Health Insurance in rural states

By Amy Norton

NEW YORK (Reuters Health) - Americans who live in rural states or work for small businesses get less bang for their buck when it comes to health insurance, new research shows.

In a first state-by-state look at the "generosity" of employer-based health insurance, researchers found that people in largely rural states often paid more for the benefits they got than their urban-area counterparts did.

The researchers gauged insurance plans' generosity by calculating their actuarial value - the percentage of an employee's medical expenses that the plan covers.


When average premiums were adjusted for actuarial value, people in states such as Maine, West Virginia, Wisconsin and Wyoming got the least value for their money, according to findings published in the journal Health Affairs.

In contrast, residents of states with large urban populations, including California, New York, Massachusetts and Pennsylvania, tended to get more service for their dollar.

Similarly, the study found, people employed by the smallest businesses paid an average of 18 percent more than workers at large corporations, when their insurance premiums were adjusted for generosity.

This latter finding may not be surprising, as large employers have much greater leverage to negotiate with insurers.

But the findings "put actual numbers on the conventional wisdom" that small-business employees end up with less generous health insurance, said lead study author Jon Gabel, vice president of the Center for Studying Health System Change, a non-partisan policy research organization in Washington, D.C.