Document Type

Policy Brief

Publication Date



Cutler, Population Health and Health Policy


Numerous studies have found that rural residents are more likely to be uninsured than urban residents, in part because rural workers are more likely to be employed by a small business or have low wages and thus have more limited access to employer coverage.1-5 Yet, our knowledge about how coverage changes with employment transitions is limited. Prior research indicates that loss of a job puts workers at greater risk of becoming uninsured,6 and there is some evidence that this risk is even greater for rural workers.7

In the past 20 years, much of the federal-level policy attention related to health insurance coverage (e.g. the Consolidated Omnibus Budget Reconciliation Act and the Health Insurance Portability and Accountability Act) has emphasized ensuring continuity of coverage for individuals that experience an employment transition. However, these key policy interventions do not apply to smaller employers that are the backbone of rural economies. !us, rural workers may be more likely than urban workers to experience disruptions in health insurance coverage following an employment transition.

The purpose of this study was to explore the impact of changes in employment status on insurance coverage for rural and urban workers, and the factors behind any differences. !e Affordable Care Act (ACA) provides a new backdrop against which to consider the issues of job change, job loss, health insurance portability and coverage of rural residents. Our findings provide important information about the health insurance coverage challenges that rural workers may face, and may help to identify potential challenges and opportunities for implementing ACA in rural areas.



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