During the last decade, health insurance coverage trends
show an increased reliance on public sources of coverage,
in part due to the Patient Protection and Affordable Care
Act (PPACA). However, little is known regarding the
relative importance of the different sources of coverage
in nonmetropolitan areas compared to metropolitan areas.
This brief uses the American Community Survey
five-year estimates from 2009 to 2013 and 2013 to 2017 to
compare types of health insurance coverage for the
nonelderly in metropolitan and nonmetropolitan areas.
Post-PPACA implementation, nonelderly individuals living
in Medicaid expansion states experienced significant
growth in public insurance rates compared to those living
in nonexpansion states. This increase was larger for
those living in nonmetropolitan areas compared to
metropolitan areas. Pre- and post-PPACA, uninsured rates
were higher in nonmetropolitan areas than in metropolitan
areas and remained the highest in nonexpansion states.
The overall differential in uninsured rates between
metropolitan and nonmetropolitan areas grew between 2009
and 2017 and was driven by expansion status.