Study finds rural areas have most to gain in Medicaid growth

By Traci Gleason
Missouri Budget Project

A Missouri Medicaid expansion would reduce the state’s uninsured population by more than one-fourth, bringing an estimated $1.56 billion in new health care funding and providing coverage for roughly 267,000 previously uninsured Missourians, according to a new analysis.  The expansion would have the most dramatic impact in rural areas, reducing the uninsured by up to 31 percent.
“The entire state would benefit from the expansion, both by the reduction in the rate of the uninsured, and by the infusion of economic activity into the economy,” said Dr. Timothy McBride, Professor at Washington University in St. Louis. “However, rural counties will have a larger portion of their residents benefit from the expansion, so they will also see a larger positive impact in their economies.”
The Missouri Medicaid Expansion: Good for All Missourians, issued by Washington University health policy expert Dr. Timothy McBride, Saint Louis University Professor of Law Sidney Watson, and Missouri Budget Project Executive Director Amy Blouin, shows that Medicaid expansion would cover more people and attract more health care dollars in urban areas.  However, due to several factors, rural areas would experience a greater reduction in the rate of the uninsured, and health care spending would have a larger impact on rural economies.
“Rural residents often have less employer-sponsored insurance and more residents living in poverty, creating higher rates of the uninsured,” said Watson. “Within 21 Missouri counties, more than 10 percent of the county population will be eligible for expanded coverage.”
As a result of a Supreme Court ruling earlier this year, states may choose to expand Medicaid as called for in the federal health care law, the Affordable Care Act.  In Missouri, the expansion would extend eligibility from 19 percent of the federal poverty level to 138 percent.  Governor Jay Nixon has indicated that he will include the Medicaid expansion in his budget to be released later this month.  As legislators convene for the legislative session that begins Wednesday, they will begin discussing whether to expand Medicaid in Missouri.
“The expansion will have positive consequences for health outcomes and the economy throughout the state,” said Blouin.  “But despite popular misconceptions, legislators should understand that the most dramatic impact will be on the rural areas that the majority of them represent.”
The full report on Medicaid expansion can be accessed at

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