Center for Rural Affairs

Two new Center for Rural Affairs reports examine health insurance coverage in rural Nebraska and rural Montana, the two states where we do much of our health care work. Based on recently released county data from the US Census Bureau, we found more rural residents under 65 in both states are without health insurance.

The charts show the uninsured rates by county type (metropolitan counties are large city and suburbs as designated by the Census Bureau; micropolitan counties are counties with a small city of 10,000 to 49,999; and rural counties are all other counties). 

Clearly, rural Americans face structural barriers to adequate health insurance coverage. With an economic foundation of small businesses and self-employment, rural communities are not well served by a health insurance system that relies on employer-based coverage. Many families are forced to purchase from the individual insurance market where they often wind up underinsured, with coverage that costs too much and provides too little. Those who cannot afford the generally more expensive individual packages must go without or rely on public insurance.

Unfortunately, these primary means of getting (or not getting) health insurance translate into weaker rural communities. A community’s economic development, community cohesiveness, and health care infrastructure are all threatened by a lack of affordable health insurance that results in more families without health insurance or less than adequate insurance.

And we all pay for the skyrocketing costs of health insurance as the insured and health care providers in rural Nebraska and Montana face increasing economic pressure from uncompensated care, or the costs of health care services to the uninsured or underinsured that are not paid by insurance or any other source. Like most issues facing rural America, everyone is in it together.

The significantly higher uninsured rates in rural Nebraska and Montana also affect the health status of rural residents and communities. Research shows rural people receive fewer necessary health care services and less preventive care, leading to more expensive health care later. The ultimate result of less than adequate care for rural residents is a worsening of health status and an increase in chronic conditions, exactly what has been found in rural areas.

In the coming months policymakers in both states have opportunities to enhance health insurance coverage that will improve the health of rural people and the economies of rural communities. We found that choosing the new Medicaid initiative for working adults as allowed in the Affordable Care Act will reduce the rural uninsured rate in Nebraska by half and in Montana by a third. The federal government pays all the cost of this initiative for its first three years.

Both states would be wise to opt for this new initiative. It’s a smart investment. It provides hard-working families in both states the security of quality health care, boosts the economy of both states and prevents health problems.