Sunday, December 17, 2017

Medicaid expansion had much bigger impact in rural areas; advocates worry about impact of tax bill on programs

By Melissa Patrick
Kentucky Health News

The expansion of Medicaid under the Patient Protection and Affordable Care Act resulted in larger coverage gains in rural areas than urban ones, suggesting that any roll-back of the program would hurt rural America the most, according to a recent University of Louisville study.

The study, published in The Journal of Rural Health, found the percentage of low-income residents who signed up for health insurance through the expansion was greater in rural regions compared to urban ones: an 8.5 percent increase, compared to a 4.1 percent increase, respectively.

These findings are especially important to Kentucky, which had more rural people sign up for Medicaid through the expansion of the program to people who earn up to 138 percent of the federal poverty level than any other state, according to the Kentucky Center for Economic Policy.

In all, 478,000 Kentuckians signed up for coverage through the expansion and 223,700 of them lived in rural areas. Medicaid as a whole covers about 1.4 million Kentuckians. For a spreadsheet of enrollment by county in June 2017, click here.

The U of L researchers used data from the 2011-2015 Behavioral Risk Factor Surveillance System and compared trend changes for coverage, access to care and health care utilization in response to Medicaid expansion among urban and rural residents.

Joseph Benitez, who led the study as an assistant professor in U of L's School of Public Health and Information Sciences, said that even with the Medicaid expansion, cost-related barriers weighed more heavily on rural residents related to things like transportation to a medical provider. He said that can be problematic for individuals who live in health provider shortage areas.

“Any efforts by the government to roll back Medicaid expansion will certainly disproportionately affect the ability of rural residents to gain affordable coverage and access to care,” Benitez said in a news release.

Health advocates fear impact of tax cuts

While there isn't much talk right now about repealing and replacing the Affordable Care Act, the tax bill that is about to become law could trigger cuts to Medicaid funding down the line to help reduce the deficit most economists expect it to create.

Janet Currie, chair of the economics department at Princeton University and co-director of the Center for Health and Wellbeingtold Daniel Bush of "PBS NewsHour" that potential cuts to Medicare and Medicaid are "by far the most important potential impact of the tax bill on the health-care system. A $1.5 trillion (or larger) deficit will necessitate spending cuts. And cutting large social programs like Medicare and Medicaid using across the board cuts is the absolute worse way to do it."

Medicaid is jointly funded by the federal government and states, with the payment mix for traditional coverage varying depending on how poor the state is. For example, the federal government pays an average of 57 percent of traditional Medicaid costs, but pays 70 percent of the costs in Kentucky.

Medicaid expansion is paid at a higher rate. The federal government paid the full amount of the expansion until 2016; states are paying 5 percent of the cost this year, rising in steps to the law's maximum of 10 percent in 2020.

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