Changes in Access to Care During the Public Health Emergency: Examining Rural-Urban Disparities by Insurance Type

Access to care is an important predictor of health, especially in rural communities. Access may be hampered due to prohibitive cost, barriers to providers, or lack of visits to the provider. Indicators of access to care vary by insurance status of the beneficiary, and previous studies have found disparities in access to certain services in rural areas during the COVID-19 pandemic.

This study analyzed 2017-2022 data from the Behavioral Risk Factor Surveillance System (BRFSS) to examine access to care outcomes pre- and post-Public Health Emergency (PHE) and stratify the analysis by insurance type.

With the end of the PHE (January 27, 2020 - May 11, 2023), there was significant changes in coverage and access to care outcomes for adult beneficiaries across the U.S., which may be exacerbated in rural areas. It is likely that the uninsured rate will increase as states resume Medicaid disenrollment. Although rural populations were at greater risk of contracting COVID-19 and developing severe symptoms, they had lower access to health care services. Despite the wide availability of services such as telehealth during the pandemic, rural residents were still accessing care at a significantly lower rate than their urban counterparts.

The findings of this study informed policy makers how access to care outcomes varied for rural and urban adults before and after the PHE by insurance types. It helped to develop specific insurance type focused policy interventions aimed at increasing access to care for rural residents.

Publications

• Rural-Urban Differences in Dental Care Utilization After a Public Health Emergency
  Policy Brief
  Rural and Underserved Health Research Center
  Date: 02/2026
  This study utilized Behavioral Risk Factor Surveillance System data to examine dental care utilization during the COVID-19 pandemic period. The pandemic significantly reduced overall dental health care utilization for both rural and urban populations. However, the rural population experienced increased odds of delayed dental service utilization.