Author granted license

Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International

Document Type


Publication Date





Harvard Law School




Health disparities are persistent and worsening for rural communities, which have smaller patient populations with higher rates of uninsurance and greater incidence of the diseases and deaths of despair. Hospital closures and provider shortages are more common than in urban areas, also contributing to worsening population health and crises in maternal and infant health. This paper posits that these disparities are tied to the unique rural features of space and population. Efforts to address persistent problems in health care through universal legislation, such as the ACA, have given rural communities important tools to address some long-standing health problems by improving insurance coverage, which facilitates better access to health for patients and more consistent payment for health care providers. But, some rural states have rejected the ACA’s effort at universality while seeking targeted legislation to fill the gaps left by that choice. Drawing on Skocpol’s work studying effective social programs, the paper suggests that state resistance to the ACA’s universality impedes efforts to address health disparities and that targeted legislation can only minimally improve rural health disparities without universal baselines.

Find on SSRN Link to Publisher Site (BU Community Subscription)



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.