Liberal-leaning group warns proposed changes to Medicaid would hurt millions in rural America

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People who have health insurance through the Medicaid expansion are at great risk of losing their coverage if the Senate passes the House health bill, a decision that would greatly harm rural America, says a Center on Budget and Policy Priorities report.

Republican senators have said they are "starting from scratch" and writing their own bill, but that is misleading because "the House bill's core provisions remain firmly at the center of Senate discussion," said Shannon Buckingham, spokesperson for the liberal-leaning group.

The report says the House health bill, called the American Health Care Act, would "effectively end" the Medicaid expansion because "beginning in 2020, states would receive only the regular federal Medicaid matching rate, which averages 57 percent for any new enrollees under the expansion instead of the permanent expansion matching rate of 90 percent." The matching rate for Kentucky is 70 percent, so the state would have to pay "2.8 to 5 times more than under current law for each new enrollee," the report said.The bill also allows states to stop enrolling people in expanded Medicaid.

The detailed CBPP report, which offers state-level details on many measures, found that in at least eight expansion states, more than one-third of expansion enrollees live in rural areas.

The report notes that states that expanded Medicaid had the largest drops in rural people without health coverage, from 16 percent in 2013 to 9 percent in 2015. In non-expansion states, the uninsured rate dropped from 19 percent to 15 percent in 2015.

Mary Wakefield, former acting deputy secretary for the U.S. Department of Health and Human Services, said the rural states of Kentucky and Arkansas, which expanded Medicaid, saw a "one-third increase in the share of low-income adults getting regular check-ups and a two-thirds decrease in the share depending on the emergency room for care."

Wakefield said Medicaid expansion has reduced people's risk of medical bankruptcy, improved treatment access for people with substance use disorders and dramatically decreased uncompensated care in rural hospitals.

"The House health bill is a threat to rural hospitals," said Jesse Cross-Call, a senior policy analyst at CBPP and co-author of the report. "Over the past few years, closures of rural hospitals around the country have been heavily concentrated in states that have not expanded Medicaid."