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Share Of Rural Adults Gaining Health Coverage Under ACA Exceeds That In Urban Areas

Bryan Thompson
Heartland Health Monitor

Rural Americans are gaining health insurance coverage through the Affordable Care Act at rates outpacing their urban counterparts, according to a recent report from the U.S. Department of Health and Human Services.

Mark Andes is among those in rural Kansas who have benefited. Andes was living and working in McPherson last year when he began having some scary health symptoms.

“I was getting dizzy, and falling to my left, and started getting weak,” he says. “I couldn’t even hardly tear a piece of paper.”

Andes eventually learned that his symptoms were caused by two cancerous tumors in his brain that were putting pressure on his spinal cord. He also found out he had stage IV lung cancer.

“That was not what I wanted to hear, not at all,” he says.

Andes underwent surgery and a series of radiation treatments. He says his brain tumors are gone now. He’s receiving an immunotherapy drug, which he says has stabilized his lung cancer.

But Andes, who now lives in the tiny community of Medora, near Hutchinson, hasn’t been able to work since his diagnosis. And that has led to another problem.

“I came in to do chemo, and they said, ‘We can’t do it, because your insurance has expired, so you have no insurance,’” he says.

Andes had no way to cover the cost of his treatment, which he said is more than $12,000 a month. His employer held his job in reserve for a year. But when Andes officially lost his job, he also lost his health insurance. Andes says nobody told him his coverage was about to end or what his options might be.

Before the Affordable Care Act, Andes probably couldn’t have found an insurance company willing to cover him. But the ACA stopped insurance companies from turning away people with pre-existing conditions

The cancer center referred Andes to Via Christi insurance navigator Judy Murray, who was able to connect him immediately with a policy through the federal health insurance marketplace, healthcare.gov. Because Andes qualified for subsidies, he was able to purchase coverage for himself and his 11-year-old son for only $174 a month.

“Premiums are based on household size and income,” Murray says. “Mr. Andes is on disability, so he has a somewhat low income. With that, he also qualifies for what’s calledcost-share reduction, which is in reference to a lower copay and deductible.” 

Not every rural Kansan will qualify for that coverage rate. But Murray says she knows of several people who have been helped by Obamacare. For instance, a farm couple near Wichita with six children saw their income drop when they had a bad crop year.

“Their premiums before were about $1,400 a month, and based on their household size and everything, I think he got ’em down to about $400 or $500 … and he was very happy with that,” Murray says.

The recent federal report said the share of rural adults gaining coverage since portions of the health law went into effect in 2013 has gone up a little more than the percentage in urban areas. That’s in spite of the fact that two-thirds of uninsured rural people live in states, like Kansas, that have not expanded Medicaid eligibility.  

Brock Slabach, of the National Rural Health Association, says it’s encouraging that health coverage rates are going up for rural Americans.

“But just because more people are insured, it doesn’t necessarily mean that they’ll have access to health services that are local and relevant to their needs,” he says. “We’ve seen 75 hospitals close since 2010, and those hospitals employ many of the physicians that work in these rural communities.”

And Slabach says there’s less competition among insurers in rural areas, so premiums are rising faster than in more-populated areas. He worries that this might eventually erode the coverage gains.

Counterbalancing that is the fact that nine out of 10 rural residents seeking coverage qualify for federal tax credits

The HHS report said for rural residents receiving tax credits, the average premium increased only 4 percent, or $5 a month, from 2015 to 2016.

Andes, for one, considers the Obamacare marketplace a godsend.

“Get online and check that out. That would be my suggestion,” he says. “It’s saved my life.”

Bryan Thompson is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team.

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