Missouri’s overall uninsured rate closely mirrors the national average. In 2024, 7.6% of Missourians were uninsured, slightly lower than the 8.2% national rate.

Yet that statewide figure masks a sharper divide between rural and urban communities. In rural Missouri, 9.9% of residents lacked health insurance, compared with 6.9% of people living in urban areas.

The resulting 3-percentage-point rural-urban gap is far wider than the national difference of about 0.6 percentage points, indicating that Missouri’s rural communities face a larger coverage disparity than those elsewhere in the country. The policy brief analyzes U.S. Census data, providing the first comprehensive look since the end of pandemic-era Medicaid enrollment protections.

Researchers say the gap reflects structural differences in the types of jobs available in rural areas. Residents are more likely to work for smaller employers or in sectors such as agriculture, retail and service industries where coverage is less common. Rural workers also are more likely to work part time and earn lower incomes, making private coverage harder to obtain. Health insurance premiums tend to be higher in rural areas, and disability rates are higher, creating additional barriers to consistent coverage.

“These jobs are less likely to offer health insurance,” said Timothy D. McBride, the Bernard Becker Professor in the School of Public Health and co-director of the Center for Advancing Health Services, Policy & Economics Research.

“That difference in employer-sponsored coverage is one of the key factors behind the rural-urban gap we see in Missouri,” he added, noting the disparity merits further study.

Public programs fill rural gaps

Uninsured rates are lowest among adults ages 65 and older because most people in that group qualify for Medicare. Residents under age 65 in rural Missouri are significantly less likely to have private health insurance — typically obtained through employers or purchased individually — than those in urban areas.

In 2024, 60.6% of rural residents had private insurance, roughly 10 percentage points lower than the 70.8% rate in urban areas. Employer-sponsored coverage accounted for much of the difference: 46.1% of rural Missourians had job-based coverage, compared with 59% of urban residents.

Urban Missourians are also more likely to have private coverage than urban residents nationally, reflecting a higher concentration of jobs that offer employer-sponsored insurance, including positions in health care, finance, legal services and education.

With fewer rural workers covered through employers, public programs fill a larger share of the gap. In 2024, 21.9% of rural residents were covered by Medicaid, compared with 16% of urban residents. Overall, 43.2% of rural Missourians were covered by public programs such as Medicare, Medicaid and veterans benefits, compared with 33.7% of urban residents.

“Employer-sponsored insurance is still the main pathway to coverage for most Americans,” McBride said. “When fewer rural residents have access to those jobs, public programs like Medicaid become an even more important source of coverage.”

Medicaid unwinding shifts rural coverage

Medicaid coverage declined in rural Missouri between 2023 and 2024 as states completed the unwinding of pandemic-era policies that had allowed people to remain continuously enrolled. 

The share of rural residents covered by Medicaid fell by 1.9 percentage points, contributing to a broader 1-percentage-point drop in public program coverage overall. Coverage changes in urban areas were minimal over the same time period.

Some residents shifted to other forms of coverage, including employer-sponsored insurance, but the changes still led to a small increase in the uninsured rate. In rural Missouri, the share of residents without coverage rose by 0.4 percentage points from the previous year.

Children experienced the largest coverage declines. Public insurance coverage for children in rural Missouri fell by about 4.4 percentage points, compared with a 1.6-point decline in urban areas.

Researchers said it will be important to monitor how insurance coverage changes in the coming years, particularly as Medicaid enrollment continues to adjust following the end of pandemic-era eligibility protections.

The policy brief, written by Sarah A. Eisenstein, statistical data analyst, and McBride, draws on data from the American Community Survey conducted by the U.S. Census Bureau.

The research was supported by the Missouri Foundation for Health.

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The report is an update to a 2019 analysis. The new edition incorporates newer data and expands the scope of the earlier research. For example, the 2019 report examined childhood asthma, while the updated analysis also looks at asthma among adults. It also includes new data visualizations that illustrate how environmental conditions and health outcomes intersect across neighborhoods.

“We wanted to ensure that the updated report incorporated the latest available data and that it reflected what we have learned from the community over the last six years,” said Elizabeth Hubertz, director of the Interdisciplinary Environmental Clinic at Washington University in St. Louis School of Law.

In addition, while the 2019 report largely documented environmental disparities, the new version also focuses on solutions.

