title: Uninsured rural families.
abstract: BACKGROUND
  Although research shows higher uninsured rates among rural versus urban individuals, prior studies are limited because they do not examine coverage across entire rural families.
  
  
  OBJECTIVE
  This study uses the Medical Expenditure Panel Survey (MEPS) to compare rural and urban insurance coverage within families, to inform the design of coverage expansions that build on the current rural health insurance system.
  
  
  METHODS
  We pooled the 2001 and 2002 MEPS Household Component survey, aggregated to the family level (excluding households with all members 65 and older). We examined (1) differences in urban, rural-adjacent, and rural nonadjacent family insurance coverage, and (2) the characteristics of rural families related to their patterns of coverage.
  
  
  RESULTS
  One out of 3 rural families has at least 1 uninsured member, a rate higher than for urban families-particularly in nonadjacent counties. Yet, three fourths of uninsured rural families have an insured member. For 42% of rural nonadjacent families, this is someone with public coverage (Medicaid/SCHIP or Medicare); urban families are more likely to have private health insurance or a private/public mix.
  
  
  CONCLUSIONS
  Strategies to expand family coverage through employers may be less effective among rural nonadjacent than urban families. Instead, expansions of public coverage or tax credits enabling entire families to purchase an individual/self-employment plan would better ensure that rural nonadjacent families achieve full coverage. Subsidies or incentives would need to be generous enough to make coverage affordable for the 52% of uninsured rural nonadjacent families living below 200% of the federal poverty level.
authors.affiliation: Maine Rural Health Research Center, Muskie School of Public Service, University of Southern Maine, Portland, Maine 04101, USA. eziller@usm.maine.edu
authors.forename: Erika C
authors.initials: EC
authors.lastname: Ziller
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Coburn
authors.forename: Nathaniel J
authors.initials: NJ
authors.lastname: Anderson
authors.forename: Stephenie L
authors.initials: SL
authors.lastname: Loux
mesh_terms: D000293:Adolescent; D000328:Adult; D005191:Family Characteristics; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D012424:Rural Population; D014481:United States; D014505:Urban Population