The Affordable Care Act (ACA) aimed to improve access to healthcare for all Americans, including those

living in rural areas, by expanding Medicaid eligibility and providing subsidies to help individuals
purchase health insurance through the marketplace. The ACA and the Medicare expansion under the
ACA had different impacts on rural and urban areas in states that expanded eligibility. (book) In rural
areas, the ACA and the Medicare expansion provided greater access to health insurance coverage,
particularly in states where the percentage of uninsured individuals was higher. Prior to the ACA, many
rural residents had limited options for health insurance coverage, and some lacked access to quality
health care due to a shortage of healthcare providers in rural areas.(book) The ACA and the Medicare
expansion helped to address this disparity by increasing the number of individuals with health
insurance, and thus improving access to care. The ACA and Medicaid expansion led to a significant
decrease in the number of uninsured individuals. This was largely due to an increase in Medicaid
enrollment among rural residents, which improved access to care and financial stability for rural
hospitals and clinics, as they received increased reimbursement for the care they provided.(Soni article)

Urban areas, on the other hand, typically had greater access to health insurance coverage prior to the
ACA, due to the presence of larger employers who offered health benefits and a larger concentration of
healthcare providers. In these areas, the impact of the ACA and the Medicare expansion was generally
more limited, although it did help to expand access to affordable health insurance options for some
individuals who were previously uninsured.(book)

Overall, the ACA and Medicare expansion had a positive impact on access to health insurance and
healthcare services for low-income residents, both in rural and urban areas. However, rural
communities still face challenges, such as limited access to healthcare services and a shortage of
healthcare providers, that need to be addressed in order to ensure that rural residents have access to
high-quality, affordable healthcare (Soni article).