Urban-Rural Differences in Employer-Based Health Insurance Coverage of Workers

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Abstract
Prior research indicates that rural workers are less likely than urban workers to obtain health insurance coverage through their employer. The reasons for this differential in coverage rates are not well understood. This study uses data from the 1993 Robert Wood Johnson Foundation Employer Health Insurance Survey to measure differences in the proportion of rural and urban workers who are offered insurance coverage and in their rates of participation in offered plans, and to assess the effects of firm size, wages, and other factors in explaining the residential differences. Both offer rates and participation rates are lower in rural areas, but the probability of employer-based coverage among rural workers rises to the level of that of urban workers when we adjust rural firm size and wages to urban levels. Rural firms and workers are not behaviorally different from urban firms and workers; they are, however, at a greater disadvantage because of their smaller size and lower wages.
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