America: Health Insurance Challenges and Opportunities
    Policy Brief
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 07/2018
    This brief discusses a series of policy considerations in three main categories: policies related to rural insurance risk, policies related to provider networks, and policies related to rural payment rates and structures.
  • Distance and Networks: A Regional Analysis of Health Insurance Marketplaces
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2018
    Using 2015-16 data on 15 Midwestern states, we examine the possibility that geographic distance to care plays a role in insurance issuer participation, premiums, and enrollment success through its effect on network adequacy and assess the moderating role that state-level policies on network adequacy standards and Rating Area design may have.

2017

  • Rural Long-Term Services and Supports: A Primer
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 11/2017
    This paper provides policymakers and other interested stakeholders a primer on the fundamentals of the rural LTSS system, rural access to and use of LTSS, and the opportunities and limitations of current federal and state LTSS policy for advancing rural health system transformation toward a high-performing rural health delivery system.
  • Rural/Urban Analysis on Individual Insurance Market Topics
    Fact Sheet
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2017
    Some special challenges face the development and sustainability of marketplace plans in rural areas. This data release provides some additional detail on some important topics, with particular importance to rural people, places, and providers.
  • After Hospital Closure: Pursuing High Performance Rural Health Systems Without Inpatient Care
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 06/2017
    A new paper describing opportunities for rural communities to develop a high performance rural health system after hospital closure, including three case studies that describe real-world transitions from hospital-based locus of care to new models of care delivery in rural places.
  • 2016 Rural Enrollment in Health Insurance Marketplaces, by State
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2017
    Cumulative county-level enrollment rates in Health Insurance Marketplaces (HIMs) in metropolitan and non-metropolitan areas of each state, defined as the percentage of "potential market" participants selecting plans, are presented as of March 2016. States are separated by Medicaid expansion status.
  • Changing Rural and Urban Enrollment in State Medicaid Programs
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2017
    Medicaid enrollment growth in 36 states is analyzed by rural and expansion status, pre- and post-Affordable Care Act (ACA). Enrollment growth was larger in expansion states but did take place in most states, with significant state-level variation in both groups. Metropolitan areas generally had higher growth than micropolitan and rural areas.

2016

  • Rural Medicare Advantage Market Dynamics and Quality: Historical Context and Current Implications
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2016
    There is significant variation in the quality ratings of MA plans that are available to rural beneficiaries. This brief suggests that policy interventions may be necessary to improve the quality of MA plans in rural areas.
  • Health Insurance Marketplaces: Premium Trends in Rural Areas
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2016
    Total Health Insurance Marketplace premiums have grown disproportionately in rural places in 2016. Urban counties have an average of 4.2 firms, while rural counties average 3.2 firms offering coverage through the HIMs. This causes concern since, at the county level, we find that as the number of firms increases, premiums increase at a slower rate.
  • Rural Medicare Advantage Plan Payment in 2015
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2016
    Payment to Medicare Advantage (MA) plans was fundamentally altered by the Patient Protection and Affordable Care Act of 2010 (ACA). This brief finds that while plans operating in both rural and urban areas have experienced a reduction in MA payment, the reduction in rural payment overall has been less significant.

