In 2018, health insurance coverage rates and patterns in metropolitan (metro) and nonmetropolitan (nonmetro) areas were similar, according to research by the USDA, Economic Research Service (ERS). That year, 88.9 percent of working-age adults (aged 26–64) in metro counties and 87.5 percent of those in nonmetro counties had health insurance coverage. The source of employment had a greater effect on health insurance coverage than whether a worker lived in a nonmetro or metro county. In 2018, self-employed working-age adults were less likely to have health insurance coverage than those employed by private firms or governments, no matter where they lived (metropolitan or nonmetropolitan area). As a result, they may have found it difficult to access health care, as affordability often is tied to health insurance coverage.