ASPE Report on Rural Care

The HHS Assistant Secretary for Planning and Evaluation, Office of Health Policy, released the report Access to Affordable Care in Rural America: Current Trends and Key Challenges.

Approximately 61 million Americans live in rural areas and communities which are diverse in terms of racial/ethnic composition, geography, socioeconomics, availability of healthcare providers, and broadband availability.

Disparities in health outcomes and mortality between rural and urban communities are worse for more vulnerable populations such as Black, American Indian/Alaska Nation, people of color, as well as people with low incomes.

The report’s section titled Disparities in Health Outcomes discusses how disparities in health outcomes and mortality between rural and urban areas have persisted for many years. The statistics are available on a wide range of measures to include:

  • Rural populations have higher mortality rates overall with higher rates of premature deaths
  • Higher percent of potentially excess deaths from the five leading causes rural areas
  • On average higher rates of maternal and infant mortality as well as maternal morbidity
  • Higher rates on several measures related to mental and behavioral health
  • Higher rates of age-adjusted suicides, overdose deaths, and higher rates of diagnosed mental illness and serious mental illness
  • Higher rates of many chronic conditions
  • Higher rates of cigarette smoking, lower levels of physical activity, and lower rates of seatbelt use


As for COVID-19, urban areas were impacted the most during the early months of the pandemic which began to spread to many rural areas during the summer of 2020. Cumulative per capita case rates were higher in metropolitan areas until the end of October 2020 when case rates in non-metropolitan areas surpassed those in metropolitan areas. The trend continued until April 2021, when the rates were about the same.

HRSA has been supportive to rural areas during the pandemic through:

  • Telehealth Resource Centers
  • Community Health Centers
  • Help for Rural Tribal communities
  • Direct allocation of COVID vaccines to rural health clinics


HHS has provided additional support through the Provider Relief Fund, Paycheck Protection Program and increased funding to the Teaching Health Center Graduate Medical Education (THCGME) program.

As for health coverage for millions living in rural areas, uninsured rates among non-elderly adults in rural areas have fallen substantially since the passage of ACA. Despite the progress, uninsured rates in rural areas have been and continue to be about 2-3 percentage points higher than in urban areas over the 2010-2019 period.

Medicaid expansion has played a key role in expanding health insurance coverage as Medicaid rates have increased from 12.2 % of the rural population in 2010 to 17.1 percent in 2019.

Go to, for the July research report Access to Affordable Care in Rural America: Current Trends and Key Challenges.


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