April 2019

The Kaiser Family Foundation’s newly released April Tracking Poll shows that the American people vehemently reject the Trump-GOP repeal and sabotage agenda and support the health care law as well as Democrats’ efforts to lower prices and improve care. Here are the poll’s key findings:

• Voters’ Top Priorities Are Lowering The Cost Of Prescription Drugs And Protecting People With Pre-existing Conditions. Nearly seven in ten Americans (68 percent), say lowering prescription drug costs for as many Americans as possible is a ‘top priority’ for Congress. This is followed closely by nearly two-thirds of the public (64 percent) who say making sure the ACA’s protections for people with pre-existing health conditions continue is a ‘top priority’ for Congress.

  

• Americans Overwhelmingly Disapprove Of Junk Plans. “Majorities, across party identification, think the federal government should require health insurance companies to cover a certain set of benefits and cover pre-existing conditions (67 percent) rather than allow them to sell short-term plans that cost significantly less but provide fewer benefits and do not cover some pre-existing conditions (26 percent). Majorities of Democrats (83 percent), independents (62 percent), and Republicans (53 percent) think the federal government should require health insurance plans to cover a certain set of benefits and cover pre-existing conditions.”

  

• People Oppose Trump’s Lawsuit To Overturn The Affordable Care Act By 15 Points And Oppose Overturning Pre-existing Condition Protections By 41 Points. “The majority of the public say they do not want to see the Supreme Court overturn either the pre-existing condition protections (68 percent) or the entire health care law (54 percent).

• Large Majorities Support Protections For People With Pre-existing Conditions. Seven in ten of those polled say it is ‘very important’ to prohibit insurance companies from denying someone coverage because of their health status, and 64 percent of voters say it is ‘very important’ that insurance companies be prohibited from charging people more because of their health status.

• Support For The Affordable Care Act Remains Steady At 50 Percent. Americans approve of the Affordable Care Act by 12 points(50-38).

Ahead of President Trump’s Appearance At A Summit on Opioid Abuse in Atlanta, It’s Clear His War On Health Care Is Hurting America’s Fight Against Opioid Addiction

Washington, DC – President Trump is set to address to the Rx Drug Abuse and Heroin Summit on Wednesday in Atlanta, but his visit is overshadowed by his administration’s relentless war on America’s health care and his relentless effort to strip protections for Americans with pre-existing conditions, including those with opioid use disorder. In his repeated attempts to gut Medicaid, Trump is cutting off a lifeline for people suffering from opioid addiction, and his Texas lawsuit to overturn the Affordable Care Act would gut protections for Americans with substance abuse disorder.

Ahead of his upcoming speech on the opioid epidemic, Protect Our Care chair Leslie Dach issued the following statement:

“Let’s be clear: Instead of waging a war on the opioid crisis, President Trump has waged a war on our health care that is hurting people with opioid use disorder. His drastic cuts to Medicaid, his lawsuit in Texas to dismantle the health care system and his support for junk insurance plans will take away care from millions. If there are two things that Americans agree on, it’s that the opioid crisis is serious and that pre-existing conditions protections need to be upheld; neither of which the Trump administration seems concerned about.”

BACKGROUND:

PRESIDENT TRUMP AND HIS REPUBLICAN ALLIES WANT TO ROLL BACK COVERAGE THROUGH MEDICAID, A LIFELINE FOR PEOPLE SUFFERING WITH OPIOID USE DISORDER

• Republicans Have Repeatedly Taken Aim At Medicaid. The GOP has attempted to restrict access to Medicaid by allowing states to impose onerous work requirements on Medicaid coverage, trying to impose per capita limits on Medicaid funding, and repeatedly proposinglegislation that would end Medicaid expansion. The Trump administration’s budget for 2020 calls for  $1.5 trillion in cuts to Medicaid, and would impose a nationwide Medicaid work requirement.

• Restricting Access To Medicaid Threatens Lives And Impedes States’ Ability To Respond To The Opioid Epidemic. Four in 10Americans with an opioid use disorder relies on Medicaid for access to treatment and life-saving overdose reversal medication. Restricting access to Medicaid puts people’s lives at risk and deprives states of funding and resources they depend on to fight the epidemic.

