Florida Public Health Review

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Background: Although health insurance coverage for adults in each of the Gulf Coast States and the rest of the country increased after implementing the Affordable Care Act, the coverage rates in the Gulf Coast region remained lower to rural residents, compared to those in the rest of the Nation. Purpose: This study aimed to update the changes of health insurance coverage in all states and the Gulf Coast states, confirm the significance of the health policy on insurance coverage by analyzing Louisiana, and examine the relationships between socio-demographic variables and rural/urban area by using interaction variables. Methods: This study used the American Community Survey, which is an annual survey of about three million U.S. households and collected social, demographic, and economic information, including health insurance coverage. Logistic regression was used to estimate the effects of the demographic and economic variables on health insurance coverage. Results: Florida and Texas increased health insurance coverage in the urban areas, while Alabama, Louisiana, and Mississippi present a more considerable increase in the rural area. However, Louisiana showed a significant increase in insurance coverage, rural areas in particular after joining the Medicaid expansion in 2016. A significant decrease in insurance coverage was found among young adults, African American, non-married, not in the labor force, and being poor for rural residents in Florida and Texas. In contrast, minorities in other races and unemployed decreased the likelihood of having insurance for rural residents in Alabama, Louisiana, and Mississippi. Discussion: Our examination of how socio-demographic variables interact with living in a rural area revealed a clear rural disadvantage pattern. The pattern, however, was varied between Florida and Texas and Alabama, Louisiana, and Mississippi. These findings have meaningful implications for the ongoing effort to reduce insurance coverage disparities in the Gulf Coast states and all Americans.