“The earlier report was largely descriptive, using a combination of public data and interviews with community members to catalogue environmental racism in St. Louis. This report is both descriptive and prescriptive,” said Eric Conners, a postdoctoral fellow in the clinic and a contributing author of the report. “It still documents how environmental racism manifests in St. Louis, but it also provides evidence-based, actionable recommendations for addressing those problems.”

The report also features “Community Spotlights” highlighting organizations working on environmental justice issues in St. Louis and includes a resource guide for residents seeking assistance or ways to get involved.

Among the recommendations, the report calls for improvements to how environmental health data are collected and shared. For example, it recommends updating Missouri’s environmental public health tracking database more frequently. It also suggests testing soils and surfaces in public areas where children gather if contamination is likely.

To address asthma and air quality, the report recommends that schools adopt the AirNow Air Quality Flag Program and calls for increasing air quality monitoring devices in the city.

Other recommendations include addressing the causes of illegal dumping; educating homeowners about beneficiary deeds to help reduce vacancy; supporting community-owned grocery stores in underserved areas; and improving data collection on mold complaints in rental housing.

The report also highlights how natural disasters can worsen inequalities. St. Louis neighborhoods with older housing and fewer resources may face greater damage and slower recovery after severe weather, such as the May 2025 tornado.

“Natural disasters often exacerbate preexisting inequality,” Conners said. “We can’t prevent the next tornado or flood, but we can strengthen the resilience of vulnerable communities.”

Even without strong federal support, Conners said cities and states can make meaningful progress. Residents can take action by contacting local officials, joining neighborhood organizations and reporting environmental problems such as illegal dumping or housing hazards, he added.

“A lot of the relevant action happens at the local and state level,” he said.

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WashU’s Good Nurtured spring wellness challenge gets underway soon. The challenge, which will run from March 23-April 19, is a chance to refresh through a holistic approach to well-being.

Good Nurtured raises awareness of the mental, emotional and physical health benefits of kindness, civility and graciousness by inspiring participants to spread kindness, develop strong connections and build well-being rituals into their day.

Registration is open; log in to the WashU Wellness Launchpad with your WashU Key.

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Some 200 films later, the African Film Festival is celebrating its 20th anniversary with award-winning movies, a master class from leading producer Ekwa Msangi and an appearance by actor Ntobeko Sishi, star of the movie, “Laundry.” The festival will feature 12 films and runs from March 27-29 in Brown Hall at Washington University in St. Louis. Admission is free. 

“Film is the perfect way to learn about the past, think about contemporary issues and open up your visual imagination to the diversity of Africa: the cultures, religions, languages, urban life, rural life,” said Toliver-Diallo, senior assistant dean in Arts & Sciences and a lecturer in African and African-American studies, who stages the annual event with the African Student Association. Here, Toliver-Diallo shares more about the festival’s mission and its upcoming lineup.

African Film Festival

When: March 27-29

Where: Brown Hall, WashU

How much: Free

More info: African Film Festival

Parking: Free parking available, east end garage

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“Think of it like an ant colony — a swarm. Just as ants will link their bodies together to form a physical bridge, our robots can autonomously lock together to build whatever structure the situation demands,” said Sebastian Theiler, captain of SWARM and a junior studying electrical engineering and robotics at the WashU McKelvey School of Engineering. “Right now, modular robotic systems are largely confined to the lab, but there are many possible applications.”

Take, for instance, a search-and-rescue operation. First responders could deploy a single robot to crawl through a collapsed building to asses damage. That robot could then beckon other robots to help it move heavy debris or to make a chain to clear a gap.

SWARM’s robots — essentially four-inch cubes of 3D-printed plastic — aren’t ready for such real-world tasks. Right now, the team is focused on getting the robots to autonomously shapeshift to navigate simple obstacles. But SWARM’s work today could lead to future discoveries.

“There’s a lot that we’re doing here that hasn’t been done before, which is one of the most exciting things about this project,” Theiler said. “We want to make our work open source and accessible so that anyone with a 3D printer and some resources can create their own system. We think that will speed up modular robotics research.”  

Theiler joined SWARM as a first-year student and calls it his “dream project” because it has allowed him to explore his interest in emergent properties, i.e. systems that can accomplish much more than the total of their components. He calls SWARM a robotics playground. 

