People who are medically uninsured or underinsured face a number of obstacles to both their financial and medical well-being. This includes higher out of pocket costs for care, poorer health outcomes than their insured counterparts, and a greater likelihood that easily treatable ailments will go untreated and become serious medical problems.
Rural communities are faced with the task of ensuring the health of their citizens with fewer options for care. It is important for policymakers and service providers to understand issues facing the uninsured and underinsured in rural communities and how communities may work toward reducing this problem among rural citizens.
Related Guides
Frequently Asked Questions
Tools
Coverage
Web site
Formerly called Cover the Uninsured. Presents information on resources, policy, programs, and publications addressing the issue of uninsurance.
HealthCare.gov
Web site
A consumer website that provides one-stop shopping access for health care information that includes: federal and state public policies, comparison of private coverage and option plans, and personal health tools.
HRSA Information Center
Web site
Provides publications, information, resources, and referrals about health care services for medically underserved individuals and populations.
InsureKidsNow.gov
Web site
Supplies information on free and low-cost health insurance programs for children including Medicaid and CHIP (Children's Health Insurance Program).
Key Resources on Health Coverage and the Uninsured
Web site
Contains links to recent resources on health insurance coverage and the uninsured.
MedlinePlus: Health Insurance
Database
Contains a list of resources including news, related issues, organizations, and statistics related to health insurance.
Rural Health Research: Health insurance and the uninsured
Web site
Provides summaries of current and completed rural health research projects and related publications addressing the topic of health insurance and the uninsured, produced by the Office of Rural Health Policy's funded rural health research centers.
State Coverage Initiatives
Web site
Works with states to plan, execute, and maintain health insurance expansions, as well as to improve the availability and affordability of health care coverage.
State Coverage Initiatives for Children
Web site
Map and state-by-state summary of state efforts to provide health insurance coverage for children.
Uninsured: The Basics
Web site
Contains a list of resources for obtaining key data on the uninsured.
Funding
CVS Caremark Community Grants
Grants to support children with disabilities and healthcare for the uninsured.
RGK Foundation Grants
Grants that support projects in the broad areas of education, community, and medicine/health.
Inactive Funding
Inactive Funding Opportunities -
Lists additional funding programs for this topic that are not currently accepting applications. Programs that are inactive may be offered again in the future.
Maps & Map Collections
Health Insurance Coverage Status
Interactive
Geographic coverage: United States
Printable map that shows percent of population without health insurance nationwide by county. Data source: U.S. Census Bureau, 2009.
Date: 2009
Regulations, Forms & Other Useful Documents
Causes and Consequences of the Rural Uninsured and Underinsured
Author(s): Joe Blankenau, Jon M. Bailey, Julia Hudson
Sponsoring organization: Center for Rural Affairs
Details health insurance coverage in rural America. Includes how rural citizens get insurance coverage and how it differs from urban America, reviews research that explores obstacles in attaining health insurance, addresses the problem of underinsurance, and explores the impact of inadequate financing for health care and its effects on the community.
Date: 04 / 2009
Chartbook #13: Health Care in Urban and Rural Areas, Combined Years 1998-2000
Author(s): Sharon L. Larson, Steven R. Machlin, Alice Nixon, Marc Zodet
Sponsoring organization: Agency for Healthcare Research and Quality
Examines the differences in health care access, use, and expenses between urban and rural areas. Counties are classified along the urban-rural continuum according to whether they are metropolitan statistical areas (MSAs) and, if not, their proximity to an MSA. An MSA is a large population nucleus with a high degree of economic and social interaction. The categories along the continuum are metro (counties in an MSA), near-metro, near-rural, and rural.
Date: 06 / 2004
Five Facts About the Uninsured
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Provides basic facts that explain why so many people in America lack health coverage and how being uninsured affects their health and financial security.
Date: 09 / 2011
Health Care Access and Use Among the Rural Uninsured (Policy Brief)
Author(s): Erika C. Ziller, Jennifer D. Lenardson, Andrew F. Coburn
Sponsoring organization: Maine Rural Health Research Center
Examines access to care and service use among non-elderly, uninsured rural and urban residents compared to each other and to their insured counterparts.
Date: 11 / 2011
Impact of the Patient Protection and Affordable Care Act on Covered Persons as Amended
Author(s): Tim McBride
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
An analysis of the Patient Protection and Affordable Coverage Act (as amended on December 19, 2009 by the Senate Majority Leader’s Manager’s Amendment) using statistics and data to identify how it would reduce the number of uninsured in non-metropolitan areas.
Date: 12 / 2009
Impact of the Recession on Rural America: Rising Unemployment Leading to More Uninsured in 2009
Author(s): Timothy McBride, Leah Kemper
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Presents the results of state and county analysis of unemployment rates nationally in urban and rural (non-metropolitan) areas over the period 2007-February 2009 and discusses the impact of rising unemployment on uninsurance in rural areas and their combined impact on the need for health care reform.
Date: 06 / 2009
Income, Poverty, and Health Insurance Coverage in the United States: 2010
Author(s): Carmen DeNavas-Walt, Bernadette D. Proctor, Jessica C. Smith
Sponsoring organization: U.S. Census Bureau
Provides the latest income, poverty, and health insurance data from the Current Population Survey.
