Jim Carnes: Congress’ plan to cut Medicaid threatens Alabama’s rural communities

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In many small towns across Alabama, the Great Recession of 2008 is still visible in empty storefronts, shrunken paychecks and lives put on hold. Unfortunately, those rural communities will soon be dealt another devastating blow if Congress cuts federal funding for our state’s Medicaid program. Medicaid is a critical lifeline for 24 percent of Alabama’s rural and small-town residents, and the deep cuts to Medicaid being considered right now by Congress would have a harmful and disproportionate impact on our children, seniors and families in need.

According to a new independent report by researchers at Georgetown University and the University of North Carolina, a larger share of children and families living in small towns and rural areas rely on Medicaid for their health coverage. This is especially true for children. About 52 percent of children living in non-metro areas of Alabama are covered by Medicaid and ALLKids (known in other states as the Children’s Health Insurance Program, or CHIP), compared to 42 percent in metro areas. Nationally, the researchers found a direct connection between increases in Medicaid and CHIP coverage and reductions in the rate of uninsured children in small towns and rural areas.

For almost 20 years, ALLKids has been a point of pride for Alabama. Our CHIP program was the first to be authorized when federal law made the coverage possible, and ours has been a national leader in quality and reach. We can’t afford to turn our backs now on the progress we’ve made for our kids. Studies show that when children have health coverage they can get important doctor-recommended screenings and care to help them stay healthy and are more likely to enter school ready to learn.

The study also found that Medicaid covers a higher percentage of adults living in small towns and rural areas (14 percent) than in our state’s metro areas (11 percent). Many adults covered by Medicaid are parents or caregivers, and when they have health care coverage, they are better able to provide children with the care they need to grow and thrive. Medicaid also helps improve financial security by protecting the entire family against medical debt and bankruptcy.

Alabama’s rural seniors also depend more heavily on Medicaid coverage (24 percent) than their peers in urban areas (19 percent). The proposed cuts would fall especially hard on Alabama’s small-town nursing homes and other long-term care services.

Even Alabama residents who aren’t directly covered by Medicaid should be concerned about what cuts to Medicaid would mean for hospitals, clinics and physicians serving our state’s small towns and rural communities. When fewer people are covered, ER visits and uncompensated care drive up costs for all of us and put rural hospitals and doctors’ offices at risk of closing their doors. When a community hospital closes, the entire community suffers.

Medicaid is a lifeline for the rural parts of our state. It ensures that the most vulnerable among us–children, seniors and people with disabilities – can get the care they need. It keeps our rural hospitals running and able to serve patients who otherwise would be forced to drive long distances to get care. City dwellers sometimes forget that rural health care can be a life-saver for any traveler who has a highway emergency.

Medicaid cuts are bad for Alabama. They won’t rein in personal health care costs. They won’t give our state flexibility to innovate and find better ways to deliver care. Instead, they will take away coverage from those who need it most and undermine the healthcare infrastructure on which we all depend. 

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Jim Carnes is policy director for Arise Citizens’ Policy Project, a statewide nonprofit coalition of 150 congregations and organizations working to improve public policies that affect low-income Alabamians.

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