The percentage of people without health insurance was fairly equal in rural, exurban and urban counties in 2005. But after the recession, the rate of people in rural communities without coverage jumped over 8 percent; now the percentage of people without health insurance in rural America is higher than it is in urban counties.
The number of rural residents without health insurance jumped between 2005 and 2010. The increase was large enough that there is now a higher percentage of people under the age of 65 without health insurance in rural American than in either the cities or the suburbs.
In 2005, that was not the case. (See the chart above.) Then, 17 percent of rural residents not old enough to qualify for Medicare (that is, under 65) did not have health insurance. In the same year, a slightly higher percentage — 17.3 percent — of those living in urban counties did not have health care coverage.
As the recession struck, however, the percentage of people without health coverage increased across the country. Rural counties were hit the hardest.
The percentage of uninsured in rural counties rose to 18.4 percent by 2010, well above the urban rate of 17.7 and the exurban rate of 16.7 percent.
(Exurban counties are part of metro regions but have about half their residents living in rural settings. In 2005, 16.5 percent of exurban residents did not have health insurance.)
By 2010, according to data from the U.S. Census, more than 7.6 million rural Americans under the age of 65 lacked health insurance, up 300,000 from just five years earlier.
For years there was little difference in the percentage of people in rural and urban communities in terms of health insurance coverage. The larger issue in rural America was access to health care, not access to insurance.
The recession has changed that assessment, however. The number of rural uninsured increased 8.1 percent from 2005 to 2010.
There is a huge variation in the percentage of uninsured by state. In Texas, the uninsured rate in rural communities reached 28 percent in 2010. There were 16 states where at least one out of five rural residents under the age of 65 lacked health insurance.
These states are Texas; Alaska (25.7%); Florida (24.5%); Nevada (23.8%); New Mexico (23.7%); Oklahoma (23.4%); Georgia (23.2%); Idaho (22.9%); Colorado (21.8%); Mississippi (21.8%); Montana (21.7%); South Carolina (21.7%); Arkansas (21.6%); Oregon (21.4%); Louisiana (21.1%); and North Carolina (20.7%).
Both Massachusetts and Connecticut have less than 10 percent of their rural residents without health insurance.
(See chart below.)
The rural rate of uninsured was higher than the urban rate in all but six states in 2010 — Illinois, California, Nevada, Connecticut, Florida and New York.
Texas had the largest number of rural uninsured, nearly 680,000.