Date: 09 / 2011
Modernizing Rural Health Care: Coverage, Quality and Innovation
Sponsoring organization: UnitedHealth Center for Health Reform and Modernization
Examines health needs of rural populations, and how well the health care system addresses them. Presents new data on rural care quality; on the
views of people living in rural areas; and what their physicians see as the major challenges to overcome. This is the sixth in a series of working papers by UnitedHealth Group focusing on health reform topics.
Date: 07 / 2011
Profile of Rural Health Insurance Coverage: A Chartbook
Author(s): Jennifer D. Lenardson, Erika C. Ziller, Andrew F. Coburn, Nathaniel J. Anderson
Sponsoring organization: Maine Rural Health Research Center
Provides information on the health insurance
status of rural Americans under the age of 65. Includes recent estimates and changes since 1997 in rural health insurance coverage; differences in the demographic, socio-economic, employment and other risk factors for uninsurance among rural and urban residents; demographic and economic characteristics and employment differences of the rural and urban uninsured; and policy implications for covering the rural uninsured.
Date: 06 / 2009
Rural Coverage Gaps Decline Following Public Health Insurance Expansions
Author(s): Ericka Ziller, Andrew Coburn
Sponsoring organization: Maine Rural Health Research Center
Assesses how uninsured rates and sources of coverage have changed since the State Children’s Health Insurance Program (SCHIP) was enacted. Compares the health insurance coverage of rural and urban residents in 1997 and 2005. Discusses implications for health insurance reform
Date: 02 / 2009
Rural Residents More Likely to be Underinsured
Sponsoring organization: Maine Rural Health Research Center
Multiple studies have demonstrated that rural residents, particularly those living far from urban areas, have high uninsured rates. However, even those with private health insurance coverage can be at risk of having high out-of-pocket health care costs. Understanding the degree to which rural residents are "underinsured" has important implications for rural health policy and practice.
Date: 2006
Rural Workers Would Benefit from Unemployment Insurance Modernization
Author(s): Anne Shattuck
Sponsoring organization: Carsey Institute
Suggests that rural workers can benefit if states adjust their unemployment insurance plans to include part-time employees because, on average, there is a higher number of part-time employees in rural areas.
Date: 05 / 2009
Rural-Urban Comparison of a Building Blocks Approach to Covering the Uninsured (Policy Brief)
Author(s): Timothy McBride
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Uses a health insurance model to compare the effects of a building blocks approach on health insurance coverage and health spending, focusing on the geographic differences (by metropolitan and non-metropolitan) of this approach.
Date: 06 / 2009
Why Rural America Needs a Public Health Insurance Plan
Author(s): Jon M. Bailey
Sponsoring organization: Center for Rural Affairs
Examines arguments for a public health insurance plan, how the public health insurance plan would address the health care challenges that exist for rural areas, and how the choice of a public health insurance plan option is important to the viability of rural America.
Date: 07 / 2009
Organizations
Economic Research Initiative on the Uninsured (ERIU)
Academic/Research
Initiates, commissions, and disseminates original research to spark new discussions on health coverage issues. Located at the University of Michigan and funded by the Robert Wood Johnson Foundation.
Kaiser Commission on Medicaid and the Uninsured
Nonprofit/Foundation
Provides information and analysis on health care coverage and access for the low-income population, with a special focus on Medicaid's role and coverage of the uninsured.
Research Data Assistance Center (ResDAC)
Federal government
Provides free assistance to academic and non-profit researchers interested in using Medicare, Medicaid, SCHIP, and Medicare Current Beneficiary Survey (MCBS) data for research. Staffed by a consortium of epidemiologists, public health specialists, health services researchers, biostatisticians, and health informatics specialists from the University of Minnesota.
State Health Access Data Assistance Center (SHADAC)
National organization
Helps states monitor rates of health insurance coverage and understand factors associated with uninsurance. Provides policy analysis and technical assistance to states that are conducting their own health insurance surveys and/or using data from national surveys.
Terms & Acronyms
CMS (Centers for Medicare and Medicaid Services) Federal agency responsible for the Medicare and Medicaid programs. Part of the U.S. Department of Health & Human Services.
Medicaid Federal assistance program that helps pay for medically necessary services for needy and low income individuals. The program uses state and federal funds to compensate medical providers serving these populations.
Medicare Federal health care insurance program for most adults age 65 and older and certain disabled individuals. It pays for long term care under limited circumstances and for limited periods of time.
Safety Net Support for healthcare. External support consists of local taxes, state and federal aid, and private programs or donations. Internal strategies adopted by health care facilities include increasing or stabilizing the supply of physicians in the community, changing the scope of services, forging cooperative relationships with other rural providers, and merging with providers outside the community.
SCHIP (State Children's Health Insurance Program) A State and Federal partnership to help children without health insurance, many of whom come from working families with incomes too high to qualify for Medicaid but too low to afford private health insurance.
Underinsured People with public or private insurance policies that do not cover all necessary medical services, resulting in out-of-pocket expenses that exceed their ability to pay.
Article Searches & Bibliographies
RAC Documents Search: Uninsured and Underinsured
PubMed Search: Rural Uninsured
Searches PubMed's collection of journal article citations with abstracts for items related to this topic and published in the United States.
Some citations link to the full text of articles through PubMed Central, through your library’s electronic and print holdings, or through the journal's publisher. The first two provide free access; the latter may require payment. Check with your local library for details or call your Regional Medical Library at 800.338.7657.
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