The SAME Act Will Lead to Expansion of Coverage and Benefit Rural Communities

Washington, DC–Today, Senators Mark Warner (D-VA) and Doug Jones (D-AL), among others, introduced the States Achieve Medicaid Expansion (SAME) Act, which would provide each state expanding its Medicaid program with the same levels of Federal matching funds, regardless of when it chooses to expand the program. Brad Woodhouse, executive director of Protect Our Care, praised the legislation in a statement:

“Medicaid expansion has been one of the most successful facets of the Affordable Care Act, providing millions of Americans with the health care coverage they so desperately need. Medicaid expansion has been particularly crucial to expanding access to health care in rural communities and has helped rural hospitals keep their doors open. The SAME Act will not only give all states that enacted Medicaid expansion the same funding benefits, it will incentivize more states to follow suit. Under the leadership of Senators Mark Warner and Doug Jones, the SAME Act is a major step toward ensuring better access to care, lowering costs, and keeping rural hospitals open.”

BACKGROUND:

Medicaid Expansion Is A Lifeline To Rural Communities. The Affordable Care Act opened the doors to Medicaid expansion, which has significantly expanded access to health care in rural communities, reduced rural hospitals’ uncompensated care costs, and helped rural health providers keep their doors open by allowing states to expand Medicaid coverage for adults up to 138 percent of the federal poverty line. Medicaid expansion allowed 1.7 million rural Americans to gain coverage who had not previously been eligible.

Following Medicaid Expansion, The Uninsured Rate In Rural Parts Of Expansion States Decreased By A Median Of 44 Percent. In rural states that expanded Medicaid, the uninsured rates dropped significantly after the ACA became law:

  • In Montana, the uninsured rate dropped from 19 to 8.5 percent between 2013 and 2016.
  • In Kentucky, the uninsured rate dropped from 16.3 to 7.2 percent between 2013 and 2016.
  • In Arkansas, the uninsured rate dropped from 17.8 to 9.1 percent between 2013 and 2016.
  • In West Virginia, the uninsured rate dropped from 14.2 to 8.8 percent between 2013 and 2016.

By Reducing Uncompensated Care Costs, Medicaid Expansion Means Hospitals Have Greater Financial Security. Medicaid expansion also drastically reduced the amount of costs that a hospital absorbs for any treatment or service not paid for by an insurer or patient, known as uncompensated care.. The Center on Budget and Policy Priorities finds that “states that expanded Medicaid to low-income adults under the ACA saw both larger coverage gains and larger drops in uncompensated care: a 47 percent decrease in uncompensated care costs on average compared to an 11 percent decrease in states that did not expand Medicaid.” CBPP concludes that these declines in uncompensated care were “almost certainly” the result of the ACA’s coverage gains.

A June 2018 Protect Our Care Analysis Found That The Vast Majority Of Rural Hospital Closures Since 2010 Were In States That Had Refused To Expand Medicaid. Between 2010 and June 2018, 84 rural hospitals closed. The vast majority of those rural hospital closures, 77 percent, occurred in states that refused to expand Medicaid. Nearly 90 percent of the rural hospitals that have closed since 2010 were located in states that refused to expand Medicaid by the time of their closure. Only 10 out of 84 rural hospitals closed in states after they had expanded Medicaid; of hospital closures in states that expanded Medicaid, nine closed before the state expanded the program. Since Protect Our Care’s June report, even more hospitals have closed. The Scheps Center Rural Health Research Program tracks that 97 rural hospitals have closed since 2010.