Rural Texas Poverty and Health Insurance Coverage

Yesterday I retweeted a Census Bureau infographic with national statistics on rural and urban poverty, income, health insurance coverage and housing. There are several positive messages in that data, including lower poverty rates for rural, lower rates of people living alone, and higher rates of children living in a married family households (being a single householder or the child of a single householder can be difficult). There were also some less pleasant statistics, including a larger share of rural residents without health insurance, a smaller share with a college degree, a lack of rural internet. And there were some interesting points that are positive/negative mixes. For example, a larger share of rural households own their own homes. Home ownership is generally a good thing both economically and socially, but home ownership, especially in rural area with soft housing markets, may prevent people from relocating to better jobs. Similarly, rural people are 17% more likely to live in the state of their birth. That can be a great thing, but it can also signal a lack of perceived opportunity.

The finding that rural people were less likely to have insurance wasn’t surprising. But the finding of lower rural poverty rates conflicted with other statistics that show higher rates of rural poverty. This is especially important in Texas, which tends to have higher poverty levels and a larger share of uninsured people (and especially uninsured children) than the rest of the U.S. Five-year 2015 American Community Survey statistics from the Census Bureau show this.

U.S. Texas
Poverty rate, families 11.3 13.4
Poverty rate, individuals 15.5 17.3
Poverty rate for individuals under 18 21.7 24.7
Health insurance coverage rate 87 79.4
   Private health insurance coverage 66.1 59.4
   Public health insurance coverage 32.1 28.3
Uninsured 13 20.6
Uninsured children 6.5 11.7

The difference is that the Census Bureau defines rural areas as those that are not urban. Under the Census Bureau definition of rural, there are rural parts of Dallas, Harris, Travis and Bexar Counties (containing the core of Dallas, Houston, Austin, and San Antonio, respectively, for out-of-state readers). You can certainly have a rural area within a metroplex. But the issues facing rural Houstonians tend to be very different than the issues facing people in, say, Crockett County in West Texas. Many of us working in rural economic development use county-based definitions of rural, often based on the USDA ERS rural-urban continuum codes.

Using a county-based definition of rural tells a slightly different story. Rural residents are still less likely to have insurance, but they are also more likely to be in poverty. Specifically, they are more likely to be in poverty in trade centers (small cities and towns), which have higher poverty rates than cites. The smallest counties have lower poverty rates than the Texas average. The Census Bureau data considers the urbanized areas or clusters of code 4-7 counties as urban and the rural parts of those counties as rural. That drives the different results we see using the Census v. USDA classification, but Rural Americans rely on their rural towns, and our towns and countrysides are not dichotomous.

Poverty rate, families Poverty rate, individuals Poverty rate for individuals under 18
Metro 11.9 15.8 22.0
Nonmetro 13.6 17.8 25.4
4=20,000+ Urban Popn, Adjacent 17.0 22.0 30.3
5=20,000+ Urban Popn, Non Adjacent 17.2 21.4 30.4
6=2,500-19,999 Urban Popn, Non Adjacent 14.1 18.2 26.4
7=2,500-19,999 Urban Popn, Adjacent 13.6 17.5 25.5
8=Completely Rural, Adjacent 11.6 15.6 21.9
9=Completely Rural, Non Adjacent 11.5 16.4 22.4

Poverty rates for children are also higher in those mid-size counties, but nonmetro high poverty counties are not necessarily where you think. Take a look at the Census Bureau’s American FactFinder to see where poverty, and especially youth poverty, are high. If you need some pointers, here’s a quick video to show you around FactFinder.

All nonmetro counties have a overall uninsured rate than metro counties, but with the exception of urban-adjacent completely rural (code 8) counties, a smaller share of rural children are uninsured. Some people have both public and private insurance, and one reason public insurance is higher in rural areas may be the higher proportion of Medicare-eligible seniors.

Health insurance coverage rate Private Public Uninsured Uninsured children
Metro 81.3 57.0 30.0 18.7 14.2
Nonmetro 78.8 58.6 35.5 21.2 13.0
4=20,000+ Urban Popn, Adjacent 78.3 58.6 34.2 21.7 13.5
5=20,000+ Urban Popn, Non Adjacent 77.6 60.6 35.0 22.4 10.5
6=2,500-19,999 Urban Popn, Non Adjacent 79.1 58.2 36.2 20.9 13.5
7=2,500-19,999 Urban Popn, Adjacent 77.9 57.4 33.9 22.1 13.0
8=Completely Rural, Adjacent 80.5 58.0 35.7 19.5 14.4
9=Completely Rural, Non Adjacent 78.5 61.3 36.8 21.5 11.6

There are a few take-away messages here. Rural communities have some positive statistics in their favor. But how we define rural matters. If we look a continuum of rural-urban and the need to access goods and services in trade centers and to complete regionally in a global economy, we in Rural Americans may need to take an active in interest in our small cities and towns. We’re in this together. And we Texans have some work to do.

And seriously, check out the video to see how to access the Census data and learn more about your region.


About Rebekka Dudensing

Dr. Rebekka Dudensing is an Associate Professor and Extension Economist - Community Economic Development with Texas AgriLife Extension and Research in the Department of Agricultural Economics at Texas A&M. Her research interests include the evaluation of economic development opportunities, taxation and public/private goods issues, entrepreneurship, and regional economic cooperation.
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