Repealing the Patient Protection and Affordable Care Act would have the biggest impact on rural areas, which typically have higher rates of chronic illness, obesity, drug overdose, alcoholism, mental illness and suicide, opine Margaret Greenwood-Erickson and Mahshid Abir for Bridge, published by The Center for Michigan. Greenwood-Erickson is national clinician scholar and clinical lecturer, and Abir is a professor, at the University of Michigan medical school.
"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)
"One option forward would be to encourage states to apply for special waivers, or 1115 waivers, which allow states a more flexible implementation of Medicaid expansion," Greenwood-Erickson and Abir write. "For some states, this allows them to expand coverage under Medicaid in a way that is more attuned to each state’s unique demographics and values. For example, alterations range from healthy behavior incentives that reduce premiums in Iowa to permitting higher cost-sharing than is otherwise allowed under federal rules for non-emergency use of emergency rooms in Indiana."
"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."
"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."
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