Medicaid expansion has especially helped low-income adults in small towns and rural areas, according to a new report by Georgetown University's Health Policy Institute and the University of North Carolina's NC Rural Health Project.
The uninsured rate for people who are below 138% of the federal poverty level dropped from 35% to 16% in rural areas and small towns in Medicaid expansion states between 2008-2009 and 2015-2016. That's compared to a decline of 38% to 32% in non-expansion states.
Virginia, Utah, Florida and Missouri are non-expansion states with the biggest coverage disparities between rural/small towns and metro areas. However, Virginia recently approved expanding Medicaid and Utah voters will decide on a similar measure in November.
It's not surprising that Medicaid expansion helped reduce uninsured numbers in rural areas and small towns. Overall, expansion contributed to the uninsured rate dropping from 18.2% in 2010 to 10.4% in 2016.
Getting more people insured can help a community's health. It can also help provide more reliable funding sources for hospitals and less uncompensated care.
"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 Affordable Care Act helped improve the nation's insured rate. The individual mandate nudged people to get insurance, the exchanges provided easier access to individual plans and regulations required plans to offer essential health benefits and accept members regardless of pre-existing conditions. That all helped improve the insured numbers, but it was Medicaid expansion that's credited with getting more than 15 million people health insurance coverage.
The report found that uninsured rates for low-income adults have decreased in nearly all states since the ACA. States that saw the largest drops in uninsured rates for low-income adults in small towns and rural areas include Arkansas and Kentucky. CMS recently approved work requirements for people who receive coverage through Medicaid expansion in both of those states. A judge rejected Kentucky's plan, but CMS may grant another approval.
Despite improvements, uninsured rates in small towns and rural areas remain higher than in cities. Rural areas usually have lower household incomes and job participation rates, as well as higher rates of disability. These all contribute to Medicaid helping those areas more than in metropolitan areas.
Medicaid expansion could help many of the non-expansion states with significant rural populations, according to the report. Those states include Idaho, Mississippi, Nebraska, Oklahoma, South Dakota and Wyoming.
"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."