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Health Coverage and Care in the South in 2014 and Beyond

Over 115 million individuals live in the American South today, and together, they make up over a third of the U.S. population. The South, as defined by the U.S. Census Bureau, includes 17 states, stretching from Oklahoma, Texas, and Arkansas on the West to the Atlantic Ocean on the East, and northward to Delaware, Maryland, Kentucky, and West Virginia (Figure 1). This brief provides an overview of health coverage and care in the South today and the potential impact of the Affordable Care Act (ACA) health coverage expansions. It includes key findings in several areas including the following:

Figure 1: Census Regions and Divisions of the United States

Figure 1: Census Regions and Divisions of the United States

Demographics. The southern population is large and growing rapidly. The region’s population is racially and ethnically diverse and also diverse across a number of factors including citizenship status, age, urban-rural composition, and income. Southerners are significantly more likely than those in the Northeast and Midwest to be poor, and the South includes states with some of the highest poverty rates.

Health Coverage and Care Today. The South has faced longstanding disparities in health coverage, health status, and health care relative to the rest of the United States. Compared to those in other regions, Southerners are more likely to be uninsured, less likely to have access to needed health services, and more likely to experience a number of chronic health conditions such as diabetes and heart disease.

The Impact of the ACA Coverage Expansions. The ACA has the potential to extend health coverage to many uninsured Southerners through an expansion of Medicaid and the creation of new Health Insurance Marketplaces with tax credit subsidies. However, most southern states are not moving forward with the Medicaid expansion, and many poor uninsured Southerners will not gain a new coverage option and may remain uninsured. Even with these gaps in coverage, millions of uninsured Southerners are now eligible for coverage, and effective outreach and enrollment efforts are key for ensuring that they are enrolled.

Translating Coverage to Care: Delivery Systems and the Safety Net. Improving health outcomes in the long-term will take more than expanding coverage. It will be important to ensure that insured individuals as well as Southerners who remain uninsured are connected to care. Ongoing development of provider capacity and delivery system innovation in the South will be important for addressing health care needs and challenges.

Profile of the Southern Population Today