Leah Kemper, MPH

RUPRI Center for Rural Health Policy Analysis


Publications - (10)

  • 2012 Rural Medicare Advantage Quality Ratings and Bonus Payments
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2014

    Analyzes differences in rural Medicare Advantage (MA) quality ratings and payments and suggests reasons why quality ratings vary by geography. Overall, the quality rating of MA plans in rural areas is lower than in urban areas, a result of the availability of, and enrollment in, different types of MA plans.

  • 2014: Rural Medicare Advantage Enrollment Update
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2015

    Rural Medicare Advantage (MA) and other prepaid plan enrollment in March 2014 was nearly 1.95 million, or 20.3 percent of all rural Medicare beneficiaries, an increase of more than 216,000 from March 2013. Enrollment increased to 1.99 million (20.4 percent) in October 2014. MA enrollment increased in both rural and urban areas despite reductions in payment and the conclusion of the MA bonus payment demonstration at the end of 2014.

    Some rural counties were reclassified, due to a change in population, and nearly 10 percent of the previously rural MA population is now considered urban; however, the percentage of the rural Medicare beneficiaries enrolled in MA did not change significantly. The majority of growth in rural MA enrollment was in Preferred Provider Organization plans, with over 56 percent of enrollment, while nearly a third of beneficiaries were enrolled in Health Maintenance Organization plans.

  • 2016 Rural Enrollment in Health Insurance Marketplaces, by State
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2017
    Cumulative county-level enrollment rates in Health Insurance Marketplaces (HIMs) in metropolitan and non-metropolitan areas of each state, defined as the percentage of “potential market” participants selecting plans, are presented as of March 2016. States are separated by Medicaid expansion status.
  • Health Insurance Marketplaces: Early Findings on Changes in Plan Availability and Premiums in Rural Places, 2014-2015
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2015

    Analysis of nationwide county-level Health Insurance Marketplace plan and premium data for 2014 and 2015 provides evidence that many low-density rating areas are gaining firms and that average premium growth is low in many rural areas. However, premium growth is somewhat higher in low-density rating areas, and a small minority of rural states have experienced large average premium increases. Thus there is no systematic pattern to rural experiences of HIMs, although some isolated places may be at risk for weak outcomes.

  • Health Insurance Marketplaces: Premium Trends in Rural Areas
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2016
    Total Health Insurance Marketplace premiums have grown disproportionately in rural places in 2016. Urban counties have an average of 4.2 firms, while rural counties average 3.2 firms offering coverage through the HIMs. This causes concern since, at the county level, we find that as the number of firms increases, premiums increase at a slower rate.
  • Rural Enrollment in Health Insurance Marketplaces
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2015

    This brief provides analysis of Health Insurance Marketplace enrollment outcomes for 2015 at the rating area and county levels. Enrollment rates are reported by number of firms participating and for multiple geographic categories: population density, Census region, and metropolitan status of the county. Rural rates are similar to urban rates in many places, but areas of concern exist and may benefit from additional outreach in the future.

  • Rural Enrollment in Health Insurance Marketplaces, by State
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2015

    In this brief, we provide comparisons between cumulative enrollment totals in Health Insurance Marketplaces in metropolitan and non-metropolitan areas of each state and corresponding percentages of “potential market” participants enrolled, controlling for Medicaid expansion status. We show that in several states, non-metropolitan enrollment rates exceed metropolitan enrollment rates, a finding that is obscured in an aggregate comparison. This analysis provides some indication of how well outreach and enrollment efforts targeting rural populations are proceeding in the states.

  • Rural Medicare Advantage Market Dynamics and Quality: Historical Context and Current Implications
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2016
    There is significant variation in the quality ratings of MA plans that are available to rural beneficiaries. This brief suggests that policy interventions may be necessary to improve the quality of MA plans in rural areas.
  • Rural Medicare Advantage Plan Payment in 2015
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2016
    Payment to Medicare Advantage (MA) plans was fundamentally altered by the Patient Protection and Affordable Care Act of 2010 (ACA). This brief finds that while plans operating in both rural and urban areas have experienced a reduction in MA payment, the reduction in rural payment overall has been less significant.
  • The Uninsured: An Analysis by Age, Income, and Geography
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2014

    Using the 2010 Small Area Health Insurance Estimates (SAHIE), we analyze the rural and urban uninsured populations by age, showing that in both places, uninsured rates decline dramatically with age. We find that, within each age group, rural uninsured rates are somewhat lower than urban uninsured rates at income levels below 400% of the Federal Poverty Level. However, since a greater proportion of the rural population falls into the age and income categories with high uninsured rates, rural people as a group stand to benefit slightly more from subsidized coverage through the Health Insurance Marketplaces (HIM) or Medicaid expansion (if enacted). Furthermore, we discuss the potential for age differences between rural and urban uninsured populations to drive HIM premiums upward, an effect which may be mitigated or compounded by various other factors.