High costs limit rural Nebraskans’ access to health care

Most rural Nebraskans report having health insurance coverage and a personal doctor. However, for some, high costs precluded them from needed health care.

According to the most recent Nebraska Rural Poll — conducted annually by Rural Prosperity Nebraska with funding from Nebraska Extension — 94% of rural Nebraskans said they have health insurance. A slight majority, 53%, said their primary insurance is provided through an employer, while 25% have Medicare.

Eighty-seven percent of respondents have a person or group of doctors they think of as their personal doctor. However, 14% said they were unable to see a doctor when they needed to during the past year because of the cost.

"The data show that having health insurance and a personal doctor is important to rural Nebraskans," said David Palm, research team member with the Department of Health Services Research and Administration in the University of Nebraska Medical Center's College of Public Health. "However, the fact that the cost of healthcare is a barrier to seeing a doctor could lead to worse overall rural health and well-being. These findings highlight the importance of looking into how rural Nebraskans can access and afford the healthcare they and their families need to remain healthy."

While relatively few respondents reported experiencing economic hardships during the past year — 0.4% reported lacking a steady place to sleep or needing shelter, and 4% had utility companies threaten to shut off service in their home — costs remain an issue for some.

Although most rural Nebraskans surveyed said it is not at all or not very hard to pay for basics like food, housing, medical care and heating, 25% said it is somewhat hard. Five percent said it is hard and 3% very hard to pay for these basics. Just 37% said it is not at all hard to pay for basics, while 30% said it is not very hard.

Furthermore, when asked if, within the past year, they worried that their food would run out before receiving money to buy more, 15% of respondents said this was sometimes true and 3% said it was often true. Most, 83%, said that was never the case. The opposite held true, however, for lower-income households. Forty-one percent of respondents with household incomes under $40,000 said this was often or sometimes true, compared to 9% of those with incomes of $100,000 or more.

"While most rural Nebraskans can meet their basic needs, these findings show that financial security isn't a given for everyone," said Brad Lubben, extension associate professor of agricultural economics at the University of Nebraska–Lincoln. "If having food, paying utility bills or affording a doctor depends on when the next paycheck arrives, these findings remind us that economic well-being can look very different from one household to the next, and that even in communities where severe hardship is uncommon, some residents are still facing difficult choices in meeting their basic needs."

Overall, few respondents experienced transportation issues during the past year. Three percent reported that a lack of transportation kept them from medical appointments or from getting medications, and 4% said it kept them from meetings, work or getting necessities.

Most rural Nebraskans surveyed said they never or rarely feel lonely or isolated from others, but a significant portion feel this way at least sometimes. Forty-two percent said they never feel this way, and 23% said they rarely do. Just 27% said they sometimes feel lonely or isolated. Six percent said they often feel this way, and 2% said they always do.

Younger people were more likely than their older counterparts to say they feel lonely or isolated, according to the poll, with 13% of people ages 19 to 29 often or always feeling this way, compared to 4% of those 65 and older.

"Feeling connected to others is an important part of individual well-being and the strength of rural communities," said Cheryl Burkhart-Kriesel, a Rural Prosperity Nebraska Extension educator. "These findings show that social isolation remains a concern for some residents, particularly younger adults. This is a reminder that living in a close-knit rural community does not necessarily mean everyone feels connected. Creating opportunities for people to build relationships, participate in community life and develop a sense of belonging is integral to strengthening both individual well-being and communities overall."

The "Health Care" report and its implications for rural Nebraska will be highlighted during a Rural Poll webinar at noon CST Nov. 18. Register here. The full report can be found on the Nebraska Rural Poll website.

The 2026 Nebraska Rural Poll marks the 31st year of tracking rural Nebraskans' perceptions about policy and quality of life. It is the largest and longest-running poll of its kind. Questionnaires were mailed in April and May to nearly 6,900 Nebraska households, with 881 households from 86 of the state's 93 counties responding. The poll carries a margin of error of plus or minus 3%. Current and past reports are available here.

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