2015

  • Medicare Value-Based Payment Reform: Priorities for Transforming Rural Health Systems
    Report
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 11/2015
    As Medicare moves to value-based payment, healthcare groups are made more accountable for patient health. But the changes have been concentrated in urban areas. Policies meant to strengthen rural health systems are complicating payment and delivery system reform in rural areas. This study examines ways to include rural areas in the changes.
  • Rural Enrollment in Health Insurance Marketplaces, by State
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2015
    This brief compares cumulative enrollment totals in Health Insurance Marketplaces in metropolitan and non-metropolitan areas by state and the percentages of potential market participants enrolled. Non-metropolitan enrollment rates were higher in several states. The analysis shows how well outreach/enrollment efforts targeting rural areas work.
  • Rural Enrollment in Health Insurance Marketplaces
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2015
    This brief analyzes Health Insurance Marketplace enrollment outcomes for 2015 at rating area/county levels. Enrollment rates are reported by number of firms participating and for multiple geographic categories: population density, census region, and metropolitan status of the county. Rural/urban rates are often similar, but areas of concern exist.
  • Care Coordination in Rural Communities Supporting the High Performance Rural Health System
    Report
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 06/2015
    This paper examines care coordination programs and processes that affect rural areas to discover what is happening in rural communities, how various programs and approaches are working, who benefits, and to make policy recommendations that will facilitate care coordination efforts in support of high performance rural health system development.
  • Health Insurance Marketplaces: Early Findings on Changes in Plan Availability and Premiums in Rural Places, 2014-2015
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2015
    Analysis of national county-level Health Insurance Marketplace (HIM) plan data for 2014 and 2015 shows there is no systematic pattern to rural experiences of HIMs, although some isolated places may be at risk for weak outcomes.
  • 2014: Rural Medicare Advantage Enrollment Update
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2015
    Rural Medicare Advantage (MA) and other prepaid plan enrollment in March 2014 was about 1.95 million, an increase of more than 216,000 from March 2013. Enrollment increased to 1.99 million in October 2014. Rural and urban enrollment increased despite reductions in payment and the conclusion of the MA bonus payment demonstration at 2014's end.

2014

  • Geographic Variation in Premiums in Health Insurance Marketplaces
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2014
    This policy brief analyzes the 2014 premiums of health insurance plans available in the new marketplaces created by the Affordable Care Act.
  • A Guide to Understanding the Variation in Premiums in Rural Health Insurance Marketplaces
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2014
    This brief provides a framework for assessing variations in the premiums of plans offered in the Health Insurance Marketplaces across geography.
  • The Uninsured: An Analysis by Age, Income, and Geography
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2014
    This brief analyzes the rural/urban uninsured populations by age. Furthermore, we discuss the potential for age differences between rural and urban uninsured populations to drive Health Insurance Marketplace premiums upward, an effect which may be mitigated or compounded by various other factors.
  • 2012 Rural Medicare Advantage Quality Ratings and Bonus Payments
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2014
    This brief analyzes differences in rural Medicare Advantage (MA) quality ratings and payments and suggests reasons why quality ratings vary by geography. Overall, the quality rating of MA plans in rural areas is lower than in urban areas, a result of the availability of, and enrollment in, different types of MA plans.

2013

  • March 2013: Medicare Advantage Update
    Rapid Response to Requests for Rural Data Analysis
    Date: 09/2013
    This policy brief discusses current rural Medicare Advantage enrollment data.
  • The Uninsured: An Analysis by Income and Geography
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2013
    This brief reports that a larger proportion of the rural versus urban population is uninsured and low income and will be eligible for subsidized Health Insurance Marketplace coverage due to income levels and current lack of insurance.
  • September 2012: Medicare Advantage Enrollment Update
    Rapid Response to Requests for Rural Data Analysis
    Date: 04/2013
    This policy brief discusses current rural Medicare Advantage enrollment data.
  • June 2012: Rural MA Enrollment and Premium Update
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2013
    Though 2012 Medicare Advantage enrollment grew and premiums declined, rural enrollees faced higher premiums than urban enrollees. Analysis of the zero premiums by plan in relationship to plans charging premiums gives insights into the MA marketplace.

2012

  • The Current and Future Role and Impact of Medicaid in Rural Health
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 09/2012
    This report outlines and describes the current Medicaid program and its importance to rural America. It also discusses rural implications of program expansion, including whether and how states choose to implement changes.
  • Stand-Alone Prescription Drug Plans Dominated the Rural Market in 2011
    RUPRI Center for Rural Health Policy Analysis
    Date: 09/2012
    This report shows that as of May 2011, 59.1% of rural Medicare beneficiaries were enrolled in Medicare Part D through insurance plans that provide coverage for prescription medications. It also provides further detail, including urban and rural enrollment by type of plan and by state.
  • March 2012: Rural Medicare Advantage Enrollment Update
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2012
    This policy brief presents key findings on rural Medicare Advantage enrollment and on rural Preferred Provider Organization enrollment.

