Despite largely living in areas run by Republicans who have sought to stymie the Affordable Care Act, rural Americans may very well be the greatest beneficiaries of the landmark health law, suggests a report from the U.S. Department of Health and Human Services.

The report cited two studies that found that insurance coverage has risen slightly more for those living in rural zip codes than for residents of urban ones.

A Gallup survey found that coverage rose by 8 percentage points for rural residents and 7.9 percentage points for urban residents, while a study by the Washington, D.C.-based Urban Institute found a 7.2 percentage point increase in rural America, compared to an increase of 6.3 percentage points in urban areas.

As is the case for all demographic groups, rural Americans would have experienced far greater gains in health care coverage if all states had opted to expand Medicaid, as was originally intended by the ACA.

In states that expanded Medicaid, coverage rose for rural residents by 9.2 percentage points and for urban residents by 7.2 percentage points, according to the Urban Institute study. In nonexpansion states, coverage rose in rural areas by 5.7 percentage points and in urban areas by 4.8 percentage points.

As Kaiser Health News notes, two-thirds of rural Americans live in GOP-controlled states that opted not to expand Medicaid, as was their right granted by a 2012 Supreme Court decision that otherwise upheld the ACA.

Over the past year and a half, a number of Republican-run states have reconsidered their initial decision to reject the Medicaid expansion.

A number of states, including Indiana, Michigan, Montana, Iowa and New Hampshire, opted for a Section 115 waiver that allows them to accept the additional federal funds but to operate slightly differently, including by charging premiums to Medicaid beneficiaries. Others, such as Pennsylvania, Louisiana and Alaska, have transitioned to full embrace of the expansion as a result of changes in state political leadership.

In addition to coverage increasing, HHS reports that rural areas have benefited from relatively small increases in the cost of insurance. For those receiving premium tax credits to buy insurance through the ACA insurance exchange, the average cost of a policy only rose by $5 a month between 2015 and 2016.

Granted, insurance coverage does not always translate to quality care. Brock Slabach, senior vice president of member services for the National Rural Health Association, told Kaiser that many rural areas have been hurting in terms of access.

“But just because more people are insured, it doesn’t necessarily mean that they’ll have access to health services that are local and relevant to their needs,” he says. “We’ve seen 75 hospitals close since 2010, and those hospitals employ many of the physicians that work in these rural communities."

Instant Insights /

Rural America biggest beneficiary of ACA, studies show

More From HR Executive

Related Stories

Recommended For You