• Among Those With Opioid Addiction, People Covered Through Medicaid Are More Than Twice As Likely As Those With Private Insurance Or No Insurance To Receive Treatment. In 2016, 43 percent of people who had substance use disorders received treatment when they were covered through Medicaid, significantly higher than the 21 percent of those privately insured who received treatment and 23 percent of those who were uninsured and received treatment.

A TRUMP-GOP LAWSUIT COULD OVERTURN THE AFFORDABLE CARE ACT, WHICH PROTECTS PEOPLE WITH SUBSTANCE USE DISORDER

• Because Of The Affordable Care Act, Insurance Companies Can No Longer Deny Coverage Or Charge More Because Of Pre-Existing Conditions. The Affordable Care Act prevents insurance companies from denying someone coverage or charging them more because of a health problem they had before the date that new health coverage starts. It also prevents insurance companies from rescindingor canceling someone’s coverage arbitrarily if they get sick.

• The ACA Outlawed Medical Underwriting, The Practice That Let Insurance Companies Charge Sick People More. As the Brookings Institution summarizes, “The ACA outlawed medical underwriting, which had enabled insurance carriers to court the healthiest customers while denying coverage to people likely to need costly care. The ACA guaranteed that all applicants could buy insurance and that their premiums would not be adjusted for gender or personal characteristics other than age and smoking.”

• The ACA Requires That Insurance Companies Cover Mental Health And Substance Use Disorder Services, And Paved The Way For Medicaid Expansion, Which Helps People Access Services For Substance Use Disorders. The Affordable Care Act established ten essential health benefits, including mental health services, substance use disorder services, and prescription drug coverage, that insurance companies are required to cover. Without these protections, people in the individual market could be on their own — before the ACA, 45 percent of individual market plans did not cover substance use disorder services, and 38 percent of plans did not include mental health services.  The ACA also enabled states to expand Medicaid, which has helped people with substance use disorders and mental illness receive treatment. Recent research finds that Medicaid expanding reduced the unmet need for substance use treatment by 18.3 percent.

TRUMP-GOP JUNK INSURANCE PLANS OFTEN EXCLUDE COVERAGE FOR PRE-EXISTING CONDITIONS, MENTAL HEALTH CARE AND MORE

Short-Term Plans May Exclude Coverage For Pre-Existing Conditions. “Policyholders who get sick may be investigated by the insurer to determine whether the newly-diagnosed condition could be considered pre-existing and so excluded from coverage.” [Kaiser Family Foundation, 2/9/18]

• As Many As 130 Million Nonelderly Americans Have A Pre-Existing Condition. [Center for American Progress, 4/5/17]

• 1 in 4 Children Would Be Impacted If Insurance Companies Could Deny Or Charge More Because Of A Pre-Existing Condition.[Center for American Progress, 4/5/17]

Short-Term Junk Plans Can Refuse To Cover Essential Health Benefits.“Typical short-term policies do not cover maternity care, prescription drugs, mental health care, preventive care, and other essential benefits, and may limit coverage in other ways.” [Kaiser Family Foundation, 2/9/18]

Under Many Short-Term Junk Plans, Benefits Are Capped At $1 Million Or Less. Short-term plans can impose lifetime and annual limits –  “for example, many policies cap covered benefits at $1 million or less.” [Kaiser Family Foundation, 2/9/18]

Short-Term Junk Plans Can Retroactively Cancel Coverage After Patients File Claims. “Individuals in [short-term (STLDI)] plans would be at risk for rescission. Rescissions are retroactive cancellations of coverage, often occurring after individuals file claims due to medical necessity. While enrollees in ACA coverage cannot have their policy retroactively cancelled, enrollees in STLDI plans can.” [Wakely/ACAP, April 2018]

As part of Medicaid Awareness Month, Protect Our Care is detailing how President Trump and Republicans nationwide have waged a relentless war on Medicaid — with no signs of stopping. From seeking to end Medicaid expansion and aiming to force caps on the program’s funding to encouraging states to impose burdensome Medicaid work requirements, Republicans are hellbent on making it as hard as possible for millions of Americans to access Medicaid.

WHO REPUBLICANS HURT WHEN THEY TARGET MEDICAID

12.7 Million Americans Who Will Lose Coverage If The Trump Administration Successfully Ends Medicaid Expansion. The Trump administration is arguing in court that the Affordable Care Act and its Medicaid expansion should be overturned. If the administration ends Medicaid expansion, 12.7 million people will lose their health care.

