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

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

A Gallup survey found that coverage rose by 8 percentage pointsfor rural residents and 7.9 percentage points for urban residents,while a study by the Washington, D.C.-based Urban Institute found a7.2 percentage point increase in rural America, compared to anincrease of 6.3 percentage points in urban areas.

As is the case for all demographic groups, rural Americans wouldhave experienced far greater gains in health care coverage if allstates had opted to expand Medicaid, as wasoriginally intended by the ACA.

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

As Kaiser Health News notes, two-thirds of ruralAmericans live in GOP-controlled states that opted not to expandMedicaid, as was their right granted by a 2012 Supreme Courtdecision that otherwise upheld the ACA.

Over the past year and a half, a number of Republican-run stateshave reconsidered their initial decision to reject the Medicaidexpansion.

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

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

Granted, insurance coverage does not always translate to qualitycare. Brock Slabach, senior vice president of member services forthe National Rural Health Association, told Kaiser that many ruralareas have been hurting in terms of access.

“But just because more people are insured, it doesn’tnecessarily mean that they’ll have access to health services thatare local and relevant to their needs,” he says. “We’ve seen 75hospitals close since 2010, and those hospitals employ many of thephysicians that work in these rural communities."