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."