Up To 4 Million Americans Who Could Lose Coverage If The Trump Administration Imposes A Nationwide Medicaid Work Requirement. The Trump administration is working to change the fundamental structure of Medicaid by preventing people from accessing coverage through Medicaid if they fail to document working a certain number of hours each month. Though experts warn that imposing such requirements could significantly reduce Medicaid enrollment by adding administrative hurdles that make it harder for people to access care, the administration has called for a nationwide Medicaid work requirement in its 2020 budget that is estimated will cause up to 4 millionpeople to lose coverage.

More Than 18,000 Arkansans Who Have Already Lost Coverage Under A Work Requirement In Arkansas. In Arkansas, more than 18,000 people lost coverage in 2018 due to the state’s onerous reporting requirements. Of those required to report their work activities, only 12 percent reported enough hours of qualifying activities. One difficulty in reporting? Though 20 percent of Arkansans with Medicaid do not have home internet access, the state is using an online portal as the primary way for people with Medicaid to report their work activities.

1.4 Million Adults With Disabilities Who Would Lose Medicaid Under Trump’s Plan For Medicaid. The Trump FY20 budget once again revived the call to pass Graham-Cassidy, a bill that would impose funding caps on Medicaid by block-granting the program. The Center for American Progress estimates that between 1.4 million and 1.8 million nonelderly adults with disabilities would lose coverage under the bill’s proposed cuts.

Children, Including 600,000 Who Disenrolled From Medicaid And CHIP Last Year. As the children lost access to Medicaid and CHIP, the children’s uninsured rate increased for the first time since the ACA was implemented. As Georgetown’s Center On Children and Families notes, the uninsured rate for children went up from 4.7 to 5 percent between 2016 and 2017. Three quarters of children who lost coverage lived in states that refused to expand Medicaid.

Four In Ten Americans With An Opioid Use Disorder Who Rely On Medicaid For Access To Treatment. Recent research finds that Medicaid expansion reduced the unmet need for substance use treatment by 18.3 percent. Should Republicans successfully overturn or restrict Medicaid expansion, these gains will be jeopardized.

430 Rural Hospitals That Are At A High Financial Risk Of Closing. Roughly 21 percent of the country’s rural hospitals are at a high financial risk of closing. Medicaid is a crucial support to rural hospitals, and cuts to the program threaten the stability of already struggling rural hospitals.

HOW PRESIDENT TRUMP & CONGRESSIONAL REPUBLICANS ARE TRYING TO DISMANTLE MEDICAID:

President Trump And His Republican Allies In Congress Have Repeatedly Tried To Slash Funding For Medicaid And Impose Per-capita Caps On Coverage. In 2017, the House of Representatives passed the American Health Care Act (AHCA) repeal bill, which included a per capita limit on federal Medicaid spending that would have resulted in huge cuts to Medicaid across states. After failing to pass the AHCA in the Senate, Republicans have continued to launch relentless attacks on Medicaid. The Trump administration’s budget for 2020 calls for  $1.5 trillion in cuts to Medicaid, and would impose a nationwide Medicaid work requirement. 

The Trump Administration Is Encouraging States To Impose Work Requirements And Other Bureaucratic Restrictions On Medicaid Enrollment In Order To Deny Coverage. Experts warn that work requirements are fundamentally bureaucratic hurdles designed to restrict access to health care rather than increase employment. Already, more than 18,000 have lost their Medicaid in Arkansas because of the work requirement the state imposed last year. Now, the Trump administration is proposing a nationwide work requirement for those with insurance through Medicaid.

Trump States Are Hurting Their Own Residents By Pushing Forward on Work Requirements. Despite a federal judge ruling that work requirements were unconstitutional in Arkansas and Kentucky, other states that President Trump won — Ohio, Utah, Idaho, Alabma, Oklahoma — have either rejected the will of voters by placing work requirements on Medicaid expansion, or have applied for waivers through Trump’s CMS.

