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Tuesday, June 10, 2014

Rural Americans More Likely to Fall into Medicaid “Coverage Gap” and Lack Health Insurance

Kathleen Stoll

Director of Health Policy

A recent analysis by the Kaiser Family Foundation showed that, compared to Americans who live in cities, rural Americans* are poorer and more likely to have jobs that don’t offer health insurance. The analysis, which is based on Census Bureau data, found that rural Americans are more likely to fall into what is called the Medicaid “coverage gap”—they have been left without affordable health insurance options because their state chose not to expand Medicaid to more low-income people.

Compared to those who live in cities, more rural Americans are poor

About 75 percent of rural Americans have incomes low enough to qualify for financial help for coverage in the health insurance marketplaces. And of those 75 percent, one third have incomes that are even lower—they fall below the federal poverty level ($19,790 for a family of three in 2014).

By comparison, about 64 percent of urban Americans have incomes that are low enough to get financial help to pay for marketplace coverage, and 21 percent of those have incomes below the federal poverty level.

More rural Americans have jobs that don’t offer health insurance

Compared to workers in urban areas, workers in rural areas are more likely to have “blue collar” jobs. These rural workers tend to make less money and have fewer benefits.

Between 2012 and 2013, only 51 percent of rural residents had job-based coverage, compared to 57 percent of workers in metropolitan areas. Why? Because in rural areas, many industries don’t even offer job-based insurance to their employees (more than 20 percent of the workforce lacks job-based insurance).

If more states expand Medicaid, the Affordable Care Act would benefit rural Americans who don’t have affordable health insurance options

The Affordable Care Act expands affordable health coverage through Medicaid to people with incomes at or below 138 percent of the federal poverty level. However, the Supreme Court’s ruling on the law allowed states to choose whether they wanted to expand the program.

In states that have not expanded Medicaid, people with incomes at 100 percent of the federal poverty level and up can get financial assistance with marketplace plans. But many people with incomes below the federal poverty level are left without any affordable health insurance options. They fall into the Medicaid coverage gap.

Rural Americans in states that have not expanded Medicaid fall into the coverage gap

Almost two-thirds of rural, uninsured Americans live in states whose leaders have decided not to expand Medicaid. That’s more than 1 million rural Americans— many of whom work hard but still have no health insurance. According to the Kaiser report, without health insurance, these Americans have a more limited number of providers who are willing to give them low-cost or charity care than their urban counterparts.

What can I do to help rural Americans?

Families USA’s recent infographic shows the 24 states that have not yet decided to expand Medicaid.

If you live in one of these states, call or write to your state legislators and governor to urge them not to leave rural Americans without the security and peace of mind that comes from having health insurance. Encourage them to join the 26 states (and the District of Columbia) that have already expanded Medicaid, accepting the federal dollars that will bring jobs and economic benefits to their state and provide health coverage to low-income residents.

* Kaiser defined rural areas as areas that are outside of Metropolitan Statistical Areas (MSAs). An MSA is a city (and its suburbs) that has more than 50,000 residents. About 16 percent of the U.S. population lives in rural areas.