"Taken as a whole, Medicaid expansion through the ACA has resulted in critical gains toward improving rural population health by expanding insurance coverage and stabilizing rural hospitals," Greenwood-Erickson and Abir write. "The repeal of Medicaid expansion and collapse of the individual insurance market, which could occur as part of repeal of the ACA, could threaten strides the country has made in advancing the health of rural America." (Kaiser Family Foundation map: Medicaid expansion states)
"We do not yet know how the debate over ACA repeal and replace will play out," Greenwood-Erickson and Abir write. "Yet, we do know that some of the proposed alternatives could result in real harm to rural states, the most obvious being a repeal of Medicaid expansion. Further, block grants have been discussed as a method to control Medicaid costs. These are grant programs from the federal government that give states annual fixed amounts to spend on a specific program, but they can result in neglect of rural populations. As block grants limit the amount of money states have to spend on vulnerable populations, they may overlook national objectives, such as caring for rural and poor communities."