President Trump And Congressional Republicans Are Targeting Medicaid To Pay For Tax Cuts For The Wealthiest. In 2017, President Trump signed a $1.5 trillion tax bill that disproportionately benefits the wealthy. How do Republicans plan on paying for it? Former Speaker Ryan’s answer was clear: “Frankly, it’s the health care entitlements that are the big drivers of our debt.” In an attempt to pay for these tax cuts, last April, House Republicans passed a balanced budget amendment that would slash Medicaid funding by $114 billionin a single year alone. Just a few weeks ago, President Trump announced his FY20 budget which would block grant Medicaid, cutting the program by $1.5 billion over ten years.

President Trump Fully Backs A Lawsuit That Would End Medicaid Expansion. By expanding access to Medicaid for parents, children were more likely to gain coverage. One study estimated that between 2013 and 2015, 710,000 low income children gained coverage because of Medicaid expansion.

Final Rule on Exchange Plans Will Increase Out-of-Pocket Costs and Rip Coverage Away from Countless Americans

Washington, DC – Yesterday, the Centers for Medicare & Medicaid Services (CMS) issued its final rule for the annual Notice of Benefit and Payment Parameters (NBPP) for the 2020 benefit year, which outlines regulatory and financial guidelines applicable to exchange plans. The administration predicts a cut to premium tax credits by nearly $1 billion and 70,000 people losing their marketplace coverage. In response to this latest act of sabotage, Brad Woodhouse, executive director of Protect Our Care, released the following statement:

“The Trump administration issued the final rule for exchange plans while the whole country is focused on the Mueller report hoping to hide the rule’s disastrous impacts on Americans who are already struggling with the cost of their health care. These Trump administration changes will cause premiums to increase, make patients pay more out-of-pocket, put protections for people with pre-existing conditions further at risk, and rip coverage away from countless Americans. It’s high time for President Trump and his allies to reverse course and stop sabotaging our health care system.”

Washington, DC – Today, Protect Our Care is releasing state-by-state reports as part of Medicaid Awareness Month that highlight the barriers many Americans living in rural communities face when it comes to receiving quality health care, and the significant role that Medicaid expansion has played in expanding coverage. The reports examine on a state-by-state basis the vital role Medicaid plays in rural communities, and the myriad ways President Trump and Republicans are working to undermine and sabotage the program.

Medicaid expansion has been instrumental in providing health care to America’s rural populations. These reports make clear that Medicaid, and especially expanded Medicaid, have overwhelmingly supported rural populations, giving communities increased access to care and health services. The reports also dig into the many risks rural communities face due to the Trump administration’s war on Medicaid and the Trump Texas lawsuit, which would dismantle the entire health care system and strip care from more than 20 million Americans.

Protect Our Care executive director Brad Woodhouse released the following statement on the new reports:

“America’s rural populations have benefited immensely from Medicaid, and the program has played an essential role in providing quality, and affordable health care to rural communities across the country. The Trump administration’s continued war against Medicaid jeopardizes access to rural health care, and the Trump Texas lawsuit would strip coverage from millions of Americans and take away programs that are instrumental in providing health care for rural America.”

State-By-State Rural Reports Can Be Found Here: 
Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South, Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming.

Washington, DC – Today, Senate Republicans led by Senators Chuck Grassley and Joni Ernst introduced a bill that would resurrect association health plans (AHPs) after they were struck down in the courts for not providing the vital health care protections mandated by the Affordable Care Act. AHPs are not required to cover the essential health benefits put in place by the Affordable Care Act and are allowed to charge people more based on their age, health status, and gender. While AHPs might legally be required to cover people with pre-existing conditions, they have broad discretion to refuse coverage for any treatment associated with a pre-existing condition. Anne Shoup, communications director of Protect Our Care, issued the following statement in response:

“Senate Republicans’ bill to resurrect association health plans after they were struck down in the courts is just their latest attempt to undermine the vital protections provided by the Affordable Care Act. In addition to a well-documented history of fraud and abuse, association health plans open the door to allowing insurance companies to once again refuse coverage at their discretion. We can’t go back to the days when people purchased a health care plan only to realize the coverage is not there when they need it.”

For more resources:

• Fact Sheet: Association Health Plans

• Reminder: Association Health Plans Have A Long History of Fraud and Unpaid Claims

Washington, DC – On Tax Day, millions of Americans contend with higher health care premiums and skyrocketing costs of prescription drugs, while insurance companies reap the benefits of billion-dollar tax breaks, all thanks to the GOP’s tax bill.