“Most robots have a single function, like a robotic arm or a rover. But modular robotics allows us to challenge ideas about what it means for something to be a robot,” Theiler said. “We’re not really building the finished product. We are building something that can theoretically be very general and can shapeshift into meeting whatever application you require at that moment.”

Just as the robots collaborate to build something greater, so too do the members of SWARM. The mechanical, electrical and software teams each play an essential role in building SWARM’s Transformer-like prototypes, said Christena Berry, a member of SWARM’s mechanical unit. She credits the club with teaching her how to go from an abstract idea to a tangible product.

“It’s truly a team effort. It’s not me just doing one specific thing,” said Berry, a junior studying mechanical engineering. “It’s coming every week being ready to contribute ideas and fix the issues that we have each week and help with whatever somebody may be struggling on.”

WashU Robotics President Chris Brusie said club alumni have leveraged the lessons learned on their projects to land prestigious jobs at companies such as Tesla and Google. One alumnus, who mastered wiring printed circuit boards, got a job wiring circuit boards for Ford Motor Co.; another, who created software solutions for his project, was accepted into one of the top PhD robotics research programs in the country, he said.

“Here, students actually get to build things and be hands-on and work on a project that goes over a few years on a big team,” said Brusie, a junior studying electrical and systems engineering. “These are really important experiences you can’t always get in a classroom.” 

One skill that SWARM members have mastered is prototyping. So far, they’ve built and tested more than 100 prototypes.

“You never get it on the first try,” said Harrison Felipe, a sophomore studying mechanical engineering and a member of SWARM’s mechanical unit. “I’ve learned iteration here more than anything. You try something, the first time you put it through rigorous testing and see a lot of flaws, and then work on solving them for the next prototype.”

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Washington University in St. Louis researchers and clinicians have been incorporating data from Fitbit wristbands into machine-learning models that could predict surgical outcomes, pain after surgery and potential mental health issues, among other uses. While working with clinicians to predict pancreatic surgery outcomes, WashU researchers encountered an unexpected factor that changed their prediction model: the COVID-19 pandemic.

The pandemic disrupted daily life, from school and work to medical procedures, including pancreatic surgery, which can be complex with risks for complications and a challenging recovery. While it may be difficult for clinicians to determine who might be a good candidate for such surgery and who has a good prognosis for recovery, they may get some insight from using a model that analyzes patient data from their electronic health record as well as from a Fitbit wristband, a previous study published in 2021 revealed.

In a follow-up study, Jingwen Zhang, who earned a doctorate in computer science from the McKelvey School of Engineering in 2024 in the lab of Chenyang Lu, the Fullgraf Professor in computer science and engineering and director of the AI for Health Institute, found that their model performed better to predict the outcome of patients who had pancreatic surgery before the COVID-19 pandemic than after, leading Zhang to develop a novel solution in collaboration with a multidisciplinary team of artificial intelligence (AI) researchers and surgeons.

Results of the research were published online in ACM Transactions on Computing for Healthcare Jan. 19.

Read more on the McKelvey Engineering website.

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Tonya Edmond, a professor at the WashU Brown School, has been installed as the William E. Gordon Distinguished Professor. A ceremony took place Feb. 9 in Hillman Hall’s Clark-Fox Forum.

A nationally recognized expert on violence against women and children, Edmond’s research tests the effectiveness of trauma-focused interventions and the implementation of evidence-based treatments for survivors of sexual violence, intimate partner violence and childhood abuse.

Although Gordon was not a social worker, then-Dean Benjamin Youngdahl, a fellow University of Minnesota alumnus, recruited him in 1951 to establish one of the nation’s first doctoral programs in social work at the Brown School. Gordon awarded the school’s first doctorate in social work to Sidney E. Zimbalist in 1955.

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“As one of the largest employers in the St. Louis region, we’re proud to be an economic anchor, attracting talent to the region, providing and supporting thousands of jobs and partnering with local organizations to strengthen the fabric of our community,” said Chancellor Andrew D. Martin. “That local impact is amplified by the federal funding we receive, which makes it possible for us to continue advancing our mission in service to both our region and the nation.”

In 2025, WashU directly contributed $4.1 billion to the local economy, including $2.6 billion in employee salaries, $334 million spent on local goods and services and $196 million on construction. In addition, WashU students spent $217 million at local businesses. Every dollar WashU spends in the community generates another $1.25 in regional economic activity.

