​The most likely Medicaid cuts would hit rural areas the hardest

New Mexico has the highest percentage of residents on Medicaid in the U.S.
By: Scott S. Greenberger, Stateline
​Source NM

Working-age adults who live in small towns and rural areas are more likely to be covered by Medicaid than their counterparts in cities, creating a dilemma for Republicans looking to make deep cuts to the health care program.
 
About 72 million people — nearly 1 in 5 people in the United States — are enrolled in Medicaid, which provides health care coverage to low-income and disabled people and is jointly funded by the federal government and the states. Black, Hispanic and Native people are disproportionately represented on the rolls, and more than half of Medicaid recipients are people of color.
 
Nationwide, 18.3% of adults who are between the ages of 19 and 64 and live in small towns and rural areas are enrolled, compared with 16.3% in metro areas, according to a recent analysis by the Center for Children and Families at Georgetown University.
 
In 15 states, at least a fifth of working-age adults in small towns and rural areas are covered by Medicaid, and in two of those states — Arizona and New York — more than a third are. Eight of the 15 states voted for President Donald Trump.
 
Health insurance for millions could vanish as states put Medicaid expansion on chopping block
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Twenty-six Republicans in the U.S. House represent districts where Medicaid covers more than 30% of the population, according to a recent analysis by The New York Times. Many of those districts have significant rural populations, including House Speaker Mike Johnson’s 4th Congressional District in Louisiana.
 
Republican U.S. Rep. David Valadao of California, whose Central Valley district is more than two-thirds Hispanic and where 68% of the residents are enrolled in Medicaid, has spoken out against potential cuts.
 
“I’ve heard from countless constituents who tell me the only way they can afford health care is through programs like Medicaid, and I will not support a final reconciliation bill that risks leaving them behind,” Valadao said to House members in a recent floor speech.
 
U.S. House Republicans are trying to reduce the federal budget by $2 trillion as they seek $4.5 trillion in tax cuts. GOP leaders have directed the House Energy and Commerce Committee, which oversees Medicaid and Medicare, to find $880 billion in savings.
 
Trump has ruled out cuts to Medicare, which covers older adults. That leaves Medicaid as the only other program big enough to provide the needed savings — and the Medicaid recipients most likely to be in the crosshairs are working-age adults. But targeting that population would have a disproportionate impact on small towns and rural areas, which are reliably Republican.
 
Furthermore, hospitals and other health care providers in rural communities are heavily reliant on Medicaid. Many rural hospitals are struggling, and nearly 200 have closed or significantly scaled back their services in the past two decades.
 
Before the Affordable Care Act was enacted in 2010, there were far fewer working-age adults on the Medicaid rolls: The program mostly covered children and their caregivers, people with disabilities and pregnant women. But under the ACA, states are allowed to expand Medicaid to cover adults making up to 138% of the federal poverty level — about $21,000 a year for a single person. As an inducement to expand, the federal government covers 90% of the costs — a greater share than what the feds pay for the traditional Medicaid population.