Wealthy health insurers and rich pharmaceutical companies have gotten a massive tax windfall thanks to the Trump tax bill, while those same companies continue to charge higher costs for every day prescription drugs relied on by millions of Americans.

To make matters worse, the Trump administration continues to wage their war on America’s health care, and Trump’s lawsuit in Texas threatens to dismantle the nation’s health care system end protections for pre-existing conditions. Trump’s tax bill alone could strip coverage from 13 million Americans and raise premiums double-digits each year while continuing to fund trillion-dollar tax breaks for the wealthiest individuals and corporations.

Protect Our Care executive director Brad Woodhouse released the following statement on Tax Day:

“As drug companies enjoy billion dollar tax breaks this tax day, millions of Americans are being forced to pay more out of pocket for their prescriptions as the Trump administration continues its war America’s health care. To add insult to injury, the drug companies receiving massive tax breaks are charging more for prescription drugs while Trump’s tax bill puts more than 13 million Americans at risk of losing coverage.”

BACKGROUND

Thanks to the Republican tax bill, big pharma and insurance companies are raking in huge profits…

Pharmaceutical Companies Have Reaped Huge Benefits From The Trump Tax Bill. The Trump tax scam means billions of dollars in tax breaks for pharmaceutical companies. An Axios study found that 21 health care companies collectively expect to gain $10 billion in tax savings during 2018 alone. Most of the tax break windfall for health care companies is going toward share buybacks, dividends, acquisitions and paying down debt. According to Axios, nine pharmaceutical companies are spending a combined $50 billion on new share buyback programs. All of the buybacks were announced during or after passage of the tax bill. Some drug companies are also increasing dividends for shareholders, with AbbVie increasing its cash dividend by 35 percent while also announcing a new $10 billion share repurchase program.

The GOP Tax Law Let Pharma Keep $7 Billion In Tax Savings. As Axios reports, “Johnson & Johnson, Pfizer, Merck and Abbott Laboratories collectively kept $7 billion in tax savings last year due to lower corporate tax rates and bringing home cash that was parked overseas, according to a new report from anti-poverty charity Oxfam. Why it matters: The Republican tax law made it possible for the largest pharmaceutical companies to retain money that otherwise would have gone to public coffers, Axios’ Bob Herman reports. But as Oxfam notes, there has not been a corresponding increase in drug development or lower drug prices.”

Pharmaceutical Companies Are Pursuing Massive Profits And Price Increases. Pharmaceutical companies raked in more than $30 billion in profits in the third quarter of 2018, with Pfizer alone bringing in $4.1 billion — the highest of any publicly traded health care company. Of the 19 companies that tallied at least $1 billion of third-quarter profit, 14 were drug companies.  Meanwhile, pharmaceutical companies continue to increase prices.  In January 2019 alone, Pfizer and Novartis announced price increases on dozens of drugs, including increasing the cost of a breast cancer medication to $12,000 for 21 pills.  All in all, nearly 30 drugmakers are expected to raise prices in 2019.

…while Americans pay even more for prescription drugs and access to care.

Drug Prices Continue to Soar Under Trump. A report by Senate Democrats finds that the prices of the 20 most-prescribed drugs under Medicare Part D have increased substantially over the past five years, rising 10 times faster than inflation. Another report from the Pharmacy Benefits Consultants finds that over the past 14 months, 20 prescription drugs saw list-price increases of more than 200 percent.

Drug companies are engaging in the dangerous practice of price-gouging — pursuing massive profits to the detriment of people who need their medication to survive. In September 2018, Nostrum chief executive Nirmal Mulye defended his choice to raise the price of an antibiotic from $474.75 to $2,392 a bottle, saying he had “moral requirement…to sell the product for the highest price.” In 2017, Mylan, the company that made the EpiPen, came under fire for charging $609 for a box of two devices even though each only contained about $1 worth of the drug epinephrine. Between 2012 and 2016, the price of insulin, which 7.5 million Americans depend on, nearly doubledfrom $344 to $666.

Not only do health care costs top the list of Americans’ worries, but millions forgo care they need due to costs. According to a West Help and Gallup survey, in the past twelve months, Americans borrowed an estimated $88 billion to pay for health care, 65 million adults had a health issue but did not seek treatment, and 15 million Americans have deferred purchasing prescription drugs due to cost. Fifty-five percent of Americans worry a great deal about the availability and affordability of health care, and 45 percent of Americans are concerned a major health event will leave them bankrupt.

