William Parke-Sutherland, Health Policy Outreach Coordinator
The subsidized health insurance Marketplace established by the Affordable Care Act (ACA) continues to be important for people across our state, but especially so for those in rural areas.
During the 2018 open enrollment period, about 225,000 Wisconsinites signed up for coverage through the ACA Marketplace, and more than four out of five people who signed up receive assistance to help pay their premiums. Federal financial assistance is tied to income, so people who make less money receive more help so that they can more likely afford comprehensive health coverage. The Marketplace is especially important in rural communities where people are more likely to be self-employed, such as farmers, and are less likely to have insurance through their employer.
Due in large part to the ACA, the number of people who are uninsured has steadily decreased over the past few years, but people in rural areas are generally more likely to be uninsured. In 2016, all 20 of the counties with the highest percentage of people who are uninsured were considered rural by the Wisconsin Department of Workforce Development.
Insurance is also generally more expensive in rural areas, in part because there are fewer people and health care tends to be more expensive. This holds true for insurance sold through the ACA Marketplace as well, but those who qualify for premium tax credits are insulated from the higher costs associated with living in a rural area.
All these factors help explain why rural counties tend to have higher rates of participation in the ACA Marketplace. In fact, of the 20 counties with the highest percentage of people enrolled in ACA plans for this year, 18 are considered rural and the other two counties, Kewaunee and Oconto, still have large rural areas. This map shows the percentage of the county population who signed up for Marketplace during the 2018 open enrollment period.
Marketplace consumers in rural areas are also more likely to qualify for premium tax credits, and because their premiums are generally higher their premiums tax credits are above the state average. All but three of the 20 counties with the highest percentage of people who qualify for premium tax credits are rural. In Wisconsin 84 percent of people who purchase Marketplace plans qualify for tax credits; in those top 20 counties 88 percent received tax credits.
Rural communities make up a greater percentage of marketplace consumers than the average for states using the federal marketplace. According to a report by the Center on Budget and Policy Priorities (CBPP), 37 percent of Marketplace consumers in Wisconsin live in rural areas, compared to an average of 18 percent for the states that use healthcare.gov.
Despite the many sabotage efforts of the Trump administration and other ACA opponents, as long as the tax credits remain in effect, the vast majority of Wisconsinites in rural communities will be able to access affordable coverage through the ACA. The administration’s latest actions attempt to invalidate rules that bar insurers from charging people more based on their health status, their sex, where they live, or their occupation. These changes could easily jeopardize the long-term stability and affordability of the Marketplace. If the Marketplace were to collapse, many people in rural Wisconsin would be left with little or no choices for getting affordable health insurance.
Read more about how the Affordable Care Act is working in Wisconsin despite attacks by the Trump Administration in our newest report Sabotage Watch: Proposed Changes to the Affordable Care Act Insurance Marketplace Will Harm Many Wisconsinites