Small towns and rural areas saw the biggest benefits of Medicaid expansion under the Affordable Care Act, according to a recent report from Georgetown University’s Center for Children and Families and University of North Carolina’s NC Rural Health Project.
Rural areas and small towns typically have higher uninsured rates, and Medicaid plays an even bigger role in these areas, covering more adults and children than in metro areas.
States that expanded Medicaid saw three times the decline in uninsured rates for low-income adults living in rural areas and small towns compared to non-expansion states. Rising insurance rates beneficially impact clinics, hospitals and other healthcare providers that operate in these areas.
The uninsured rate dropped from 35 percent to 16 percent in rural areas and small towns in expansion states from 2008/2009 to 2015/2016, compared to a drop from 38 percent to 32 percent in non-expansion states, according to the study.
“This result underscores that the Medicaid expansion has been the key driver as the ACA was implemented in reducing the number of uninsured adults in rural areas and small towns nationwide,” the study found.
Nationally, the uninsured rate for all Americans under the age of 65 fell from 18.2 percent to 10.4 percent from 2010 and 2016.
“Expanding Medicaid has had a very positive impact on small towns and rural communities,” Joan Alker, executive director of the Georgetown University Center for Children and Families and a Research Professor at the McCourt School of Public Policy, said in a statement. “Improved coverage rates typically translate to a more stable healthcare system and help rural areas and small towns maintain availability of healthcare providers in areas where shortages are all too common. Access to rural health providers is especially important to women of child-bearing age and those with chronic conditions such as asthma."
State decisions over expansion options have “resulted in uneven patterns of insurance coverage,” the study found.
Expansion states with the biggest drops in uninsured rates for this group of adults in small towns and rural areas were Arkansas, Colorado, Connecticut, Hawaii, Kentucky, Michigan, Nevada, New Mexico, Oregon and West Virginia. Several states with “sizable rural populations” have not yet expanded Medicaid—Idaho, Mississippi, Nebraska, Oklahoma, South Dakota and Wyoming. Alaska and Louisiana, which recently made decisions to expand Medicaid, are also among the states with the highest uninsured rates for low-income adults in non-metro areas.
“Overall, the experience of Medicaid expansion states demonstrates the great opportunity for states that have not yet expanded Medicaid,” Jack Hoadley, lead author of the report, said in a statement. “Not only do they have the chance to reduce the number of uninsured adults overall, but they have a significant opportunity to bring down the uninsured rate in small towns and rural areas and narrow the gap in many states between metro and rural areas.”
The study looked at data from the Census Bureau’s American Community Survey from 2008/2009 to 2015/2016.
Amy joined TriMed Media as a Senior Writer for HealthExec after covering home care for three years. When not writing about all things healthcare, she fulfills her lifelong dream of becoming a pirate by sailing in regattas and enjoying rum. Fun fact: she sailed 333 miles across Lake Michigan in the Chicago Yacht Club "Race to Mackinac."