Last month, the Fifth Circuit Court of Appeals ruled in favor of the Trump administration and Republicans in Texas vs. United States, striking down as unconstitutional the ACA’s individual mandate and remanding to the lower court judge a final decision on what parts of the ACA should be eliminated – the very judge who has already ruled the entire law unconstitutional. If President Trump and Republicans have their way, 20 million Americans will lose their insurance coverage, 135 million Americans with pre-existing conditions will be stripped of their protections, and costs will go up for millions. 

“The Fifth Circuit’s disastrous decision on President Trump’s Texas lawsuit puts the health care of millions of Americans at risk. The court’s decision will impact every corner of the American health care system including eliminating Medicaid expansion, which has served as a lifeline for rural Americans and has played a key role in fighting the opioid crisis in communities across the country,” said Protect Our Care Executive Director Brad Woodhouse. “Over the course of these days of action, we will be reminding Americans what’s really at stake if the courts ultimately overturn the health care law.” 

Days of Action: Day 9 of 11 focuses on Rural Health. To learn more about our Days of Action, visit our website.

What’s At Stake: Rural Health

Rural Americans Stand To Lose If The Texas Lawsuit Overturns The ACA.

  • Nearly 1.7 million rural Americans gained coverage through Medicaid expansion under the ACA. 24 percent of Americans living in rural areas have health coverage through Medicaid.
  • In 2017, nearly 1 in 5 marketplace enrollees (1.6 million people) lived in rural areas. 
  • 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. 
  • Rural Americans are more likely to be uninsured than Americans living in non-rural areas. 

Medicaid Is A Lifeline For Rural Hospitals: 

  • The Affordable Care Act led to a $12 billion reduction in uncompensated care costs. Between 2013 and 2015, hospitals’ uncompensated care costs decreased by $12 billion, or roughly 30 percent. The majority of this reduction was concentrated in states that chose to expand Medicaid. 
  • 430 rural hospitals are at a high financial risk of closing. This represents roughly 21 percent of the country’s rural hospitals. 
  • 120 rural hospitals have closed since 2010. The vast majority closed in states that had not expanded Medicaid at the time of the hospital closure.

American Hospital Association, Federation Of American Hospitals, The Catholic Health Association Of The United States, And Association Of American Medical Colleges: “A Judicial Repeal Would Have Severe Consequences For America’s Hospitals, Which Would Be Forced To Shoulder The Greater Uncompensated-Care Burden That The ACA’s Repeal Would Create.” [American Hospital Association et. al, 6/14/18]

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

  • More than half of people with an opioid use disorder earn incomes below 200 percent of the federal poverty line.
  • In 2014, Medicaid paid for 25 percent of all addiction treatment nationwide.
  • It is estimated that Medicaid expansion covers four in ten people with an opioid use disorder.
  • Among those with opioid addiction, people covered through Medicaid are more than twice as likely as those with private insurance or no insurance to receive treatment.  In 2016, 43 percent of people who had substance use disorders received treatment when they were covered through Medicaid, significantly higher than the 21 percent of those privately insured who received treatment and 23 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 expanding reduced the unmet need for substance use treatment by 18.3 percent.