By Liz Carey
About 40 percent of rural and urban residents worry about medical bills, the research found, but more rural residents than urban residents say they have had problems paying medical bills (12.2 percent compared to 10 percent), or have been unable to pay their medical bills (8.3 percent compared to 6 percent).
“The biggest thing I took from this is that no matter if you’re a rural or urban resident, there’s a very large percentage of both groups reporting being worried about medical bills,” Ingrid Jacobson, lead researcher said in an interview with the Daily Yonder. “To me that speaks to how common concerns about health care affordability are.”
Using data from the 2022 National Health Interview Survey, the researchers looked at the differences between rural and urban residents’ responses on health care affordability and medical debt concerns. Overall the research found that health care affordability and medical debt issues impact rural residents more often than urban residents and can prevent rural residents from seeking timely and necessary care.
Additionally, the research found disparities amongst different social groups. While about 41 percent of white rural residents reported being worried about medical bills, 51 percent of Black rural residents and nearly 72 percent of Hispanic residents reported the same. Similarly 55 percent of LGB respondents said they worried about medical bills.
And those groups are more likely to have problems paying those bills. The researchers found that 11.5 percent of white rural residents said they had problems paying medical bills, and 7.6 percent were unable to pay them. But more than 17 percent of rural Black and Hispanic residents said they had problems paying the bills, while 14.9 percent of Black rural residents and 12.4 percent of Hispanic rural residents said they were unable to.
“Rural residents already have issues with access to care and quality of care compared to urban residents,” Jacobson said. “(Affordability) does spiral into a bigger issue in rural areas where there are already known barriers intersecting with systemic racism, when it comes to access to care.”
Worries also increased along gender lines and in specific age groups. Rural women (44.9 percent) were more likely to worry about medical bills than men. Rural residents between the ages of 25-64 were more likely to worry than other age groups with those between 45-54 worrying the most (49 percent). Nearly 15 percent of those between 35 and 64 said they had problems paying medical bills and a little over 10 percent said they had been unable to pay those bills. Only about a third (32.8 percent) of rural residents 65 and over were concerned about medical bills, but Jacobson said that could be explained by Medicare.
But more than 20 percent of rural residents who make less than twice the federal poverty level (up to $30,400 for a family of one to $83,080 for a family of six) reported having problems paying their medical bills. In states where Medicaid has been expanded, household incomes below 138 percent of the federal poverty level qualify for Medicaid, but not all states have chosen the expansion, including several states with large rural populations, such as Texas, Alabama and Kansas.
“It was very interesting that the group with the highest percentage of reporting these issues were in the group just above the poverty threshold, which may seem a little counterintuitive,” Jacobson said. “These individuals who are living close to but still above that poverty threshold may have incomes that are too high for financial assistance programs, but not high enough to cover medical bills which can be very, very expensive.”
Medical debt is a problem for rural hospitals as well, Alan Morgan, CEO of the National Rural Health Association.
“I think it’s a bigger issue among rural communities and rural populations,” he said in an interview with the Daily Yonder. “What it comes down to is how do we put federal reimbursement systems in place that ensure the viability of these (rural) hospitals while still not putting the communities in horrific debt moving forward?”
Research by the Commonwealth Fund in 2020 found that America had more geography-based health disparities than 10 other high-income countries – Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom – and that the disparities could mean more significant health challenges. Studies show that the inability to afford health care is a substantial factor in American rural residents having higher rates of chronic disease and suicide, worse maternal health and limited access than those in urban areas.
Jacobson said the research is important for policy makers when they are considering how to address rural healthcare issues. Expanding Medicaid could help the 10 states that have not – Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming – alleviate health care affordability issues, she said.
“Policy makers who are looking to address the issues of the health care affordability and medical debt should really consider the implications of their policy for rural residents as they are more likely than their urban counterparts to report health care affordability issues,” she said. “And we would also point out that the policies be tailored to the specific subgroups that are experiencing higher rates of health care affordability issues.”
This article first appeared on The Daily Yonder and is republished here under a Creative Commons license.
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