REPORT:

A Tough Row to Hoe: How Washington Policies Are Leaving 
Rural Health Care in the Dust

Read full report here

Rural Health At A Glance

Americans living in rural communities face unique barriers to accessing health care: they often have to travel longer distances to visit a doctor, have fewer options for doctors and other health care providers, and experience provider shortages more often. They also tend to be lower-income, but live in areas with higher-cost health care.

The Affordable Care Act (ACA) and its Medicaid expansion have been crucial in supporting rural communities, but the relentless war on health care being waged by President Trump and Republicans in Congress has reversed many of these gains, raised premiums, and threatened key components of the rural health care system, including rural hospitals.

Following the implementation of the ACA, the uninsured rate in rural areas droppedfrom 17 percent in 2013 to 12 percent in 2015. The ACA has expanded access to health care to nearly 1.7 million rural Americans who have gained coverage through the Medicaid expansion, not only playing a central role in improving rural communities’ health, but also supporting these communities’ economic well-being. Medicaid covers nearly 24 percent of rural Americans, 45 percent of rural children, 15 percent of rural seniors, and pays for 51 percent of rural births. The uninsured rate in rural areas in states that expanded Medicaid has dropped by a median of 44 percent since expansion. However, Republicans’ relentless war on Medicaid now threatens much of this progress.

In addition to expanding Medicaid, the Affordable Care Act has paved the way for people who are self-employed or work at small businesses to purchase health insurance in the state Marketplaces, which is particularly important given rising self-employment in rural areas. Between 2013 and 2015, the number of uninsured small business employees fell from 13.9 million to 9.8 million, and the uninsured rate for small business employees fell from 27.4 percent to 19.6 percent.

Read full report here

Especially at risk because of Republicans’ health care sabotage agenda are rural hospitals, which rural communities often depend on for both primary and specialized health care services. Since 2010, 104 rural hospitals have closed. The vast majority, 88 percent, were in states that had refused to expand Medicaid at the time of the hospital’s closure. As of 2016, 673 rural hospitals were at risk of closing. Republicans’ continued attacks on Medicaid threaten the financial stability of these hospitals.

Since January 2017, President Trump and his Republican allies have repeatedlyattempted to repeal the Affordable Care Act, end Medicaid expansion, and sabotagestates’ individual insurance markets. In December, a federal judge ruled in favor of conservative states to overturn the Affordable Care Act, its Medicaid expansion, and its protections for people with pre-existing conditions. In February, President Trump, whose administration joined conservative states in arguing that pre-existing condition protections should be overturned, boasted that because of the lawsuit, the ACA would be “terminated.”

Instead of building on the Affordable Care Act’s progress, Republican policies seek to walk back recent progress in rural health. The Republican health care agenda strips Americans of comprehensive health coverage and guts Medicaid.

These measures disproportionately impact rural areas, increase barriers in access to health care, lead to coverage losses, increase the likelihood that rural hospitals will close, threaten major sources of jobs in rural communities, and jeopardize access to health services. Simply put, the Republican health care agenda fails rural Americans.

The Affordable Care Act And Medicaid: Lifelines For Care In Rural Communities

Medicaid is critical to health coverage in rural communities, which generally have lower rates of employer-sponsored coverage than other areas. Nearly one in fourrural Americans have health coverage through Medicaid. As the Kaiser Family Foundation finds, rates of Medicaid coverage are generally higher in rural areas than in other areas of the country. In 41 of the 43 states that have both rural and non-rural areas, the rural areas have a higher Medicaid coverage rate than non-rural areas. For instance, in Kentucky, 32 percent of adults living in rural areas have health insurance through Medicaid compared to 24 percent of adults in urban areas.

Medicaid plays an especially important role in covering rural seniors and children. Nearly 15 percent of seniors living in rural areas have health coverage through Medicaid, and Medicaid pays for more than 50 percent of long-term care. Similarly, Medicaid provides health care for 45 percent of children in rural areas, and pays for 51 percent of rural births.

