May 1, 2017
Rural Minnesotans saw biggest insurance gains from Affordable Care Act
New analysis by the Minnesota Department of Health shows the number of Minnesotans without health insurance dropped more sharply in Greater Minnesota than in urban areas since 2011.
The percentage of rural residents under age 65 who were uninsured dropped from 12 percent in 2011 to 5 percent in 2015, a decrease of 7 percentage points. During the same period, the urban uninsured rate dropped by 5 percentage points.
Importantly, this closed the gap between the rates of insurance coverage for urban and rural Minnesotans. In 2011, rural children had significantly higher uninsured rates than urban children, but by 2015 the child uninsured rates in both areas were equal at 3 percent. In addition, the gap between urban and rural insurance rates previously seen among people of color and American Indians was eliminated.
The Affordable Care Act (ACA), also known as “Obamacare,” went into full effect in 2014.
“It is encouraging to know that in recent years Minnesota made significant progress on a key health equity issue by eliminating insurance disparities between rural and urban residents,” said Minnesota Health Commissioner Dr. Ed Ehlinger. “However, it is also clear that this important gain could be in jeopardy. This study shows that any repeal of the ACA without a replacement ensuring similar rural coverage levels would disproportionally hurt rural Minnesotans.”
MDH has released three reports related to rural health care: Health Care Access in Minnesota (PDF), Finance in Rural and Urban Hospitals (PDF) and Public and Individual Health Insurance Trends in Rural Minnesota (PDF).
Repealing the ACA could cost Minnesota $2.5 billion a year and impact coverage for 1.2 million people, according the Minnesota Department of Human Services.
The MDH analysis also found that rural Minnesota continues to have a higher proportion of residents enrolled in the state’s public insurance programs (Medical Assistance or MinnesotaCare). By 2015, 28 percent of rural Minnesotans under 65 were covered by public insurance, compared to 22 percent of those in urban areas.
Further analysis shows where Minnesotans obtained coverage after ACA implementation. While the majority of rural Minnesotans got their coverage through an employer, 7 percent purchased their own coverage in the individual market. Minnesotans from rural areas were more likely to purchase their own coverage than in urban counties, and by 2016, were more likely to obtain it through MNsure.
While insurance coverage improved, some residents still struggled to access and pay for health care services. Nearly a quarter of rural Minnesotans had difficulty paying medical bills and 1 in 5 did not get needed health services because of cost.
“Rural Minnesotans – including farmers, entrepreneurs, children and communities of color – have made tremendous gains in health care under the ACA,” said Minnesota Human Services Commissioner Emily Piper. “Despite this progress, these reports demonstrate that we have work yet to do. Minnesotans served by the individual market continue to see high premiums and cost sharing. As part of his commitment to serve the needs of rural Minnesota, Gov. Mark Dayton has proposed allowing individuals and families to buy into the affordable coverage of MinnesotaCare.”
Overall, the findings in this analysis suggest that even as rural Minnesota has seen significant improvements in key measures of health care access – particularly insurance coverage related to the ACA – gaps remain between rural and urban areas, as do weaknesses around the availability, cost and use of health services.
"When Minnesotans have health care coverage our state is healthier and our economy is stronger," said MNsure CEO Allison O'Toole. "While there is still more to do, the significant gain for Greater Minnesota pointed out in this study is more evidence that the Affordable Care Act is working."