Share of uninsured Kentuckians in rural areas and small towns dropped to 13 percent from 40 percent after Medicaid expansion

OPINION By Emily Beauregard
Executive director, Kentucky Voices for Health

Medicaid expansion has made an overwhelmingly positive impact on rural Kentucky. Our state was among the top three leaders in lowering our uninsured rate for low-income adults in rural areas and small towns.

That rate dropped from 40 percent to 13 percent between 2008-09 and 2015-16, according to a new report from researchers at Georgetown University and the University of North Carolina. This may be the first time Kentucky has been a leader in anything other than cancer deaths and poor health outcomes.

Compare the dramatic dip in uninsured to our neighbors in Tennessee, where the uninsured rate for low-income adults in rural communities is 35 percent, down just 6 percentage points from 2008-09. In Mississippi, it’s 35 percent, down about 5 percentage points. In Kentucky, we saw a 27-percentage-point improvement.

What is Kentucky doing that our neighbors aren’t? It’s simple; our leaders agreed to expand Medicaid to adults who earn up to 138 percent of the federal poverty line, and that has been one of the keys to this successful reduction in our uninsured rates. This was a provision of the Patient Protection and Affordable Care Act that some of our neighboring states chose to reject.

Kentucky bet that expanding the benefit to more working families would be a good investment for our residents and would help rural hospitals and clinics keep their doors open. That bet is paying off for our state; hardworking Kentuckians without employer-sponsored health insurance have been able to seek care, some for the first time in their lives.

Not only was the decision to expand Medicaid in Kentucky beneficial to low-wage workers and those in rural communities with few job opportunities, it also likely saved some rural hospitals from closing their doors. Hospitals in states that expanded Medicaid are six times less likely to close their doors than those in non-expansion states.

Kentuckians have made clear their desire to retain Medicaid expansion as it is, without changes to benefits or the addition of barriers. In recent comments to the Centers for Medicare and Medicaid Services, Kentuckians spoke out 20 to 1 against a waiver that would alter Medicaid from its current state.

The decision to expand Medicaid is giving residents in our small towns and rural communities a reliable source of health coverage. It is giving rural hospitals and community health centers a reliable stream of revenue for treating people who get sick. And it is fueling the economic vitality of these communities.

Workers with health coverage are better able to show up for work regularly. They are less likely to fall into medical debt or bankruptcy. And their children are more likely to have their health needs met, giving the next generation a better chance at success in school and life.