The Affordable Care Act opened the doors to Medicaid expansion, which has significantly expanded access to health care in rural communities, reduced rural hospitals’ uncompensated care costs, and helped rural health providers keep their doors open by allowing states to expand Medicaid coverage for adults up to 138 percent of the federal poverty line. Medicaid expansion allowed 1.7 million rural Americans to gain coverage who had not previously been eligible. Following Medicaid expansion, the uninsured rate in rural parts of expansion states decreased by a median of 44 percent. In rural states that expanded Medicaid, the uninsured rates dropped significantly after the ACA became law:

• In Montana, the uninsured rate dropped from 19 to 8.5 percent between 2013 and 2016.

• In Kentucky, the uninsured rate dropped from 16.3 to 7.2 percent between 2013 and 2016.

• In Arkansas, the uninsured rate dropped from 17.8 to 9.1 percent between 2013 and 2016.

• In West Virginia, the uninsured rate dropped from 14.2 to 8.8 percent between 2013 and 2016.

By increasing access to health care, Medicaid expansion also drastically reduced the amount of costs that a hospital absorbs for any treatment or service not paid for by an insurer or patient, known as uncompensated care. The Center on Budget and Policy Priorities finds that “states that expanded Medicaid to low-income adults under the ACA saw both larger coverage gains and larger drops in uncompensated care: a 47 percent decrease in uncompensated care costs on average compared to an 11 percent decrease in states that did not expand Medicaid.” CBPP concludes that these declines in uncompensated care were “almost certainly” the result of the ACA’s coverage gains.

A Commonwealth Fund study yielded similar findings: uncompensated care costs decreased substantially in states that expanded Medicaid. On average, uncompensated care costs in Medicaid expansion states decreased from 3.9 percentage points to 2.3 percentage points between 2013 and 2015. In expansion states with an especially high burden of uncompensated care, the share of uncompensated care costs fell from 6.2 percent to 3.7 percent between 2013 and 2015.

Community Health Centers Fare Better In States That Expanded Medicaid

Just as rural hospitals fare better in states that expanded Medicaid, so too do community health centers (CHCs). Community health centers, which provide comprehensive primary health services to underserved areas without regard for ability to pay, are particularly important in rural areas where people face increased barriers to care. A recent study in Health Affairs highlighted how Medicaid expansion strengthens community health centers in rural areas by reducing the number of uninsured patients they see, and improving their quality of care.

The study revealed that Medicaid expansion decreased the percentage of uninsured patients seen by community health centers. Expansion was associated with an 11.4 percentage point decrease in the proportion of uninsured patients a community health center received, and a 13.2 percent increase in patients with health coverage through Medicaid.

The report also found that expansion was associated with improved quality of care in rural areas. For instance, in rural areas that expanded Medicaid, patients with asthma were 3.5 percent more likely to receive appropriate pharmacologic treatment, adults were 6.7 percent more likely to receive a BMI treatment with follow-up if needed, and patients with hypertension were 2.1 percent more likely to receive blood pressure control.

Republicans Want to Slash Medicaid

Since taking office, the Trump administration and Republicans in Congress have tried time and again to slash funding to Medicaid. These efforts include:

• Trump-GOP lawsuit: Arguing in court that the entire Affordable Care Act, including its Medicaid expansion, should be overturned

• President Trump’s FY 2020 budget: $1.5 trillion in cuts to Medicaid

• President Trump’s FY 2019 budget: $1.4 trillion in cuts to Medicaid

• September 2017 – Graham-Cassidy: more than $1 trillion in cuts over 20 years

• July 2017 – Senate’s repeal, “Better Care Reconciliation Act”: $842 billion cut by 2026

• May 2017 – House repeal bill, “American Health Care Act”: $834 billion in cuts to Medicaid over 10 years

Following several failed attempts to slash Medicaid funding, President Trump and Congressional Republicans passed a massive $1.5 trillion tax cut in 2017. To pay for these tax cuts, Republicans have suggested they will need to decimate public health programs like Medicaid.

Speaker Paul Ryan made the GOP’s priorities clear: “Frankly, it’s the health care entitlements that are the big drivers of our debt, so we spend more time on the health care entitlements — because that’s really where the problem lies, fiscally speaking.” In his fiscal year 2010 budget, President Trump requested a $1.5 trillion cut to Medicaid — attempting to strip health care from millions of low-income Americans to pay for tax cuts for the rich.