Health reform

Research Products & Journal Articles

Browse the full list of research publications on this topic completed by the Rural Health Research Centers.

Products – Freely accessible products include policy briefs, fact sheets, full reports, chartbooks, and interactive data websites.

Journal Articles – Articles in peer-reviewed journals may require a subscription or affiliation with a subscribing library. For these publications, Gateway lists the article citation, a brief summary, a link to additional information and access to the full-text of the article, if available.

2021

  • Sources of Insurance Coverage in Nonmetropolitan Areas: The Role of Public and Private Insurance Since 2009
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 03/2021
    This brief uses 2009-13 and 2013-17 American Community Survey five-year estimates to compare types of health insurance coverage for the nonelderly in metropolitan and nonmetropolitan areas. The significant growth in public insurance rates due to Medicaid expansion was larger for those living in nonmetropolitan areas compared to metropolitan areas.
  • Advancing Population Health in Rural Places: Key Lessons and Policy Opportunities
    Report
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 01/2021
    This paper advances policy discussion of population health in rural places, focusing on the role of rural healthcare organizations. Lessons from ongoing programs provide policy considerations. Medicare and Medicaid programs should prioritize staff and infrastructure development, flexibility in covered benefits, and further expansion of telehealth.

2020

  • Telehealth Use in a Rural State: A Mixed Methods Study Using Maine's All-Payer Claims Database
    Rural Telehealth Research Center
    Date: 10/2020
    This study examines trends in telehealth use in Maine and identifies barriers and facilitators to its adoption. While telehealth appears to improve access to behavioral health and speech therapy services, provider shortages, lack of broadband, and restrictive Medicare and commercial coverage plans limit telehealth services use in rural areas.
  • Rural Hospital Participation in Medicare Accountable Care Organizations
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2020
    This policy brief summarizes national and regional rates of rural hospital participation in Medicare Shared Savings Program Accountable Care Organizations (ACOs) and identifies factors associated with ACO participation.

2019

2018

  • Health Insurance Marketplaces: Issuer Participation and Premium Trends in Rural Places, 2018
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2018
    This brief assesses changes from 2014 to 2018 in average Health Insurance Marketplace plan participation and pre-subsidy premiums in rural and urban places. Insurance carriers reduced participation across both, while the gap between average premiums in expansion and non-expansion states is widening at a similar rate in rural and urban counties.
  • Medicaid Income Eligibility Transitions Among Rural Adults
    Policy Brief
    Maine Rural Health Research Center
    Date: 08/2018
    The Affordable Care Act allows Medicaid expansion to adults under 65 with income below 138% of poverty. Research suggests income shifts affecting Medicaid eligibility are common, but the rural impact is unclear. This national study examines rural and urban adults' annual income shifts above or below the Medicaid expansion eligibility threshold.
  • Insuring Rural America: Health Insurance Challenges and Opportunities
    Policy Brief
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 07/2018
    This brief discusses a series of policy considerations in three main categories: policies related to rural insurance risk, policies related to provider networks, and policies related to rural payment rates and structures.
  • Organizational Attributes with Medicare ACO Quality Performance
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2018
    Cross-sectional and longitudinal analyses of Medicare Shared Savings Program Accountable Care Organizations' (ACOs') quality performance found rural ACOs' score was comparable to those in other categories. ACOs with hospital-system sponsorship, larger beneciary panels, and higher post-hospitalization follow-up rates had better performance.
  • Distance and Networks: A Regional Analysis of Health Insurance Marketplaces
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2018
    Using 2015-16 data on 15 Midwestern states, we examine the possibility that geographic distance to care plays a role in insurance issuer participation, premiums, and enrollment success through its effect on network adequacy and assess the moderating role that state-level policies on network adequacy standards and Rating Area design may have.

2017

  • Knowledge of Health Insurance Concepts and the Affordable Care Act Among Rural Residents
    Policy Brief
    Maine Rural Health Research Center
    Date: 07/2017
    Health insurance literacy is central to identifying eligibility for coverage and subsidies, choosing a plan, and using optimal healthcare services. This study examined rural-urban differences in knowledge and/or use of the Affordable Care Act Marketplaces; subsidies; the health insurance mandate; and health insurance terms and concepts.

2016

2015

  • Rural Provider Perceptions of the ACA: Case Studies in Four States
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 02/2015
    This brief summarizes the perceptions from rural providers in four states regarding the early effects of the Affordable Care Act, including changes to patient populations, financial health, and capacity for rural hospitals and rural federally qualified health centers.

2014

  • Best Practices for Health Insurance Marketplace Outreach and Enrollment in Rural Areas
    Fact Sheet
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 12/2014
    Research suggests enrollment rates for those in rural areas was less than urban areas during the first Health Insurance Marketplace enrollment period. Interviews of navigators, health centers, and others in rural counties with high enrollment rates were conducted to uncover best practices for marketing, outreach/education, in-reach, and enrollment.
  • Geographic Variation in Plan Uptake in the Federally Facilitated Marketplace
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 10/2014
    This brief combines the data on plan selection in the federally facilitated marketplaces with estimates of those likely to qualify for the marketplace to calculate the percentage of potential eligible individuals who chose a health insurance plan (the uptake rate). It contains a heat map showing the variation in uptake rates across the country.
  • Rural Implications of the Blueprints for State-Based Health Insurance Marketplaces
    Report
    RUPRI Center for Rural Health Policy Analysis
    Date: 09/2014
    This report presents various states' approaches to the Health Insurance Marketplace, including service and rating areas, network adequacy requirements, rural consumer outreach, rural representation on the marketplace governing board, certification and oversight of Qualified Health Plans, and design of the Small Business Health Options Program.
  • Geographic Variation in Premiums in Health Insurance Marketplaces
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2014
    This policy brief analyzes the 2014 premiums of health insurance plans available in the new marketplaces created by the Affordable Care Act.
  • A Guide to Understanding the Variation in Premiums in Rural Health Insurance Marketplaces
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2014
    This brief provides a framework for assessing variations in the premiums of plans offered in the Health Insurance Marketplaces across geography.

2012

2010

2009