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chartbook, rural, health insurance, policy, WP47, Medicare, OOP, MRHRC


More than twenty years of research has demonstrated that rural residents are at greater risk of being uninsured compared to urban residents and more recent studies point to problems of underinsurance as well. Most studies have shown that the problems of uninsurance and underinsurance are greatest among rural residents living in smaller communities located further from more urbanized areas. Section I examines recent estimates and changes since 1997 in rural health insurance coverage. Section II explores differences in the demographic, socio-economic, employment and other risk factors for uninsurance among rural and urban residents. Section III profiles the demographic and economic characteristics of the rural and urban uninsured. Section IV examines differences in the employment characteristics of the rural and urban uninsured. The final section discusses policy implications for covering the rural uninsured. Methods and an appendix of data tables provide source material for the chartbook.

Funding Organization

This study was funded by a cooperative agreement from the federal Office of Rural Health Policy, Health Resources and Services Administration, DHHS. The conclusions and opinions expressed in the paper are the authors’ and no endorsement by the University of Southern Maine or the funding source is intended or should be inferred.

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