Rural Inclusion in the Development of Health Insurance Exchanges

Research center:
Lead researcher:
Project funded:
September 2011
Project completed:
March 2014

Problem Statement: As of 2014 individuals and small employers will be able to access health plans through Health Insurance Exchanges (HIEs), a mechanism designed to entice health plans to offer affordable insurance options to large pools of potential enrollees. State HIE plans must include access to web based portals for enrollment, and can include grants to patient navigators who help prospective enrollees make choices among competing plans. Little is known about how HIEs can be certain to reach rural uninsured residents in remote locations, and entice health plans to offer affordable options in rural places and contract with local providers It is critical that the state and federal administrators involved in this process have access to empirical research and analysis to guide their decisions regarding the implementation of the exchanges.

In addition, understanding the implications for access to services in rural areas will be vital when writing or commenting on new rules and regulations regarding the Exchanges. The RUPRI Center has obtained and performed preliminary analysis using the Federal Employees Health Benefit Plan (FEHBP) enrollment data and will use this data to perform simulations modeling, insurance carrier participation, and projections of analysis of enrollment into the state based exchanges.

The RUPRI analysis will focus on the plan availability and the benefits that will be offered to residents in rural areas across the country in the Exchanges.

Goals, Methods, and Products: The primary goal of this project is to produce timely evidence-based analysis of the effects of the PPACA implementation on the rural population. The Center plans to accomplish this by tracking the development of exchanges in the states and analyzing the implications of the proposed state-based exchanges.

In addition, the Center will perform simulations of the array of plans that may become available in the HIEs, and the enrollment in these plans as they become available, with a focus on the state-specific environment in which HIEs will operate. Finally, the Center 6 plans to conduct analysis of the potential for HIEs to effectively reach rural populations, and the challenges to outreach populations. Products from this work will be policy briefs and potentially research papers.


  • The Uninsured: An Analysis by Age, Income, and Geography
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2014
    This brief analyzes the rural/urban uninsured populations by age. Furthermore, we discuss the potential for age differences between rural and urban uninsured populations to drive Health Insurance Marketplace premiums upward, an effect which may be mitigated or compounded by various other factors.