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Health Coverage and Care in the South in 2014 and Beyond

Historically, the South has faced longstanding disparities in coverage and care. Yet, access to health coverage and care is particularly important for Southerners given a high prevalence of chronic health conditions and poor health outcomes in the region. The ACA offers the potential to connect many currently uninsured Southerners to coverage, serving as a key first step in enabling individuals in the region to access needed care and manage their health conditions.

To date, the ACA has expanded coverage options for many Southerners, particularly through the new Marketplaces. However, millions of poor Southerners who could gain access to coverage through the ACA Medicaid expansion fall into a coverage gap and are left without a new coverage option in states that are not implementing the Medicaid expansion at this time. If additional states in the South opt to expand in the future there will be even greater coverage gains within the region.

Looking ahead, helping uninsured Southerners who have gained access to new coverage options to enroll successfully will help boost coverage. Regardless of state decisions to expand Medicaid, all states must implement new simplified enrollment processes, which will help connect eligible individuals to coverage. Even with simpler processes in place, effective outreach and enrollment efforts will be key. Across the South, in communities that have historically faced restrictions in coverage and barriers to enrollment, using targeted strategies and one-on-one assistance are available to help eligible individuals enroll and access the health care services they need will be required.

Furthermore, to improve health outcomes in the South, newly-insured individuals need to be able to access health services. The ACA includes a number of provisions to help expand the availability of primary and specialty services in underserved communities, including an increase in Medicaid fees to primary care physicians. Separately, many southern states are adopting a number of innovative approaches to provide comprehensive and patient-centered care to Medicaid beneficiaries including an expansion of managed care and reform of delivery systems to improve care coordination for medically-complex low-income populations. Even with these efforts, safety net providers will likely remain a primary source of care for millions of newly-insured Southerners and for many low-income individuals in the South who remain uninsured.

Given the growing and diverse population in the South, changing patterns of health coverage and care in the region have important implications nationally and for people of color. As such, continued attention to health coverage and care in the South for those gaining coverage and those remaining uninsured will be important for understanding the impact of the ACA and implications for longstanding efforts to reduce disparities in coverage, care, and health outcomes.

This brief was prepared to help inform a collaborative effort with the Satcher Health Leadership Institute at the Morehouse School of Medicine, which focuses on advancing opportunities and assessing challenges in health care and health equity.

Translating Coverage to Care: Delivery Systems and the Safety Net Appendix Tables