Rural Missourians More Likely to Be Uninsured, New Study Finds

St. Louis, Mo. (KFMO) - A new policy brief from researchers at Washington University in St. Louis shows Missourians living in rural communities are significantly more likely to lack health insurance compared to those in urban areas.

According to the report, 9.9 percent of rural Missouri residents were uninsured in 2024, compared to 6.9 percent in urban areas. While Missouri’s overall uninsured rate of 7.6 percent is slightly below the national average of 8.2 percent, researchers say the statewide number hides a much larger rural-urban divide.

The nearly three-percentage-point gap in Missouri is far greater than the national difference of about 0.6 percentage points, suggesting rural communities in the state face more significant barriers to health coverage.

Researchers say one of the biggest factors is the type of jobs available in rural areas. Many residents work for smaller employers or in industries like agriculture, retail, and service sectors, where health insurance benefits are less common. Lower incomes, part-time work, and higher insurance premiums also make it more difficult for rural residents to obtain private coverage.

The study found 60.6 percent of rural residents had private insurance in 2024, compared to 70.8 percent in urban areas. Employer-sponsored coverage accounted for much of that difference, with just 46.1 percent of rural residents receiving insurance through their jobs, compared to 59 percent in urban communities.

As a result, public programs play a larger role in rural coverage. About 43.2 percent of rural Missourians relied on programs like Medicare, Medicaid, and veterans benefits, compared to 33.7 percent in urban areas. Medicaid alone covered nearly 22 percent of rural residents.

However, Medicaid coverage declined between 2023 and 2024 following the end of pandemic-era enrollment protections. The share of rural residents covered by Medicaid dropped by nearly two percentage points, contributing to a slight increase in the uninsured rate.

Children in rural Missouri saw the largest decline in coverage, with public insurance dropping by more than four percentage points.

Researchers say the findings highlight the importance of tracking how coverage continues to change, especially as Medicaid enrollment stabilizes after pandemic-related policies have ended.

The study was based on data from the U.S. Census Bureau’s American Community Survey and was supported by the Missouri Foundation for Health.