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ACA At 11: Health Care For Rural Americans

By March 26, 2021No Comments

Protect Our Care Is Marking the 11th Anniversary of the Affordable Care Act With 11 Days Celebrating the Success of the Health Care Law

Eleven years ago, the Affordable Care Act (ACA) became the law of the land, and millions of people gained coverage and critical protections as a result. The ACA opened the door for states to expand Medicaid, which has helped an estimated 1.7 million rural Americans gain coverage. Health care for rural Americans is especially important due to higher prevalence of pre-existing conditions and barriers to accessing health care. 

After four long years of Republican efforts to repeal and sabotage the ACA, President Biden and Democrats in Congress are now working to build on the strong foundation of the law to expand coverage, lower costs, and reduce racial disparities in health care. On March 11, President Biden signed the American Rescue Plan into law, historic legislation that includes the most significant health care expansion in a decade. This will help rural Americans in particular, who still experience lower coverage rates. In addition to providing affordable coverage options for millions of uninsured Americans through the ACA, the American Rescue Plan provides robust financial incentives for the 14 states* that have not yet implemented Medicaid expansion. 

As the nation continues to face this unprecedented health care crisis, Medicaid expansion is especially important for reducing uncompensated care costs and protecting rural hospitals from financial peril. Medicaid expansion is a critical part of our response to coronavirus, but Republicans in 12 states have rejected expansion, blocking millions from coverage. All of these states are in the southern and midwest regions with significant rural populations. 

Thanks To The ACA:

  • Nearly 1.7 Million Rural Americans Gained Coverage Through Medicaid Expansion. Thanks to the ACA, nearly 1.7 million rural Americans gained Medicaid coverage. 
  • In 2017, Nearly 1 In 5 Marketplace Enrollees Lived In Rural Areas. 1.6 million enrolled in ACA coverage lived in rural areas in 2017. 
  • The Uninsured Rate For Low-Income Adults Fell By More Than Half In Rural Areas With Medicaid Expansion. The uninsured rate for low-income adults dropped from 35 percent to 16 percent in rural areas and small towns in states that expanded Medicaid. 

Medicaid Expansion Is A Lifeline For Rural Hospitals:

  • Medicaid Covers Nearly One In Four Rural Americans. Medicaid covers nearly 24 percent of rural Americans, 45 percent of rural children, 15 percent of rural seniors, and pays for 51 percent of rural births. 
  • Rural Hospitals In Medicaid Expansion States Are 62 Percent Less Likely To Close. 75 percent of vulnerable rural hospitals are in non-expansion states. 
  • The ACA Reduces Uncompensated Care Costs. Medicaid expansion has saved hospitals an average of $6.4 million in uncompensated care costs, with safety-net hospitals seeing even greater savings. In 2017, uncompensated care costs comprised 6 percent of total expenses for hospitals in states that rejected Medicaid expansiondouble the amount for hospitals located in expansion states. 
  • 430 Rural Hospitals Were Already At A High Financial Risk Of Closing Before The Pandemic. Roughly 430 rural hospitals are at a high financial risk of closing. This represents roughly 21 percent of the country’s rural hospitals. 
  • More Than 130 Rural Hospitals Have Closed Since 2010. Nineteen closures were reported in 2020, topping the previous record of 18 rural hospitals closing in 2019 . The vast majority closed in states that had not expanded Medicaid at the time of the hospital closure.

The ACA’s Medicaid Expansion Plays A Central Role In Fighting The Opioid Crisis:

The ACA includes critical provisions, including protections for pre-existing conditions and guaranteed coverage of essential health benefits, for individuals suffering from substance use disorder, and Medicaid expansion in particular has dramatically improved access to treatment. 

  • An Estimated Four In 10 People With An Opioid Use Disorder Are Covered By Medicaid. It is estimated that Medicaid expansion covers four in ten people with an opioid use disorder. In 2014, Medicaid paid for 25 percent of all addiction treatment nationwide.
  • Among Those With Opioid Addiction, People Covered Through Medicaid Are Nearly Twice As Likely As Those With Private Insurance To Receive Treatment. In 2017, 44 percent of people who had substance use disorders received treatment when they were covered through Medicaid, significantly higher than the 24 percent of those privately insured who received treatment and 32 percent of those who were uninsured and received treatment.
  • Medicaid Expansion Has Reduced Unmet Need For Substance Use Treatment By More Than 18 Percent. Recent research finds that Medicaid expansion reduced the unmet need for substance use treatment by 18.3 percent.
  • Medicaid Expansion May Have Saved More Than 8,000 People From Fatal Opioid Overdoses. A recent study found that Medicaid expansion prevented as many as 8,132 deaths in the 32 states that expanded Medicaid between 2014 and 2016.
  • The Uninsured Rate For Opioid-Related Hospitalizations In Medicaid Expansion States Dropped By 79 Percent. In expansion states, the uninsured rate for opioid-related hospitalizations dropped from 13.4 percent in 2013 to 2.9 percent in 2015. Non-expansion states only saw a 5 percent decline over the same period.