Rate of Insured Improves, Especially in States that Expanded Medicaid

A new government brief credits the Affordable Care Act with increasing the proportion of U.S. population that has health insurance. Rural residents in states that expanded Medicaid fared the best, the report says. The news comes amid signs that there will be less competition among insurers next year.

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States that expanded Medicaid saw a significant increase in the percentage of residents who have health insurance, according to a new report from the federal Department of Health and Human Resources. The growth was especially strong in rural areas, the report says.

States that did not expand Medicaid also saw an increase in the percentage of residents with insurance, but the gains were not as large, the report says.

The findings are especially important because states that chose not to expand Medicaid under the Affordable Care Act tend to have more rural residents than states that did expand eligibility for the publicly supported insurance program.

“The overall coverage gains for rural individuals are particularly striking in light of the fact that uninsured rural individuals are disproportionately concentrated in states that have not expanded Medicaid,” the report says. About two thirds of the 4.5 million rural residents who are uninsured live in states that didn’t expand Medicaid. Only about half of urban uninsured live in states that didn’t expand Medicaid, the report said.

“Medicaid expansion in additional states would thus be of particular benefit to rural Americans,” the report concludes.

About 117 million Americans live in states that didn’t expand Medicaid, according to Census figures, while 192 million live in states that did. The combined rural population of states that didn’t expand Medicaid is about 24 percent. In states that did expand, rural residents constituted about 16 percent of the population.

Under the Affordable Care Act, states are allowed to extend Medicaid benefits to anyone earning less than 138% of the federally defined level of poverty. The Supreme Court ruled that states did not have to participate, so expansion has occurred only in the 32 states that have agreed to the program. The federal government pays for all costs of expansion through 2020.

While the percent of rural residents with insurance has increased since the ACA was put into effect, other signs show that rural medical insurance markets are not keeping pace with urban areas. The Wall Street Journal reports that the number of counties that have only one private insurer participating in the insurance marketplace will expand from 225 counties this year to more than 650 next year. About 70 of those counties are rural, according to the Journal.


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The entire states of Alaska and Alabama will have only one insurer participating in the marketplace next year, the Journal reports. Parts of Kentucky, Tennessee, Mississippi, and other states could only have one insurer next year, according to the Kaiser Family Foundation, as reported in the Journal.

The report from the Health and Human Services Department also noted the following:

  • Rural residents were slightly more likely to qualify for tax credits to defray the cost of medical insurance. Eighty-eight percent of rural residents qualified, while 84% of urban residents did.
  • The average monthly premium increased by about 4% from 2015 to 2016 in both urban and rural areas.
  • Access to medical care improved from 2012 to 2015 in both urban and rural areas, according to the Gallup Healthways Well-Being Index.
  • The Gallup survey showed the percentage increase in the number of insured Americans since 2012 was roughly equal between rural and urban areas. Another poll, the Health Reform Monitoring Survey, reported that rural areas percentage point increase in insured was higher (7.2) than urban areas (6.3).

From 2013 to 2015, the percentage of rural residents

Rural residents in states that have expanded Medicaid have seen the greatest percentage increase in

A greater percentage of Americans have health insurance because of gains made through the Affordable Care Act, according to a new report from the federal Health and Human Services Department.

The increase in the number of people insured was especially pronounced in rural parts of states that expanded Medicaid under the terms of the ACA, the report says.

The gains have been more pronounced in rural areas, the report says.

A report from the federal Health and Human Services Department cites gains in the percentage of Americans who have health insurance as evidence of the impact of the Affordable Care Act


Topics: ConnectionHealth

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