NC Budget and Tax Center, public health, Trump Administration

GOP health care bill would hurt one million rural North Carolinians who benefit from Medicaid

A new report finds the House-passed health bill – the American Health Care Act – would devastate health care in rural America, primarily because of the dismantling of Medicaid.

This is concerning considering that last year in North Carolina Medicaid offered health coverage to 1.9 million poor seniors, children, parents, and people with disabilities – of which the majority (1 million) lived in the rural parts of the state.

Specifically, North Carolina’s rural counties accounted for the following Medicaid beneficiaries: 60 percent of poor seniors, 53 percent of blind individuals, 58 percent of people with disabilities, 54 percent of pregnant women, and 51 percent of all infants and children. In other words, rural North Carolinians benefit greatly from Medicaid.

According to the report, “Medicaid has long played an even larger role in providing health coverage and paying for care in rural areas than in urban areas. Medicaid’s importance to rural America has only grown under the ACA. Nearly 1.7 million rural Americans have newly gained coverage through the Medicaid expansion.”

Below are key points from the report of why the proposed GOP health care bill would not meet rural needs:

  • Medicaid has expanded access to substance use disorder treatment at a time when many rural communities have been ravaged by the opioid crisis.
  • Medicaid expansion has become a critical financial lifeline sustaining rural hospitals.
  • The bill’s new tax credit for the purchase of individual market coverage would be woefully inadequate for many people in rural areas, and would leave many of the 1.6 million current rural marketplace enrollees unable to afford their high insurance premiums. Unlike the Affordable Care Act’s (ACA) far more generous and flexible tax credit, the House bill’s credit wouldn’t adjust for geographic variation in premiums and would provide too little assistance for older people.
  • In North Carolina, 25 percent of Marketplace Consumers live in rural areas; under the ACA, their average tax credit is $8,411. However, under the proposed bill, their average tax credit would decrease by 66 percent to $2,869. Furthermore, North Carolinians living in rural areas would see the biggest increase – $7,549 – in total out-of-pocket costs under the proposed health bill. Both the net premium ($5,921) and cost-sharing ($1,628) out-of-pocket costs would increase.
  • Rural populations tend to be older and sicker than urban populations. For example, people in rural areas are more likely to die from heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke than their urban counterparts. For these reasons, rural residents likely benefited disproportionately from the ACA’s protections against discrimination based on medical history — and they could be disproportionately harmed by removing those protections, as well as by the other major provisions of the House bill.

To learn more see: Medicaid works for women in North Carolina and Medicaid has allowed millions with substance use disorders to get health coverage, access treatment.

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