Uninsured in Rural America

The percentage of rural Americans without health insurance has been rising since 2005. But the differences from one rural county to another in the rate of uninsured can be enormous.

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By 2010, the percentage of people under the age of 65 who lived without any health insurance was higher in rural America than in either the cities or the suburbs. Five years earlier, the rate of those uninsured in rural counties differed little from rates in the cities or the exurbs.

But the rates of uninsured vary wildly across rural and exurban counties — from a low of only 4.7 percent without health insurance in Franklin County, Massachusetts, to 41.4 percent uninsured in Hudspeth County, Texas. 

The map above shows the percentage of people under the age of 65 who had health insurance in 2010 in more than 2,550 rural and exurban counties. Dark red counties had the highest percentages of people who lacked health insurance in that year. Dark green counties had the lowest percentages of those without health insurance who are below the age when Medicare gives nearly universal coverage.

Overall, rural counties had higher rates of uninsured than the national average in 2010 of 17.7 percent. The green counties above all had a lower percentage of uninsured than the national average. Red counties had higher rates of residents without health insurance than the national average. Click on the map to see a larger version. 

The numbers of people without insurance were higher in 2010 than in 2005. According to the U.S. Census, 7.6 million people in 2010 lacked health insurance, up 300,000 from just five years earlier.

For years there was little difference in the rates of uninsured between rural and urban counties. That changed after 2005, when the rates of those without insurance increased faster in rural counties than in either the exurbs or the cities.

(Exurban counties are part of metropolitan regions, but they are places where a majority of people live in rural settings.)

You don’t have to look too hard at the map to see where the counties are in rural America that have the smallest percentages of people with health insurance. Thirty-two of the fifty rural and exurban counties with the largest percentages of uninsured are in Texas. (To see a state-by-state accounting, go here.) 

Below are the fifty rural and exurban counties with the smallest percentages of uninsured in 2010.




Topics: Health


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