Dates of Project: September 2010 to February 2012

Field of Work: The impact of the Affordable Care Act (ACA) on rural communities

Problem Synopsis: Access to affordable health insurance has been an enduring problem in rural America. Rural areas could benefit from the Affordable Care Act's innovations in health care delivery and financing. However, expanded coverage and financing could also bypass rural residents and providers without specific provisions that consider their unique circumstances.

Synopsis of the Work: The research team examined three key areas:

• Standards established by states to ensure that networks of rural health care providers have enough size and scope to allow enrollees to obtain a full range of services in a timely manner
• The impact on rural areas of allowing insurers to adjust premiums to reflect differences in the cost of medical care across geographic areas
• The impact on rural areas of the ACA's Consumer Operated and Oriented Plan (CO-OP), which awards fund to help nonprofit organizations develop and market health insurance plans in individual and small group markets

Key Findings and Recommendations: The research team published these key findings and recommendations in a peer-reviewed article and two issue briefs:

• State regulators could allow health plans to include midlevel clinicians in patient-provider ratios and rely on innovative delivery systems to make care more accessible to rural residents.
• To reduce market segmentation and fulfill the ACA's intent to broadly distribute risk, state and federal regulators could limit the degree to which health plans can vary premiums by geographic area.
• Nonprofit organizations will need significant administrative and financial capacity to develop health plans for state insurance exchanges. Integrated health care delivery systems that already serve rural areas may be best positioned to overcome these challenges.