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Changes in Insurance Coverage in Rural Areas under the ACA: A Focus on Medicaid Expansion States

As shown in a recent brief, people in rural areas face particular challenges in health insurance and access, including limited access to employer-sponsored coverage and low incomes. Following implementation of the Affordable Care Act (ACA) Medicaid expansion in 2014, there were increases in insurance coverage for people in states that expanded their programs, including those in rural areas. Nationwide, nearly two million people in rural areas in Medicaid expansion states gained insurance coverage between 2013 and 2015. These coverage gains in rural areas occurred in expansion states across the political spectrum.

Figure 1: The uninsured rate fell in rural areas of states that implemented the ACA Medicaid expansion.

Table 1: Health Coverage among the Rural Nonelderly Population in Medicaid Expansion States, 2013-2015
Expansion State Rural Uninsured Rate, 2013 Rural Uninsured Rate, 2015 Percent Change in Rural Uninsured Rate, 2013-2015 Change in Number of Rural Uninsured, 2013-2015
Median 16% 9% -44% -1,900,400
Alaska* 22% 19% -16% -13,600
Arizona 22% 15% -32% -68,500
Arkansas 20% 11% -44% -111,000
California 21% 11% -45% -111,400
Colorado 21% 12% -40% -73,000
Hawaii 13% 5% -63% -17,600
Illinois 12% 6% -52% -103,800
Indiana* 16% 11% -30% -85,300
Iowa 11% 6% -46% -68,700
Kentucky 19% 8% -59% -202,200
Louisiana* 20% 16% -22% -61,800
Maryland 14% 6% -56% -17,400
Massachusetts 5% 4% -30% -1,200
Michigan* 15% 8% -46% -125,100
Minnesota 10% 5% -49% -81,800
Montana* 20% 14% -30% -48,700
Nevada 22% 11% -50% -25,100
New Hampshire* 15% 11% -28% -12,200
New Mexico 23% 13% -43% -121,400
New York 11% 7% -40% -81,200
North Dakota 12% 9% -21% -12,700
Ohio 14% 8% -39% -106,100
Oregon 19% 9% -51% -102,500
Pennsylvania* 13% 8% -32% -52,000
Vermont 9% 6% -37% -12,700
Washington 21% 10% -54% -108,800
West Virginia 17% 7% -61% -74,400
NOTES: Includes nonelderly individuals ages 0-64. Totals may not sum due to rounding.
Excludes CT, DE, DC, NJ, and RI because they do not contain rural areas according to this analysis. See http://kff.org/medicaid/issue-brief/the-role-of-medicaid-in-rural-america/ for more details.
* AK, IN, LA, MI, MT, NH, and PA adopted Medicaid expansion after January 1, 2014; thus, data does not reflect full coverage gains due to the expansion.
SOURCE: Kaiser Family Foundation analysis of 2013 and 2015 American Community Survey 1-Year Estimates.

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