Alabama’s small towns and rural areas have among the highest rates of uninsured low-income adult citizens in the country, and residents there are more likely to be uninsured than those in metro areas, according to a new report by Georgetown University’s Center for Children and Families (CCF) and the University of North Carolina’s NC Rural Health Research Program.
The uninsured rate for Alabama adults with low incomes is 36 percent in rural communities and small towns, and 29 percent in metro areas. Both rates are much higher than the national averages of 26 percent for rural areas and 18 percent for metro areas.
In rural areas and small towns across Alabama, the report unveiled that the uninsured rate for low-income adults has grown stagnant — it has remained virtually unchanged between 2008-09 and 2015-16.
Medicaid and the uninsured
Alabama Arise — a nonprofit, nonpartisan coalition of congregations, organizations and individuals promoting public policies to improve the lives of low-income Alabamians — believe this number could look even worse in Alabama if the Medicaid “work requirement” plan that Alabama submitted for federal approval goes through. They say it would drive the uninsured rate even higher by stripping Medicaid coverage from thousands of parents in poverty.
The proposal would require 35 hours of work, job training, education or volunteer service each week. Exceptions would be made for people with young or disabled children. State officials says the proposal only impacts a small number of Medicaid recipients, able-bodied parents and caretakers who qualify because their income is less than 18 percent of the federal poverty level. Most Medicaid beneficiaries in the state are children, disabled or elderly. But Alabama Arise disagrees — they believe, virtually all of those parents would be left with no realistic alternative for affordable coverage.
“Not only has Alabama failed to move forward on health coverage, but now our state is seeking to move backward by leaving even more people uninsured,” said Alabama Arise policy director Jim Carnes. “Alabama should drop its cruel efforts to punish people living in poverty and focus instead on expanding Medicaid so all Alabamians can get the care they need to become and stay healthy. Medicaid expansion would save hundreds of lives, create thousands of jobs and keep rural hospitals and clinics open to serve residents across our state.”
According to the report, nationally, the uninsured rate for low-income adults fell by more than half – from 35 percent to 16 percent – in rural areas and small towns in states that expanded Medicaid. For states that have not expanded, the decline was much smaller: from 38 percent to 32 percent.
“Medicaid expansion would reduce the uninsured rate for residents across the entire state; however, the most dramatic improvement likely would be felt in small towns and rural areas of Alabama,” Georgetown CCF executive director Joan Alker explained. “Improved coverage rates typically translate to a more stable health care system and help rural areas and small towns maintain availability of health care providers in areas where shortages are all too common. Access to rural health providers is especially important to women of child-bearing age and those with chronic conditions like asthma.”
In July 2018, 10 of the 11 Alabama counties with the highest unemployment rates were rural counties.