2011

  • Rural Medicare Advantage 2011: Enrollment Trends and Plan Characteristics
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2011
    This paper reports findings from Centers for Medicare and Medicaid Services data analysis to examine the trends/geographic variations in Medicare Advantage (MA) plan enrollment, premiums, and market concentration by firm. The data provide an overview of the MA program in rural America and highlight key rural/urban differences within the program.
  • The High Performance Rural Health Care System of the Future
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 09/2011
    This project describes a future rural system that would be built on foundations of affordability, accessibility, community focus, high quality, and patient centeredness.
  • June 2011: Rural Medicare Advantage Enrollment Update
    RUPRI Center for Rural Health Policy Analysis
    Date: 09/2011
    This brief shows increases in enrollment into Medicare Advantage plans in rural America. The enrollment is concentrated in plans offered by three firms, especially in the types of plans with high rural enrollment, which are preferred provider organizations and private fee-for-service plans.
  • March 2011: Growth in PPOs Dominates the Rural MA Market in 2011
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2011
    From March 2010 to March 2011, rural Medicare Advantage (MA) enrollment in preferred provider organization (PPO) plans grew from 28% (396,006 enrollees) to 46% (702,315 enrollees) of total enrollment, while rural MA enrollment in private-fee-for-service plans fell from 38% (530,678 enrollees) to 16% (249,499 enrollees).

2010

  • Securing High Quality Health Care in Rural America: The Impetus for Change in the Affordable Care Act
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 12/2010
    The Affordable Care Act calls for the development of a National Health Care Quality Strategy and Plan (National Quality Strategy) that will affect healthcare that is delivered to millions of Americans who live in rural areas and thousands of healthcare providers who care for them.
  • September 2010: Rural Medicare Advantage Enrollment Update
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2010
    Rural enrollment in Medicare Advantage (MA) plans grew to nearly 1.5 million enrollees in September 2010 (15% of eligible Medicare beneficiaries), while national MA enrollment grew to more than 11.5 million (25%). Rural Medicare beneficiaries will find fewer options for MA health insurance coverage in 2011.
  • The Patient Protection and Affordable Care Act of 2010: Impacts on Rural People, Places, and Providers: A First Look
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 09/2010
    This report summarizes six issue areas of the Affordable Care Act and discusses implications for access to services and improving the health status of rural residents. The issue areas are health insurance coverage; Medicare and Medicaid payment; quality, financing, and delivery system reform; public health; healthcare workforce; and long-term care.
  • Rural Medicare Advantage: Modest Enrollment Growth in 2010
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2010
    Despite a slight drop in enrollment and a dramatic shift in the landscape of the rural Medicare Advantage (MA) market in early 2010, MA plans have experienced modest growth in enrollment in rural areas during the last two quarters of 2010. The majority of the growth is concentrated in preferred provider organization plans.
  • February 2010: A Dramatic Shift Away From Private Fee-for-Service Plans in Rural Medicare Advantage Enrollment
    RUPRI Center for Rural Health Policy Analysis
    Date: 03/2010
    Private fee-for-service (PFFS) enrollment fell in rural areas in early 2010. As a result, Medicare Advantage (MA) enrollment in rural areas fell. Nationwide, enrollment in preferred provider organization and health maintenance organization plans grew, offsetting the decline in PFFS enrollment and contributing to growth in total MA enrollment.
  • December 2009: Rural Medicare Advantage Enrollment Grows 15% in 2009
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2010
    Rural enrollment in Medicare Advantage (MA) and other prepaid plans grew by 15% from December 2008 to December 2009. Preferred provider organization plans drove the increased enrollment in MA plans in rural areas in 2009, while private fee-for-service plans continued to dominate the market with over 50% of enrollment.

