Expanding Rural Health Insurance Coverage: How Do Insurance Reform Strategies Stack Up?

Research centers:
Project funded:
September 2007
Project completed:
May 2009

There is renewed interest in health insurance reform at both the state and federal level due to the continuing erosion of private insurance coverage and continuing increases in the number of uninsured. The purpose of this study is to inform policymakers about the current state of health insurance coverage in rural America, and to identify how specific reform strategies may differentially affect rural residents.

Using a combination of analytic strategies, including literature review, secondary data analyses, eligibility simulation models, and policy analyses, we will provide policymakers and rural health advocates with the necessary tools to develop reform strategies that meet the needs of rural residents. We seek to address the following research questions:

  1. What does a comprehensive review of the literature and research synthesis reveal about rural-urban differences in health insurance coverage, the factors associated with these differences and how economic and/or policy changes affect these differences?
  2. What is the current (as of 2005) status of health insurance coverage among rural residents, and how does this differ by region, socioeconomic status and degree of rurality?
  3. What are the implications for rural residents of specific features of health insurance reform proposals under consideration at the time of analysis?


  • Health Insurance Profile Indicates Need to Expand Coverage in Rural Areas (Policy Brief)
    Maine Rural Health Research Center
    Date: 07/2009
    This brief provides information on the health insurance status of rural Americans, summarized from a more detailed chartbook. Analyses are based on the 2004-05 Medical Expenditure Panel Survey.
  • Profile of Rural Health Insurance Coverage: A Chartbook
    Maine Rural Health Research Center
    Date: 06/2009
    Analyses of persons under age 65 from the 2004-05 Medical Expenditure Panel Survey reveal a greater proportion of rural vs. urban residents who are uninsured or covered through public sources. Uninsured rates are highest among adults over age 50 in the most remote rural places.