Health Insurance: Location, Location…

Yes, rates of health insurance coverage are higher in rural America than in cities. But in most states, rural communities have lower rates of insured than do metro areas.

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People living in rural America are slightly more likely to have health insurance than are people in the cities, according to the latest data released from the Bureau of the Census.

The Census data comes from 2007, before the beginning of the current recession. Across all rural counties, 17.1% of those under the age of 65 don’t have health insurance.

In urban counties, 17.2% of those under 65 don’t have health insurance, and in exurban counties, the uninsured rate is 16.5%. The Census only counts those under 65, since Medicare covers all older Americans. (For details on the Census study, go here.) 

As you can see from the map above, however, those national totals are misleading. There are few “average” communities when it comes to health insurance — and the rates of coverage vary dramatically from state to state. 

The map above shows the rate of health insurance for all rural counties. Green counties are at the national average — 17.1% — or have a lower percentage of uninsured. (Click on map to see a larger version.)

The light red counties have rates above the national average up to 27.1% uninsured. The dark red counties have more than 27.1% of their populations living without health insurance. 

The regional differences are stark. The rural counties with the lowest rates of uninsured are clustered in the upper Midwest. Of the 50 rural counties with the lowest rates of uninsured, all but three can be found in Iowa, Wisconsin and Minnesota.

Henry County, in the southeast corner of Iowa, has the lowest rate of uninsured. Only 6.6% of those under the age of 65 aren’t covered, according to the Census.

(To download an Excel file with the Census data on health insurance by county in 2007, click here.)

Kenedy County, in far southeast Texas, has the fewest residents covered by health insurance, according to the Census.

Nearly all the counties with the highest percentage of people without health insurance can be found in Texas. All but seven of the rural counties with the fewest people under the age of 65 covered by health insurance can be found in the Lone Star State. In the South Texas ranching county of Kenedy — home of the famed King Ranch — half of those living there don’t have any health insurance.

Although rural America as a whole has a lower rate of uninsured than the cities, for most rural communities, that’s misleading. Only 48% of the nation’s 2,038 rural communities have uninsured rates below the national average.

And, in most states, the rural uninsured rate is higher than the urban rate. 

Rural counties have lower rates of uninsured only in Arizona, California, Illinois, Nevada, South Carolina, Texas and Connecticut.

Here is a chart showing the uninsured rate for each state, broken down by rural, urban and exurban.[img:Uninsuredbystate.png]

Just because rural areas have health insurance rates comparable to those in the cities, that doesn’t make the two equal. The USDA’s Economic Research Service reported last year:

Though metro and nonmetro insurance coverage rates may be comparable, nonmetro residents still spend a larger share of household income on out-of-pocket health expenditures (for health care and health insurance premiums) than metro residents. Overall, for those under age 65, household health expenses exceeded 10 percent of after-tax income in 2005 for 24 percent of nonmetro households and 18 percent of metro households. While both metro and nonmetro households of the nonelderly spend on average about $3,300 per year on out-of-pocket health expenses, nonmetro households have lower average incomes. 

Moreover, since the mid-1980s, the average mortality rate in rural counties has separated from the mortality rate in the cities. Overall, the gap in life expectancy between rural and urban America is widening.
Here are the 50 rural counties that have the highest percentage of their populations covered by health insurance: [img:50lowestuninsured.png]

Roberto Gallardo is a research association with the Southern Rural Development Center at Mississippi State University.

 

Topics: Health
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