Rural Health
Research Gateway

Uninsured and underinsured

Completed Projects

Listed by project completion date. You can also view these projects alphabetically.

2024

  • 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

2022

  • 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
  • Northern Border Regional Commission State and Region Chartbooks: A Health-Focused Landscape Analysis
    The aim of this study was to compile the most recent publicly available data related to health and healthcare access at the county-level and state-level for the Norther Border Region and the individual states: ME, NH, VT, and NY. We highlighted counties with worse health outcomes, as compared to the rest of the counties in the region.
    Research center: Maine Rural Health Research Center
    Topics: Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), Rural statistics and demographics, Social determinants of health, Substance use and treatment, Telehealth, Uninsured and underinsured, Workforce

2021

  • 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

2018

2016

  • How Have Changes in Insurance Coverage Under Health Reform Affected Uncompensated Care and Financial Performance in Rural Hospitals?
    This two-year project will explore the effects of changes in insurance coverage under health reform on the following outcomes in rural hospitals: (1) bad debt; (2) charity care; (3) payer mix (Medicare, Medicaid, other); (3) financial performance; and (4) hospital revenue cycle management. Results will inform federal and state agencies, rural providers and communities as to how implementation of the Patient Protection and Affordable Care Act is impacting reimbursement and financial performance of rural hospitals, allowing the Office of Rural Health Policy to identify emerging challenges and develop strategies or policy changes needed to deal with any unintended consequences.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Health reform, Hospitals and clinics, Private health insurance, Uninsured and underinsured
  • How Have Changes in Insurance Coverage Under Health Reform Affected Uncompensated Care and Financial Performance in Rural Hospitals? (Year 2)
    The second year of this two-year project will explore the effects of changes in insurance coverage under health reform on the following outcomes in rural hospitals: (1) bad debt; (2) charity care; (3) payer mix (Medicare, Medicaid, other); and (4) financial performance.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Health reform, Healthcare financing, Medicaid and CHIP, Medicare, Private health insurance, Uninsured and underinsured
  • Identification of Highly Vulnerable Counties: The Intersection of Race, Poverty, and Health Care Resources
    The United States rural population has changed since the 2000 Census; minority populations have increased while overall population growth has slowed. This analysis will identify places of high vulnerability, defined as counties with high proportions of poor and/or minority populations with low or reduced healthcare resources.
    Research center: Rural and Minority Health Research Center
    Topics: Minority health, Uninsured and underinsured

2015

  • Affordable Care Act Outreach and Enrollment: Case Studies of Rural Hospitals in Four States
    The purpose of this project is to identify best practices used by rural hospitals to educate uninsured rural patients and consumers about available health insurance coverage options and to assist them in enrolling in a Qualified Health Plan or Medicaid.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Hospitals and clinics, Medicaid and CHIP, Uninsured and underinsured
  • Expanded Look at Rural Access to Care
    This study will use newly available national health survey data to examine rural-urban differences in access to medical care, access to insurance, and affordability of care.
    Research center: Maine Rural Health Research Center
    Topics: Health disparities and health equity, Uninsured and underinsured

2014

  • Health Insurance Stability Among Rural Children Following Public Coverage Expansions
    While estimates indicate that the uninsured rate among rural children has dramatically decreased since the 1997 passage of the State Children's Health Insurance Program (CHIP), it is not clear whether or not coverage has become more stable and uninsured spells shorter. The purpose of this study is to investigate changes in insurance stability among rural and urban children following CHIP, and whether this is affected by specific state eligibility and enrollment policies or clusters of policies. Using the 1996, 2001, and 2004 panels of the Survey of Income and Program Participation (SIPP), we will measure rural-urban differences in uninsured spell length and frequency, sources of coverage before and after uninsured spells, movement between sources of coverage, how these measures of stability have changed over time, and the factors that relate to greater continuity of coverage among rural children.
    Research center: Maine Rural Health Research Center
    Topics: Children and adolescents, Medicaid and CHIP, Uninsured and underinsured
  • Rural Inclusion in the Development of Health Insurance Exchanges
    State plans for developing Health Insurance Exchanges (HIEs) will be analyzed to determine likely benefits for rural residents and communities. Three elements of each plan will be described and assessed: strategies to seek out and enroll rural residents eligible for subsidized insurance coverage or categorically eligible for plans offered through exchanges; minimum standards for participating health plans, including access to essential services; and simulations of impact on availability of plans and enrollment of currently uninsured rural residents.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Private health insurance, Uninsured and underinsured

2011

  • Consequences of Rural Uninsurance
    This study will assess whether uninsured rural residents have different levels of access to care than their urban counterparts, and the factors associated with any differences (including sub-analyses for individuals with identified chronic conditions). In doing so, it will provide policymakers with critical information for improving rural health systems.
    Research center: Maine Rural Health Research Center
    Topics: Diabetes, Uninsured and underinsured
  • Implementation of Health Reform Legislation in Rural America
    The RUPRI Center has developed particular expertise, including the use of simulations, in how changes in public policy that are now part of the Patient Protection and Affordable Care Act (PPACA) affect the rural health care providers and communities. We have published policy briefs and papers related to Medicare Advantage and Part D plans, effects of insurance reform on the percentage of uninsured in rural areas, and effects of changes in physician payment on projected total income of rural primary care physicians. The purpose of this project is to take advantage of RUPRI's capacity for further simulation analysis and empirically based analyses of changes occurring as a result of the PPACA.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Medicare, Uninsured and underinsured
  • Premature Mortality: Potential Role of Health Insurance in Moderating Race/Ethnicity and Rural/Urban Disparities
    This project will explore the degree to which lack of health insurance may contribute to high mortality rates among rural minority men and women aged 45-64.
    Research center: Rural and Minority Health Research Center
    Topics: Minority health, Uninsured and underinsured

2009

  • 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

2006

  • Impact of Health Insurance Coverage on Native Elder Health: Implications for Addressing the Health Care Needs of Rural American Indian Elders
    This project examined the types of health insurance coverage of rural Native American elders ages 55 and older, and examine how different types of health insurance coverage and lack of health insurance coverage impact access to health care services among Native American elders by geographic location (rural frontier, rural non-frontier and urban).
    Research center: Upper Midwest Rural Health Research Center
    Topics: Aging, American Indians and Alaska Natives, Frontier health, Healthcare access, Minority health, Private health insurance, Rural statistics and demographics, Uninsured and underinsured
  • Premium Assistance Programs: Exploring Public-Private Partnerships as a Vehicle for Expanding Health Insurance to Rural Uninsured
    This project examines the experience of states that have implemented premium assistance programs in rural areas to determine whether there are certain design features or certain types of rural communities where these programs may be more feasible.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Private health insurance, Uninsured and underinsured
  • 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

2005

  • Effects of Uninsurance during the Preceding 10 Years on Health Status Among Rural Working Age Adults
    Utilizing data from the 1979 National Longitudinal Survey of Youth, the effects of long-term, continuous uninsurance on health status will be analyzed through a comparison of rural and urban populations who were between the ages of 14-22 in 1979.
    Research center: Rural and Minority Health Research Center
    Topics: Diabetes, Uninsured and underinsured
  • Health Insurance Dynamics of Uninsured Rural Families
    To better understand the dynamics of insurance coverage among rural and urban families, this study will use the Medical Expenditure Panel Survey (MEPS) to compare family health insurance coverage among non-elderly rural and urban families.
    Research center: Maine Rural Health Research Center
    Topic: Uninsured and underinsured

2004

2003

2002

2001

2000