Report: Rural areas would be most impacted by Medicaid cuts – Mankato Free Press


MANKATO — Proposed cuts to Medicaid would disproportionately impact children and adults in rural areas and small towns, according to a report released Wednesday.

The analysis from researchers at Georgetown University and the University of North Carolina used census data to compare Medicaid enrollment and uninsured rates before and after Medicaid was expanded once the Affordable Care Act went into effect.

The report found Minnesota’s rural areas and small towns have higher percentages of children on Medical Assistance — the state’s Medicaid program — compared to their metro counterparts. Those outstate Minnesota areas, as with nearly all similar areas in other states, also saw childhood uninsured rates decrease since 2008.

The study comes as the Senate weighs the American Health Care Act passed by the House of Representatives in early May. As written, the current bill would cut back on the Medicaid expansion and put a cap on the amount of money states could be federally reimbursed for enrollees. 

The report’s authors say the bill would hit rural areas and small towns hard.

“For these rural communities, the significant Medicaid cuts would have a very devastating impact not only today but also in the future,” Joan Alker, a Georgetown researcher who co-authored the report, said during a conference call Tuesday.

One result could be a rise in uninsured rates. Minnesota has historically had lower uninsured rates than other states, but the Medicaid expansion and Affordable Care Act led to the percentage to drop even more.

The percent of children uninsured in rural Minnesota dropped from 8 to 4 percent between 2008 and 2015, according to the study. Adult uninsured rates dropped as well, from 14 to 7 percent.

The drop in the number of uninsured in Minnesota largely coincided with a 10 percent increase in Medicaid enrollment for rural residents since 2008. The increase has led to a growing reliance on Medicaid in rural areas compared to urban centers, which gets into why any cuts could hurt rural areas more than anywhere else. 

Statewide, 38 percent of children in less populated areas receive Medicaid health coverage, while 28 percent receive the same coverage in urban areas. Blue Earth County has a much smaller percentage of children on Medicaid, with 21 percent. The county also has a lower uninsured rate, at just 3 percent.

But rural areas and small towns generally do have higher Medicaid enrollment percentages compared to metro areas due to lower average household incomes, lower rates of workforce participation and higher rates of disabilities.

Stephanie Hogenson, research and policy director at the Children’s Defense Fund Minnesota, said the data should highlight the importance of preserving Medicaid funding. Access to affordable care in rural areas is already a problem, she said, but the cuts would hurt patients and health care providers alike.

The Medicaid patients would have less access to affordable care, which the researchers noted they’re generally able to receive at similar costs and quality to privately insured people. The providers relying on Medicaid reimbursements, meanwhile, would struggle to cover costs, Hogenson said, adding it could lead to layoffs or closures — further limiting access to quality health care in rural areas.

“It’s really a concern for everyone, this issue,” she said. “This data really needs to be taken into consideration.”

She hopes the report informs lawmakers on both sides of the aisle of the importance of Medicaid, especially since the senators deciding on the new health bill have rural constituents who could be negatively impacted by the cuts.

“I think we need to heed the data and researchers as the public discourse happens,” she said.


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