Medicaid expansion greatly increased coverage, especially in rural areas, study finds

Medicaid expansion under the Patient Protection and Affordable Care Act greatly increased access to health care for Americans, especially in rural areas, says a study by researchers at Indiana University, published in The Journal of Rural Health. Researchers, who used data from the Census Bureau's American Community Survey from 2011-15, found that expansion "increased the probability of Medicaid coverage for targeted populations in rural and urban areas, with a significantly greater increase in rural areas, but some of these gains were offset by reductions in individual purchased insurance among rural populations." 

"Medicaid expansion increased the probability of having 'any insurance' for the pooled urban and rural low-income populations, and it specifically increased Medicaid coverage more in rural versus urban populations," says the study. "There was some evidence that the expansion was accompanied by some shifting from individual purchased insurance to Medicaid in rural areas, and there is a need for future work to understand the implications of this shift on expenditures, access to care and utilization." 

Results suggested "that rural childless adults, compared to urban childless adults, experienced a 1.9-percentage-point larger increase in the probability of having Medicaid as a result of the expansion," says the study. "Rural childless adults experienced a 1.5 percentage point larger decline in the probability of having individual purchased insurance. (IU graphic)