In addition to bolstering St. Louis’ economy, the university enriches its residents as an employer and an educator.  With 23,434 employees, WashU is the region’s second-largest employer. WashU also provides a range of educational opportunities to its neighbors, from the College Prep Program and Rural Scholars Academy, which help high school students navigate the college application process, to the School of Continuing & Professional Studies, which offers degrees and certificate programs to learners who are balancing their education and professional development with work and personal responsibilities.

The university also has expanded access to students in the region through its no-loan financial aid policy and the WashU Pledge, which provides a free WashU education to lower-income students from Missouri and southern Illinois. In 2025, the average aid package for students from Missouri and southern Illinois totaled $66,918. Meanwhile, the WashU Pledge has served 351 students since its launch in 2020. 

A trusted provider for health care, WashU Medicine physicians deliver care at BJC HealthCare’s nationally ranked Barnes-Jewish and St. Louis Children’s hospitals and the nationally ranked Siteman Cancer Center. They also serve patients at BJC’s 12 community hospitals and more than 130 WashU Medicine clinical locations across Missouri and southern Illinois. In 2025, WashU Medicine providers cared for patients in more than 3.4 million visits, including 1,898,728 for outpatient specialty care, 1,054,333 for inpatient care at BJC hospitals and 471,561 for community-based primary care. One of those patients was Martin Mwita Jr., the first patient in the St. Louis region to receive an innovative gene therapy for sickle cell disease.

“WashU is leading the way in bringing groundbreaking therapies to our patients,” said David H. Perlmutter, MD, executive vice chancellor for medical affairs and the George and Carol Bauer Dean of WashU Medicine. “Our goal is to ensure that the benefits of world-class discovery reach every patient, every family and every community we serve.”

In 2025, WashU continued to work alongside educational institutions, nonprofits and neighborhoods to strengthen the region’s physical, civic and cultural infrastructure. One example is WashU’s Institute for School Partnership, which supported more than 5,000 educators and 189,000 students through quality instructional programs such as mySci and Math314. 

“If you want a great city, you have to have great schools, and the way you do that is one teacher, one educator, one school at a time,” said Victoria May, ISP executive director. “It takes time and trust to build relationships that are authentic and sustainable. You have to show up in a spirit of collaboration.”

In addition, WashU partnered with Great Rivers Greenway to plan the Brickline Greenway; Forest Park Forever to transform historic Steinberg Rink; Integrated Health Network to provide accessible and affordable health care to medically vulnerable St. Louisans; and Go! St. Louis to stage the annual Greater St. Louis Marathon. Other partners include Arch Grants, Bi-State Development, College Bound, the Donald Danforth Plant Science Center, the Missouri Botanical Garden and the Saint Louis Zoo. 

WashU also stepped up to help neighbors in the aftermath of the deadly May 16 tornado, organizing 15 community outreach projects and donating 1,148 volunteer hours. That commitment continues today with the launch of CLEAN STL, which is assessing soil and air quality in areas affected by the tornado. CLEAN STL is the inaugural project of the WashU Public Exchange, a new initiative of the Brown School. 

“We bring together WashU’s best minds and ideas that can move the needle for St. Louis and beyond. It truly exemplifies how a university can partner authentically with its home city to turn research into actionable solutions,” said Dorian Traube, the Neidorff Family and Centene Corporation Dean of the Brown School. 

Chancellor Martin said WashU students, faculty, physicians and employees will continue to seek ways to strengthen the St. Louis region in the ongoing fiscal year even as it navigates unprecedented struggles, including cuts in federal funding, a new endowment tax and structural budget challenges that led to job cuts. 

“It’s no secret we face challenging times and widespread pressures across higher education,” Martin said in an earlier message to the WashU community. “While there are many uncertainties, I believe in WashU’s strength as an institution and especially in its people. I am proud of what we’ve accomplished during the past six years and of what we will achieve next together.”

To learn more about WashU’s impact, read the Community Impact Report.

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Yifan Dai, an assistant professor of biomedical engineering at the WashU McKelvey School of Engineering, has been named to the 2025 Forbes “30 Under 30” list in the Science category.

Dai’s expertise lies in decoding and encoding the physical chemistry of biological soft matter to understand biology and engineer precision medicine. His research aims to design synthetic biology-based therapeutics for neurodegenerative disorders, including ALS and Alzheimer’s diseases and antibiotic-resistant infections.

Read more on the McKelvey Engineering website.

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