The uninsured: an analysis by income and geography (original) (raw)
Related papers
Health insurance in rural America
PubMed, 2000
The problem of lack of health insurance coverage has come to the forefront of the general healthcare debates. Each year, the results of several surveys are reported, and current data indicate that there has been a substantial rise in the number and percentage of persons without health insurance over the past decade. For instance, data from the Current Population Survey (CPS) show that since 1990 the number of persons under age 65 without health insurance increased from 34.7 to 44.3 million, a rise from 13.9% to 16.3% of non-elderly who are not covered.
2020
Background | The disparity between rural and urban health care has long been an important public health issue in the United States. 1-4 Urbanicity (i.e. urban or rural status) is measured based on the American Community Survey (ACS) Public Use Micro-Sample (PUMS) Areas in the United States 5 produced by the United States Census Bureau. Residents categorized as metro (i.e. urban) include those who live in a central or principal city or outside the central or principal city, while residents living outside a metropolitan area are designated as non-metro (i.e. rural). There are several factors relating to access to care (e.g., healthcare workers, critical care units, emergency facilities, and transportation) contributing to the urban-rural disparity. 6 This study, however, focuses on the health insurance coverage. 7-8 Individuals without health insurance are less likely to seek and receive medical attention when they are ill, and they are also less likely to receive preventative care on a routine basis States. 9-10 The Affordable Care Act (ACA) significantly increased health insurance coverage in the United States overall. 11-14 Between its implementation in 2014 and early 2016, about 20.0 Background: Although health insurance coverage for adults in each of the Gulf Coast States and the rest of the country increased after implementing the Affordable Care Act, the coverage rates in the Gulf Coast region remained lower to rural residents, compared to those in the rest of the Nation. Purpose: This study aimed to update the changes of health insurance coverage in all states and the Gulf Coast states, confirm the significance of the health policy on insurance coverage by analyzing Louisiana, and examine the relationships between socio-demographic variables and rural/urban area by using interaction variables. Methods: This study used the American Community Survey, which is an annual survey of about three million U.S. households and collected social, demographic, and economic information, including health insurance coverage. Logistic regression was used to estimate the effects of the demographic and economic variables on health insurance coverage. Results: Florida and Texas increased health insurance coverage in the urban areas, while Alabama, Louisiana, and Mississippi present a more considerable increase in the rural area. However, Louisiana showed a significant increase in insurance coverage, rural areas in particular after joining the Medicaid expansion in 2016. A significant decrease in insurance coverage was found among young adults, African American, non-married, not in the labor force, and being poor for rural residents in Florida and Texas. In contrast, minorities in other races and unemployed decreased the likelihood of having insurance for rural residents in Alabama, Louisiana, and Mississippi. Discussion: Our examination of how socio-demographic variables interact with living in a rural area revealed a clear rural disadvantage pattern. The pattern, however, was varied between Florida and Texas and Alabama, Louisiana, and Mississippi. These findings have meaningful implications for the ongoing effort to reduce insurance coverage disparities in the Gulf Coast states and all Americans.
Uninsured Hospitalizations: Rural and Urban Differences
The Journal of Rural Health, 2008
Few studies have examined hospitalization patterns among the uninsured, especially from the perspective of rural and urban differences. Purpose: To examine whether the patterns of uninsured hospitalizations differ in rural and urban hospitals and to identify the most prevalent and costly diagnoses among uninsured hospitalizations. Methods: We conducted a cross-sectional analysis of the Healthcare Cost and Utilization Project's National Inpatient Sample representing a total of 37,804,021 hospital discharges, with 4.9% of them generated by uninsured persons in 2002. We compared demographic and clinical characteristics and the proportion of frequent and costly diagnoses by rural and urban hospitals. We used multiple logistic regression models to examine the relationship between preventable conditions and rural and urban hospitals among uninsured hospitalizations. Findings: Uninsured persons discharged from rural hospitals were more likely than their urban counterparts to be working-age adults (82% vs 79%) and to reside in a ZIP code area with a median household income of less than $35,000 per year (56% vs 26%). Rural uninsured hospitalizations were more likely to be for preventable conditions than were urban uninsured hospitalizations (P < .001). The proportion of total hospital charges related to preventable hospitalizations was 15.5% in rural hospitals versus 10.0% in urban hospitals. Conclusions: The patterns of uninsured hospitalizations in rural and urban hospitals were different in many ways. Providing adequate access to primary care could result in potential savings related to preventable hospitalizations for the uninsured, especially for rural hospitals. A bout 46 million persons are uninsured in the United States. 1 Persons in rural areas are at substantially greater risk for being uninsured than are their urban counterparts. 2 The uninsured may be able to postpone some medical care, but hospitalization could be the only option for those with a serious or complicated medical condition. 3
Medical Care Research and Review, 2017
Medicaid expansions through the Affordable Care Act began in January 2014, but we have little information about what is happening in rural areas where provider access and patient resources might be more limited. In 2008, Oregon held a lottery for restricted access to its Medicaid program for uninsured low-income adults not otherwise eligible for public coverage. The Oregon Health Insurance Experiment used this opportunity to conduct the first randomized controlled study of a public insurance expansion. This analysis builds off of previous work by comparing rural and urban survey outcomes and adds qualitative interviews with 86 rural study participants for context. We examine health care access and use, personal finances, and self-reported health. While urban and rural populations have unique demographic profiles, rural populations appear to have benefited from Medicaid as much as urban. Qualitative interviews revealed the distinctive challenges still facing low-income uninsured and ...
