What Trump’s GOP health cuts mean for rural America
"Rural health care has at times been characterized as patchwork. In part, that’s because the costs of sustaining health care infrastructure in rural areas are higher thanks to the large service areas, the inability to negotiate bulk pricing and lack of financial incentives to fill in provider gaps. The ACA, intended to turn this around, has in fact led to dramatic gains in insurance coverage among rural Americans. Broadly speaking, insurance rates in rural areas reached almost 86 percent in early 2015, up from an estimated 78 percent in 2013. In Kentucky – a state with high poverty, a large rural population (42 percent of residents) and a successful Medicaid expansion initiative – tens of thousands of newly insured low-income adults began using preventative services after previously being unable to afford it. The state’s uninsured fell by half and, as a result, fewer people skipped taking their medications due to financial hardships relative to other states that didn’t expand Medicaid. The ACA also strengthened rural health care institutions by investing in upgrades to hospitals and clinics, preventative health programs and support for providers to stay in rural areas. While rural hospitals are often laden with the expense of providing extensive care without payment to indigent patients, rural hospitals in states that expanded Medicaid under the ACA finally were able to better balance their books when caring for this vulnerable group. At the same time, the ACA supported innovative models ideal for rural areas that prioritized outreach, integration of services and collaboration between safety-net players. Both the House and Senate bills to repeal and replace Obamacare would drastically reduce rural Americans’ insurance coverage and significantly threaten the ability of many rural hospitals and clinics to keep their doors open."