We previously blogged on research showing that the Medicaid expansion helps keep rural hospitals open and that the Medicaid expansion disproportionately benefited rural communities. We came to a similar conclusion in our own research when we analyzed Medicaid coverage in small towns and rural America. We found that the rate of uninsured adults in expansion states decreased 11 percentage points in small towns and rural areas between 2008-2009 and 2014-2015. This was larger than the decrease in metropolitan areas of expansion states (9 percentage points) and larger than the decrease in small towns and rural areas in non-expansion states (6 percentage points).
A new study in Health Affairs finds that community health centers (CHCs) in rural areas also benefitted from the Medicaid expansion. Using data from 2011-2015, the authors find that expansion states had a 11.44 percentage point decline in uninsured CHC patients and a 13.15 percentage point increase in CHC patients covered through Medicaid. Compared to previous research, the study concludes that the effect of the expansion on coverage for the CHC population appears to be greater than the effect on the overall low-income population.
The study also found evidence of improvements in service use. The expansion was linked to improvements in asthma treatment, BMI screening, and blood pressure control for CHC patients in rural areas. There were also increases in the number of physician visits for chronic health conditions, preventive care and behavioral health. These gains were not observed in urban CHCs in expansion states, indicating the particularly important role that the expansion has played in rural areas. The results of the study suggest that if the remaining non-expansion states were to expand, the potential coverage gains for CHC patients would be greater than the gains we have seen so far because the remaining non-expansion are starting with a higher uninsured rate and have more rural areas in their states.