Southern states spend millions on new clinics to serve rural residents. It's one way to avoid federal Medicaid expansion.

Clemson Rural Health serves rural Walhalla, S.C.
(Clemson University photo via KFF Health News)

Southern states made rural health a focus, but the sector's trendiness hasn't translated into Medicaid expansion plans. "State lawmakers nationwide are spending millions of dollars to address a rural health care crisis long in the making," reports Lauren Sausser of KFF Health News. For more than a decade most Southern states have refused billions in federal funds that would provide public health insurance coverage to more low-income adults."

Among the 10 states that refused Medicaid expansion, some have developed their own approaches to addressing rural health disparities with state dollars. Clemson Rural Health in South Carolina is a small primary care clinic run by Clemson University that "attempts to fill [rural health care] gaps by providing primary care. . .for uninsured patients free of charge or at reduced rates," Sausser explains. Clemson's clinic receives the largest part of its funding from the state Department of Health and Human Services.

Jonathan Oberlander, a professor and health policy scholar at the University of North Carolina, said "he doesn’t expect to see any of the remaining states rushing to fully expand Medicaid," Sausser writes. "Oberlander said conservative lawmakers often consider projects such as building new rural clinics more politically palatable than expanding Medicaid coverage."

Other southern states have followed suit. "The University of Georgia established a new medical school, partly to send more physicians into underserved and rural areas," Sausser adds. "The Georgia General Assembly kicked in half the cost of a new $100 million building for medical education and research in Athens. . . .The Tennessee General Assembly passed a budget last year that included $81 million for a variety of rural health initiatives."