Medicaid expansion had more impact in rural areas, study says

Medicaid expansion under the Affordable Care Act greatly increased access to health care for Americans, especially in rural areas, says an Indiana University study published in The Journal of Rural Health. Researchers, who used data from the Census Bureau‘s American Community Survey from 2011-15, found that expansion “increased the probability of Medicaid coverage for targeted populations in rural and urban areas, with a significantly greater increase in rural areas, but some of these gains were offset by reductions in individual purchased insurance among rural populations.”

Medicaid covered almost 636,000 adult Kentuckians in the second quarter of this year, with the great majority of enrollees covered under Medicaid expansion, and almost half of them young adults, according to a report done for the Foundation for a Healthy Kentucky.

The report found that 493,199, or 78 percent, of the 635,747 adult Kentuckians covered by Medicaid were covered by the Patient Protection and Affordable Care Act’s expansion of the program to those who earn up to 138 percent of the federal poverty level. The remaining 142,548 were covered by traditional Medicaid.

IU researchers found that Medicaid expansion increased the probability that low-income people would have health coverage, and it increased Medicaid coverage more in rural areas than in cities. There was some evidence that in rural areas, the expansion was accompanied by some shifting from individually purchased insurance to Medicaid.

The study suggested “that rural childless adults, compared to urban childless adults, experienced a 1.9-percentage-point larger increase in the probability of having Medicaid as a result of the expansion,” says the study. “Rural childless adults experienced a 1.5-percentage-point larger decline in the probability of having individual purchased insurance. (Indiana University graphic)