Dr. M Blatstein's Blog, Home Confinement, Medical, Preparation

About 66 million people, or 20% of the U.S. population, live in rural areas, nearly half of all births, and one-fifth of inpatient discharges. Medicaid covers 1 in 4 adults there, more than in cities. It plays a key role in funding health care, covering nearly half of all births and one-fifth of hospital stays.

The Congressional Budget Office (CBO) estimates the recent reconciliation package would reduce federal Medicaid spending by about $911 billion over ten years, potentially leaving 10 million more people uninsured. Senators from both parties have raised concerns about the impact on  rural hospitals, especially since many are already closing.

It is unclear how the funds will be distributed across states and how states will allocate funding between hospitals, other providers, and various state initiatives.

Over half of the spending reductions in rural areas are in the 12 states with large rural populations and have expanded Medicaid under the ACA, 10 of which could see rural federal Medicaid spending decline by $5 billion or more over 10 years. Those 10 states would experience the largest rural Medicaid spending, with an estimated drop of nearly $11 billion over 10 years (Figure Above).

Over half of the estimated federal spending cuts stem from provisions that only apply to states that have adopted the ACA expansions, including work requirements, more frequent eligibility determinations, and new cost-sharing requirements. As a result, the effects of the reconciliation bill in rural areas will be larger for expansion than for non-expansion states.

The Non-expansion states have left their citizens who need health insurance still unserved.

Those Released From Prison and jails will be severely affected. If they were lucky enough to have had medical care or have successfully quit a drug habit, without medical care, they may end up using again. This article was written in 2023, before the Medicaid Cuts were even a thought.