Rural Areas Benefit from Medicaid Expansion

State decisions to expand Medicaid have paid off for residents of small towns and rural areas, according to a new report. States that expanded Medicaid, like Iowa, saw more than three times as large a decline in the uninsured rates for low-income citizen adults living in rural areas and small towns than non-expansion states experienced for the period between 2008/09 and 2015/16.

The uninsured rate for this population dropped sharply from 35 percent to 16 percent in rural areas and small towns in states that expanded Medicaid (in Iowa, the rural uninsured rate dropped from 27 percent to 15 percent) compared to a much smaller decline from 38 percent to 32 percent for states that have not expanded Medicaid.

The report was published by Georgetown University’s Center for Children and Families and University of North Carolina’s NC Rural Health Project.

“Expanding Medicaid has had a very positive impact on small towns and rural communities,” said Joan Alker, executive director of the Georgetown University Center for Children and Families and a research professor at the McCourt School of Public Policy. “Improved coverage rates typically translate to a more stable health care system and help rural areas and small towns maintain availability of health care 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.”

Rural areas tend to have higher rates of uninsured people. As the report shows, in many Medicaid expansion states, there are little to no gaps between non-metro and metro areas in the uninsured rate for low-income adults. On the other hand, in many states that have not yet expanded Medicaid, residents of small towns and rural areas will disproportionately benefit if the state decides to expand.

“Overall, the experience of Medicaid expansion states demonstrates the great opportunity for states that have not yet expanded Medicaid,” said Jack Hoadley, lead author of the report. “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.”

To view the complete report, click here.