Health Care Access Among Self-Employed Workers in Nonmetropolitan Counties

Access to health care involves affordability, which is often tied to health insurance coverage, as well as availability of health care facilities and providers. Self-employed workers are less likely to have access to employer-sponsored health insurance plans, and rural areas may have fewer options for local health care. Through the lens of availability and affordability, this report studies health care access for self-employed individuals, their families, and their households in nonmetropolitan (nonmetro) counties, using data collected between 2014 and 2020. The results indicate that health insurance coverage rates and sources differ more by age and whether workers are self-employed than by whether they live in a metro or nonmetro location. Self-employed workers ages 26 to 64 are more likely to be uninsured than those employed by government or private industry, but more of these working-age adults are insured through employer-based plans than any other insurance source. Few self-employed workers over age 65 are uninsured, and more of them are insured by public plans than any other source of insurance. Family medical expenditures differ more by age and source of health insurance coverage than by whether a family member is self-employed or lives in a metro or nonmetro location. The availability of health care facilities and services varies among U.S. counties by region, metro status, and whether a large share of workers are self-employed. Uninsured rates were higher for all workers at the beginning of the Coronavirus (COVID-19) pandemic in April and May of 2020 than in 2018 and continued to increase through the pandemic in 2020, mainly due to a decline in coverage from employer-sponsored plans.