Rural coverage gaps decline following public health insurance expansions

Following the implementation of the State Children’s Health Insurance Program (SCHIP), rural health researchers noted that this public insurance expansion had the potential to dramatically improve health insurance coverage for rural children.1 At the time, rural children were more likely than their urban counterparts to be uninsured, and also were more likely to have family incomes in the range targeted by SCHIP (100- 200% of Federal Poverty Level-FPL).2 This brief uses the Medical Expenditure Panel Survey (MEPS) to compare the health insurance coverage of rural and urban residents in 1997 and 2005 to assess how uninsured rates and sources of coverage have changed since SCHIP was enacted.* We also discuss the characteristics of the rural uninsured and the implications for health insurance reform. Rural is defined as living in a non-metropolitan county, as designated by the Office of Management and Budget (OMB). All presented results are statistically significant at p. ≤ .05

Private health insurance in rural areas: Challenges and opportunities

KEY FINDINGS: Private insurance is less common in rural areas. Rural residents under age 65 are less likely than their urban counterparts to have private health insurance coverage. This difference is driven by the unique characteristics of rural places that make it challenging to create and sustain viable private insurance pools. Chief among these are the predominance of small businesses and self-employed, part time, and low wage workers. Rural workers are less likely to have an employer that offers coverage. Among those employed by a business, only 67% of rural employees work for a firm that offers coverage. Rural businesses, families and individuals pay more for the same benefits. Because of the higher premiums paid by small businesses, employees’ share of premiums is often high. Premiums for such policies tend to be high, and typically offer less generous coverage (fewer benefits and higher out-of-pocket costs). Strategies to improve access to private health insurance have particular implications for rural areas. Some of these strategies, and the rural considerations they raise, include: Employer mandate, purchasing pools/alliances/exchanges, or tax credits for individual insurance

The Underinsured in Rural America: The Root of the Problem and Possible Solutions

Presentation to National Congress on the Un- and Under-Insured Washington DC

Rural Disabled Medicare Beneficiaries Spend More out-of-Pocket Than Their Urban Counterparts

The majority of Medicare beneficiaries experience gaps between the care they need and costs covered by Medicare and seek supplemental coverage to meet this gap, including private plans offered by former employers or purchased individually, or public coverage through Medicaid. Since rural beneficiaries are more likely to purchase supplemental indemnity coverage individually, to participate in Medicaid, or to go without supplemental coverage altogether, it is likely that their out-of-pocket spending differs from that of urban residents, although the magnitude and direction of these differences may vary for individual beneficiaries. This study used data from the 2006-2010 Medical Expenditure Panel Survey to evaluate rural-urban differences in out-of-pocket spending, supplemental coverage, and variation in spending by type of service. The proportion of total spending paid out-of-pocket is 40% higher among rural disabled Medicare beneficiaries compared to urban disabled beneficiaries. Rural disabled and elderly beneficiaries are more likely to go without any form of supplemental coverage than urban beneficiaries

Profile of rural health insurance coverage: A chartbook

More than twenty years of research has demonstrated that rural residents are at greater risk of being uninsured compared to urban residents and more recent studies point to problems of underinsurance as well. Most studies have shown that the problems of uninsurance and underinsurance are greatest among rural residents living in smaller communities located further from more urbanized areas. Section I examines recent estimates and changes since 1997 in rural health insurance coverage. Section II explores differences in the demographic, socio-economic, employment and other risk factors for uninsurance among rural and urban residents. Section III profiles the demographic and economic characteristics of the rural and urban uninsured. Section IV examines differences in the employment characteristics of the rural and urban uninsured. The final section discusses policy implications for covering the rural uninsured. Methods and an appendix of data tables provide source material for the chartbook

On the terms violating the custodial symmetry in multi-Higgs-doublet models

We prove that a generic multi-Higgs-doublet model (NHDM) generally must contain terms in the potential that violate the custodial symmetry. This is done by showing that the O(4) violating terms of the NHDM potential cannot be excluded by imposing a symmetry on the NHDM Lagrangian. Hence we expect higher-order corrections to necessarily introduce such terms. We also note, in the case of custodially symmetric Higgs-quark couplings, that vacuum alignment will lead to up-down mass degeneration; this is not true if the vacua are not aligned.Comment: 16 pages, 1 figure. Title and abstract are modified, conclusions remain the same. Section on Yukawa couplings is extended. Published versio

Rural Implications of Medicaid Expansion under the Affordable Care Act

In this brief, researchers from the Maine Rural Health Research Center (University of Southern Maine, Muskie School of Public Service) present findings from a SHARE-funded evaluation of the rural implications of Medicaid expansion under the ACA. The authors examine the following issues: The extent to which prior public health insurance expansions have covered rural populations Whether rural residents who are expected to be newly eligible for Medicaid in 2014 differ from their urban counterparts The extent to which rural individuals might differentially benefit from the ACA Medicaid expansion in light of the expansion becoming optional Whether rural enrollees are likely to have adequate access to primary care The evaluation is based on the 2007-2011 panels of the Medical Expenditure Panel Survey (MEPS), linked with state-level Medicaid policy data and county-level primary care provider data