The number of people who gained insurance because of the Affordable Care Act, also called Obamacare, was the largest in rural areas and small towns across the country. And Kentucky saw one of the biggest gains in health insurance in its small towns and rural areas.
According to a new report out this week from the Center for Children and Families at Georgetown University, prior to 2008 about 35 percent of people nationwide didn’t have health insurance; now, only about 16 percent of people don’t have coverage.
States that didn’t expand Medicaid — like Georgia, Texas, Florida and Mississippi — have the highest uninsured rates in small towns and rural areas, according to the report.
Joan Alker, the executive director of the Center for Children and Families, said the expansion of Medicaid has been especially important for people in rural areas who did not have health insurance. In many parts of the country, more people in cities had health coverage compared to people living in rural areas. Alker said the Medicaid expansion has helped bridge that divide.
“It‘s been particularly important for rural areas and small towns, because those areas tend to have more poverty and higher rates of uninsurance and it just is hard to find a job in a rural area that offers good health care,” she said. “Medicaid has come into those areas, and really helped those communities out.”
In 2009, 40 percent of adults with low incomes living in rural areas and small towns didn’t have health insurance in Kentucky. In 2016, that number dropped to 13 percent. In Kentucky, the rate of people in cities who don’t have insurance is the same as in rural areas.
States that did not expand Medicaid didn’t see a big drop in uninsurance rates like states that did expand, the study shows. In Florida, where the Medicaid program was not expanded, about 37 percent of people living in rural areas with low incomes didn’t have insurance in 2008 — that number went down to 24 percent in 2016.
With Gov. Matt Bevin’s proposed changes to Kentucky’s Medicaid expansion program, there could be an increase in the number of people without insurance, according to Alker.
Bevin proposed adding a community engagement requirement that includes mandatory work hours to keep insurance. He also proposed adding mandatory payments to keep coverage — currently the expanded insurance is mainly provided for free — and other tracking requirements. Those changes, called a waiver, were approved by the federal government earlier this year, but a court kept the waiver from going into effect.
“I think if Kentucky where to go backwards with Medicaid expansion, we would expect rural areas to be hit especially hard,” Alker said. “Kentucky in particular, when you look at counties where there are adults enrolled in Medicaid expansion, have many of the highest levels in the entire country [of enrollment in Medicaid].”
Emily Beauregard, executive director of Kentucky Voices for Health, said if the Medicaid waiver is eventually implemented, people in rural areas would be especially impacted.
“You would see more people in those rural areas struggle to find job opportunities or to, you know, have the internet connection that they need to be reporting requirements,” Beauregard said. “We would see a lot of barriers that would mean that they would lose their coverage or not be able to access the care that they need when they need it.”