Interestingly, these maps show the disproportionate impact that Medicaid coverage has on primarily urban and primarily rural counties, particularly those rural counties in Appalachia. These data are consistent with recent research conducted by The Center for Community Solutions (CCS), which shows that many big cities are similar to “small hub towns” in terms of the social and economic issues they face.

With that said, there are some important differences between big urban centers and small hub towns when it comes to health care. First, nearly 43.5 percent of the population in the small hub towns are covered by Medicaid as opposed to 38.5 percent in big cities. Another important difference lies in the diversity of economies. Of the 47 small hub towns examined in our research, 35 of them had a hospital in their community, representing a major employment sector when compared to cities. Medicaid expansion, then, has had a large effect on the financial status of these rural hospitals, in addition to the effect it has had on health care coverage, also. In a recent study published by the Journal of Health Affairs, researchers determined that rural hospitals were more financially sensitive to Medicaid expansion, given the traditionally higher rates of uncompensated care and lower profit margins of rural providers. Thus, the advantages of expansion not only benefit the patient, but the economies of major employers in these communities.

Policy is the reflection of the priorities of the public through their elected representatives. Governor Kasich and the General Assembly have worked over the course of the last few years to improve Ohio’s economy and provide the means by which individuals can become economically self-sufficient and independent. In the context of Medicaid, a massive state and federal partnership, this has meant operating a program that is efficient and patient-centered, so that the resources dedicated to funding coverage allow for the greatest improvements in health and spending efficiency. Clearly, the report from the Ohio Department of Medicaid has shown that the investment of these resources has improved health and access. What’s more, when looking at small hub towns, examining the relationships between public health crises like the opiate epidemic and infant mortality alongside the challenge of a diminishing manufacturing economy shows us how Medicaid expansion addresses the health and economic needs of many Ohio communities and individuals. Indeed, the state’s Assessment suggests that many previously uninsured Ohioans are now more able to seek work, manage their finances, and have a greater ability to address other social determinants of their health including housing and food. This idea is consistent with recent research which shows that health coverage leads to greater intergenerational economic mobility and liberty, a legacy of the Medicaid program since its inception. Now, at the beginning of a new General Assembly and Congress, policymakers at the state and federal levels need a candid discussion about the impact of Medicaid expansion as they seek reform.