Rural Health, Universality, and Legislative Targeting

Health disparities are persistent and worsening for rural communities, which have smaller patient populations with higher rates of uninsurance and greater incidence of the diseases and deaths of despair. Hospital closures and provider shortages are more common than in urban areas, also contributing to worsening population health and crises in maternal and infant health. This paper posits that these disparities are tied to the unique rural features of space and population. Efforts to address persistent problems in health care through universal legislation, such as the ACA, have given rural communities important tools to address some long-standing health problems by improving insurance coverage, which facilitates better access to health for patients and more consistent payment for health care providers. But, some rural states have rejected the ACA’s effort at universality while seeking targeted legislation to fill the gaps left by that choice. Drawing on Skocpol’s work studying effective social programs, the paper suggests that state resistance to the ACA’s universality impedes efforts to address health disparities and that targeted legislation can only minimally improve rural health disparities without universal baselines