“There’s no doubt that children in small towns will be hurt,” said Joan Alker, executive director of Georgetown University’s Center for Children and Families, and co-author of the study. “Kids will be disproportionately harmed.”
The vast majority of children – eight out of 10 – who are covered through public health programs are enrolled in Medicaid, the federal-state insurance program for low-income people. More than half the children living in rural areas and small towns in 14 states in the nation, including California, are on Medicaid. In California, the program is called Medi-Cal.
The Georgetown University study, done in partnership with the University of North Carolina, found that in 2015, Medicaid covered 45 percent of children and 16 percent of adults in rural areas and small towns -- defined as non-metropolitan areas with a population of no more than 50,000 – while in the overall population, only 38 percent of children and 15 percent of adults who were covered by the program.
That is not surprising given that compared to families in metropolitan areas, those living in small towns and rural areas tend to have lower household incomes, are more likely to include individuals with disabilities, have higher unemployment rates and are less likely to have jobs that offer employer-sponsored insurance. An estimated 10 million people with disabilities depend on Medicaid to enable them to work, attend school and participate in their communities.
The threatened cuts to Medicaid in the House bill passed last month will decrease the program’s federal funding by an estimated $830 billion over the next decade.
For their study, researchers looked at US Census data between 2008 and 2009 and between 2014 and 2015. They did not break down Medicaid coverage by race or ethnicity, Alker said.
Enrollment in Medicaid has burgeoned to more than 72 million in recent years, causing a drop in the ranks of the uninsured.
Thirty-one states, including California, plus the District of Columbia, expanded their Medicaid program. An estimated 14 million people in California, or about one-third of its population, currently depend on Medi-Cal.
Alker said that although the drop in the number of uninsured people overall can be credited to the Affordable Care Act (ACA), which allowed states to expand eligibility to Medicaid with federal funding, “decades of bipartisan effort” has caused a significant drop in the number of uninsured children.
“Medicaid is an under-told success story of the Affordable Care Act,” observed Timothy McBride, co-director of the Center for Health Economics and Policy at the Institute for Public Health at Washington University, speaking at the Association of Health Care Journalists rural health workshop in Cincinnati, Ohio, last week.
California took a bold step last year when it began allowing undocumented children under 19 to enroll in full-scope Medi-Cal, but only with state funding. Nearly 185,000 children were able to get health care through the program.
But an effort this year by some lawmakers to expand the program even further by allowing undocumented youth between 19 and 26 to enroll, failed.
Health care advocates are worried that all the gains made in getting more people to enroll in Medicaid could be jeopardized if Congress’s attempts to repeal and replace the ACA with the American Health Care Act succeeds.
If that happens, an estimated 25 percent of rural hospitals will close in the next decade – a trend that began with Obamacare -- said Alan Morgan, chief executive officer of the National Rural Hospital Association.
Morgan said health is the key economic driver in rural communities and it is important to protect it.
By forcing the closure of more rural hospitals, the Trump administration will be creating a “crisis,” Morgan said.
That would be a rather odd way to reward rural residents, said Al Cross, director of the Institute for Rural Journalism and Community Issues, considering that 62 percent of them voted for Donald Trump.