The Affordable Care Act (ACA) expanded health insurance
coverage to previously uninsured populations by allowing
states to expand Medicaid coverage to adults with incomes
up to 138% of the federal poverty level (FPL) as well as
by creating health insurance marketplaces to subsidize
affordable coverage. However, states with a higher number
or proportion of rural residents were less likely to
expand Medicaid than were more urban states. In addition,
rural residents eligible for insurance coverage through
the new health insurance market place were less likely to
enroll in coverage compared to eligible urban residents.
Expanding health insurance coverage to the uninsured,
through both Medicaid and the new health insurance
marketplaces, may improve the financial well-being of
rural hospitals and Federally Qualified Health Centers
(FQHCs) by reducing the provision of uncompensated care.
Even a small increase in revenues due to expanded
coverage may have a meaningful impact for rural
prospective payment system (PPS) hospitals and critical
access hospitals (CAHs), which generally have lower
median operating margins than do urban hospitals or
larger rural referral centers.
In order to inform timely policy development, the North
Carolina Rural Health Research Program surveyed rural
providers’ early experiences of the ACA in four states:
two that chose to expand Medicaid (Arizona and North
Dakota), and two that chose not to expand Medicaid
(Georgia and Maine). Our findings brief, Rural Provider
Perceptions of the ACA: Case Studies in Four States
summarizes perceptions from these states regarding the
early effects of the ACA, including changes to patient
populations, financial health, and capacity for rural
hospitals and rural FQHCs.