Medicaid expansion has reduced the rate of uninsured low-income individuals in the U.S., and a new analysis found that uninsured rates dropped more drastically for people living in rural areas in states that expanded the program compared with those living in states that chose not to expand. The disparity between insured levels in rural and urban areas also was smaller in states with expanded Medicaid.
Under the Affordable Care Act, the federal government allowed states to expand their Medicaid programs to include individuals with incomes below 138 percent of the poverty line, or approximately $16,000 per year. While most states chose to expand the program, some – including many with large rural populations – rejected the offer. This resulted in significant disparities in uninsured rates among the states, as well as growing insurance rate disparities between low-income rural and urban areas, according to the report.
Researchers from the Georgetown University Center for Children and Families and the University of North Carolina Rural Health Research Program compared insurance rates from 2008-2009 and 2015-2016 across 46 states. The researchers then evaluated the changes in uninsured rates from the time periods before and after Medicaid expansion.
Uninsured rates for adults in rural communities fell from 35 percent to 16 percent in states that expanded Medicaid; however, they declined only 6 percent (from 38% to 32% percent) in states that did not. In urban communities, uninsured rates fell more dramatically in both categories, from 29 percent to 12 percent in expansion states, and from 38 percent to 26 percent in non-expansion states.
The study authors offered several reasons for the continued disparities between urban and rural areas, including the fact that major insurance providers often do not offer coverage in rural communities, where patients have higher incidence of many illnesses but less access to medical services. Expanding Medicaid, the study suggested, would decrease the numbers of uninsured, and might induce more providers to serve these communities.