Problem: In response to rapidly rising health insurance premiums, many employers and individuals have shifted to plans with higher employee cost-sharing, including high deductibles. The extent to which enrollment in these plans may differ by residence is unknown, yet the potential impact on access to care and on the financial health of rural families makes this an important topic for research. While the Patient Protection and Affordable Care Act has the potential to expand health insurance coverage for many rural Americans, the impact on access to health care may depend, in part, on the benefit design of the plans in which rural residents are or will be enrolled.. This study will provide baseline data on the types of health plans that rural residents have currently, and identify potential access concerns that may exist.

Project Goals: This project will test the hypothesis that privately insured rural residents are more likely than those in urban areas to have coverage under a high deductible health plan. In addition, we will assess the extent to which having a high deductible health plan affects access to health care services for rural residents, and whether this differs from the access patterns of their urban counterparts.

Methods: This study will use data from the 2007, 2008 and 2009 National Health Interview Survey (NHIS) conducted by the National Center for Health Statistics (NCHS). Although the public use NHIS does not contain a measure of rural-urban residence, we will seek access to restricted data through the NCHS Research Data Center. Using a combination of bivariate and multivariate techniques, we will compare rural and urban enrollment in high deductible health plans and the impact that this coverage may have on access to health care services.

Anticipated Products/Products: Products of this study will include a working paper and a policy brief that highlight the study's relevance to health care reform implementation. In addition, we will pursue publication in a peer-reviewed journal such as Health Affairs, Medical Care Research and Review or the Journal of Rural Health. We will also seek to present findings at national conferences such as the AcademyHealth and NRHA annual research meetings.

Publications

• High Deductible Health Insurance Plans in Rural Areas
  Maine Rural Health Research Center
  Date: 05/2014
  Using the 2007-2010 National Health Interview Survey, this study examines rural residents' enrollment in high deductible health plans and the implications for evolving Affordable Care Act Health Insurance Marketplaces.