2009

  • July 2009: Rural Enrollment in Medicare Advantage Continues to Grow
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2009
    Rural enrollment in Medicare Advantage continues to increase, with growth in the last 18 months led by the growth of preferred provider organization (PPO) plans. Despite the growth in PPO plans, private fee-for-service plans continue to dominate enrollment in rural areas and have accounted for much of the program's growth since 2005.
  • Impact of the Recession on Rural America: Rising Unemployment Leading to More Uninsured in 2009
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2009
    This brief presents the results of state and county analysis of unemployment rates nationally in urban and rural (non-metropolitan) areas during the period 2007-February 2009 and discusses the impact of rising unemployment on uninsurance in rural areas.
  • May 2009: PPOs Driving Growth in Rural Medicare Advantage Enrollment
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2009
    Rural Medicare Advantage (MA) enrollment had rapid growth in preferred provider organization (PPO) plans and a decline in the growth rate of private fee-for-service (PFFS) plans. MA enrollment has continued to climb, but it has been impacted by the slowed rate of growth in PFFS plans, which cover more than half of MA enrollees in rural areas.
  • A Rural-Urban Comparison of a Building Blocks Approach to Covering the Uninsured
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2009
    This brief uses a RUPRI health insurance model to compare the effects of a building blocks approach on health insurance coverage and health spending, focusing on the geographic differences (by metropolitan and non-metropolitan) of this approach.
  • April 2009 Rural Enrollment in Medicare Advantage: Growth in PPOs Outpacing Growth in PFFS
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2009
    Private fee-for-service (PFFS) plans dominate enrollment in rural areas and have accounted for much of the program's expansion since 2005. However, from December 2008 through April 2009 enrollment growth of preferred provider organization (PPO) plans, both nationally and in rural areas, was double the enrollment growth of PFFS plans.
  • Rural Enrollment in Medicare Advantage: Growth Slows in 2008
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 03/2009
    The rate of growth of enrollment in the Medicare Advantage program decreased significantly in 2008, compared to previous years. The growth rate in preferred provider organization plans in rural areas now exceeds that in private fee-for-service plans. This updates earlier findings from analysis of the MA program reported by the RUPRI Center.

2008

2007

2006

  • Medicare Physician Payment: Impacts of Changes on Rural Physicians
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 09/2006
    This policy brief provides an overview of the effects of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 on physician payment rates in rural areas. The brief discusses the effects of the Medicare incentive payment for providing services in shortage areas and of the bonus for practicing in a physician scarcity area.
  • Medicare Part D: Early Findings on Enrollment and Choices for Rural Beneficiaries
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2006
    This policy brief provides a first snapshot of enrollment in Medicare Part D in rural and urban areas across the United States and outlines the early findings from an analysis of plans available to rural persons under this program.

2005

  • The Impact of Welfare Reform on Health Insurance Coverage in Rural Areas
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 12/2005
    This policy brief explores the impact of welfare reform on the health insurance coverage of welfare recipients and other low-income persons during the period when the reform was phased in.
  • Why Are Health Care Expenditures Increasing and Is There a Rural Differential?
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2005
    Rising healthcare expenditures have disproportionately affected rural areas and in recent years seen higher increases in some expenditure categories, such as physician office-based visits and prescription drugs. Differences suggest strategies to contain health expenditure increases may be different in rural areas and determined on a local basis.
  • The Federal Employees Health Benefits Program: A Model for Competition in Rural America?
    Journal Article
    RUPRI Center for Rural Health Policy Analysis
    Date: 2005
    Tests the hypothesis that the Federal Employees' Health Benefits Program (FEHBP) has fostered an environment of competing health plans, especially preferred provider organizations (PPOs), in rural areas.
  • Understanding the Impacts of the Medicare Modernization Act: Concerns of Congressional Staff
    Journal Article
    Maine Rural Health Research Center, RUPRI Center for Rural Health Policy Analysis, Upper Midwest Rural Health Research Center
    Date: 2005
    The most efficient mechanism for research to affect policy is to provide policy makers with information on issues about which they have voiced concern. The Rural Policy Research Institute's Health Panel conducted 2 focus groups with 16 congressional staff in 2004 to identify a set of researchable questions concerning rural healthcare.

2004

  • Rural Physicians' Acceptance of New Medicare Patients
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2004
    Findings are presented regarding rural physicians' acceptance of new Medicare patients from an analyses of national survey data of urban and rural respondents, published studies, and results of a survey of state organizations representing physicians.

2003

2002

2001

2000