The Journal of Rural Health, 2010
Context: Past studies show that rural populations are less likely than urban populations to have health insurance coverage, which may severely limit their access to needed health services. Purpose: To examine rural-urban differences in various aspects of health insurance coverage among working-age adults in Kentucky. Methods: Data are from a household survey conducted in Kentucky in 2005. The respondents include 2,036 individuals ages 18-64. Bivariate analyses were used to compare the rural-urban differences in health insurance coverage by individual characteristics. Logistic regression analyses were used to examine the independent impact of rural-urban residence on the various aspects of health insurance coverage, while controlling for the individuals' health status and sociodemographic characteristics. Findings: The overall rate of working-age adults with health insurance did not differ significantly between the rural and urban areas of Kentucky. However, there were significant rural-urban differences in insurance for specific types of health care and in patterns of insurance coverage. Rural adults were less likely than urban adults to have coverage for vision care, dental care, mental health care, and drug abuse treatment. Rural adults were also less likely to obtain insurance through employment, and their current insurance coverage was, on average, of shorter duration than that of urban adults. Conclusions: In Kentucky, the overall health insurance rate of working-age adults is influenced more by employment status and income than by whether these individuals reside in rural or urban areas. However, coverage for specific types of care, and coverage patterns, differ significantly by place of residence.
Rural Enrollment in Health Insurance Marketplaces, by State
Rural policy brief, 2015
Since passage of the Patient Protection and Affordable Care Act (ACA), much attention has been focused on the functioning of Health Insurance Marketplaces (HIMs). In this brief, cumulative county-level enrollment in HIMs through March 2015 is presented for state HIMs operated as Federally Facilitated Marketplaces (FFMs) and Federally Supported State-Based Marketplaces (FS-SBMs). We provide comparisons between enrollment in urban and rural areas of each state and corresponding percentages of "potential market" participants enrolled. Given differences in populations eligible for HIM enrollment, we analyzed Medicaid expansion states separately. This analysis provides a gauge of how well outreach and enrollment efforts are proceeding in the states. Key Findings. (1) Overall, people living in metropolitan areas were more likely to enroll in HIMs than were people in non-metropolitan areas, as 38.9 percent of potentially eligible metropolitan residents in Medicaid expansion state...
Medicaid in Small Towns and Rural America: A Lifeline for Children, Families and Communities
2017
Medicaid is a vital source of health coverage nationwide, but the program's role is even more pronounced in small towns and rural areas. Medicaid covers a larger share of nonelderly adults and children in rural and small-town areas than in metropolitan areas; this trend is strongest among children. Demographic factors have an impact on this relationship: rural areas tend to have lower household incomes, lower rates of workforce participation, and higher rates of disability— all factors associated with Medicaid eligibility. In addition, the role of Medicaid has increased in the past few years both in small towns and rural areas and in metropolitan areas, given the implementation of the Affordable Care Act (ACA) and more aggressive efforts to enroll children in Medicaid and the Children's Health Insurance Program (CHIP). Because Medicaid plays such a large role in small towns and rural areas, any changes to the program are more likely to affect the children and families living...
The Journal of rural health, 1996
As the national health debate evolved over the past two years, a need to better understand the differential constraints of rural health delivery and popular attitudes toward policy initiatives became apparent. Selected 1994 and 1995 results of two national suroeys designed to compare rural and urban household responses are reported. The average distance those living in rural households must travel to access medical providers and emergency care is nearly double that of urban household residents. Rural household resident responses show a higher level of acceptance of nonphysician health care providers such as physicians assistants and registered nurses. Means testing of Medicare programs and use of special indicators for providing more Medicaid funds to states with medically underserved and sparsely populated areas are examples of two policy initiatives that receive favorable responses from both urban and rural household residents, but would disproportionately benefit rural areas. This project was supported by the Rural Policy Research Institute, the North Central Regional Center for Rural Development, the Farm Foundation and law State University. The authors would like to acknowledge helpful contributions by Charles Fluharty,