As President Donald Trump and his administration look to repeal the Affordable Care Act and make deep cuts to Medicaid, a new study showed evidence that Medicaid expansion has decreased the number of uninsured in rural areas of the country.
Since the state has expanded Medicaid, the number of rural Marylanders signing up for coverage increased while the number of uninsured rural Marylanders dropped, according to the study from Georgetown University’s Center for Children and Families.
“I think in general, when you look at the expansion of Medicaid to a larger eligible population, that means that they are now able to access health care resources that they might not have been able to recently,” said Dr. Jinlene Chan, acting deputy secretary for public health with Maryland’s Department of Health and Mental Hygiene.
The Georgetown study looked at rural Medicaid enrollment and rural uninsured rates in all states except Delaware, Massachusetts, Rhode Island and the District of Columbia, where less than 2 percent of the population lived in non-metro areas.
In most other states, the study found that increased Medicaid availability lead to fewer uninsured people in rural areas. States that did not expand Medicaid had higher percentages of uninsured people and saw slower drops in uninsured people between 2008-2009 and 2014-2015, the two periods used.
The Affordable Care Act was implemented in 2014.
Maryland’s gains represented some of the largest in the country among rural communities. The proportion of adults enrolled in Medicaid expanded from 9 percent in 2008-2009 to 19 percent in 2014-2015, a 10 point increase. The state had the eighth-largest increase of adults on Medicaid in the country over that period.
In particular, the study found that children had gained more access to health insurance, mostly through Medicaid working in conjunction with the Children’s Health Insurance Program.
In Maryland, just 3 percent of rural children are uninsured, less than the 4 percent of children in metro areas that have insurance. That improved access could improve outcomes for rural children, one of the study’s authors said.
“We have a lot of good research and data showing that when children have Medicaid, they have access (to health care) at similar rates to children with private insurance,” said Joan Alker, the research director at the Georgetown center. “Having insurance is correlated with having better health outcomes for children growing up.”
Those outcomes also extend to education and other areas, she added.
While access to health insurance increased, Chan warned, other improvements would be needed to create more positive rural health outcomes.
“Insurance access is very important, but there’s a lot of other issues that have to be considered as well to try to improve access to care,” she said.
In Maryland, some of those challenges include access to providers, surgical centers, hospitals and even grocery stores for healthy eating.
Another unexpected challenge in rural Maryland can be transportation. Patients often have to travel anywhere from 45 minutes to two hours to get to the nearest specialist.
“If you have to go somewhere several times a week, it really, really becomes a major barrier for people,” she said.
While more people in Maryland gained access to health insurance through Medicaid expansion, Trump’s proposed budget would cut $800 million in funding to the program over the next 10 years.
The president’s budget proposal would also cut the Children’s Health Insurance Program’s budget by 20 percent over the next two fiscal years.