King v. Burwell: Rural Implications?

Unless you live under the proverbial health policy rock, you know that today the Supreme Court will hear arguments on King v. Burwell (a brief history is here).  If the SCOTUS strikes down the subsidies provided in federally run exchanges, the impact will be significant:

• Approximately 7.2 million with insurance losing access to subsidized premiums; in other words, about 87% of those who obtained insurance via the exchanges
•  Substantial increase in the number of uninsured (due to the loss of subsidies, it is anticipated many would not be able to afford the full premium)
• Premiums (in the non-group market) would increase substantially, upwards of 35%

These changes have the potential to impact rural residents to a greater degree.  Rural residents have, on average:

• lower incomes
• reduced access to employer sponsored coverage
• more likely to live in a non-Medicaid expansion state
• have fewer enrollment options (plan and/or network choices) and higher premiums within the exchanges

If these subsidies are removed, it will further distance rural residents from the rest of the country in regards to insurance coverage, access to care, and equity in treatment.