We used recently available data from the China Health and Nutrition Survey (CHNS) from 2004 to 2011 to re-examine the impact of the New Rural Cooperative Medical System (NRCMS) in the People's Republic of China on exposure to catastrophic health expenditures. We found that the NRCMS with universal coverage and higher reimbursement rates in 2011 did not reduce the incidence and intensity of out-of-pocket catastrophic payments. Moreover, there were important distributional implications with the poorest protected to the least extent. As such, we suggest policymakers should consider using the NRCMS to shelter rural residents, especially the poorest, from catastrophic medical expenses.