Health Insurance Coverage
Over 15% of Southerners lack health insurance, compared to only 11% of Americans outside the South, largely because 7 Southern states have not implemented Medicaid expansion.
Lack of health insurance coverage by county, 2017-21 (5-yr average)
Percent of population age 19-64
Sources: Census Bureau’s American Community Survey 2017-21 and Kaiser Family Foundation. Note: *North Carolina and South Dakota have adopted but not yet implemented Medicaid expansion. **Wisconsin has not adopted the Affordable Care Act’s Medicaid expansion but it has partially expanded Medicaid, under a Medicaid waiver, to include all adults under 100 percent federal poverty level.
Lack of health insurance is one of the reasons that the U.S. has an “excess death” problem.1,2 Americans without health insurance often fail to get treatment for chronic conditions until they are very ill and go to emergency rooms. In 2010, the Affordable Care Act began to dramatically reduce the number of uninsured people across the country through Medicaid expansion and new subsidies for health insurance “marketplaces.” 10 states (6 of them in the South) have still not adopted Medicaid expansion.
In addition, patients who qualify for Medicaid must regularly renew their coverage and periodically verify their eligibility which often leads to patients inadvertently becoming unenrolled. When Covid struck, Congress required that Medicaid keep patients enrolled continuously, a provision which ended in March 2023. An estimated 5 to 14 million people will lose coverage at some point this year.3 Hospitals serving many uninsured patients become financially strapped, and thus high uninsurance rates have led to many closures of rural hospitals across the South.4,5 In 2020, a record 19 rural hospitals closed.6 In 2021, 8 of the 10 states with the highest death rates were Southern states (Death rates).
“New study finds 45,000 deaths annually linked to lack of health coverage”. Cecere. The Harvard Gazette. September, 2009. https://news.harvard.edu/gazette/story/2009/09/new-study-finds-45000-deaths-annually-linked-to-lack-of-health-coverage/
“The Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly?” Woolhandler, Himmelstein. Annals of Internal Medicine. September, 2017. https://www.acpjournals.org/doi/full/10.7326/M17-1403
“10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment Provision”. Tolbert, Ammula. KFF. April, 2023. https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-the-unwinding-of-the-medicaid-continuous-enrollment-provision/
“Key Facts about the Uninsured Population”. Tolbert, Orgera, and Damico. Kaiser Family Foundation. November, 2020. https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/#:~:text=When%20they%20are%20hospitalized%2C%20uninsured,rates%20than%20those%20with%20insurance.&text=Research%20demonstrates%20that%20gaining%20health,effects%20of%20having%20been%20uninsured.
“181 rural hospitals have closed since 2005—see the states that have been impacted”. Givens. Sidecar Health. December, 2021. https://sidecarhealth.com/blog/181-rural-hospitals-have-closed-since-2005-see-the-states-that-have-been-impacted/
“Rural Hospital Closures Threaten Access”. American Hospital Association. September, 2022. https://www.aha.org/system/files/media/file/2022/09/rural-hospital-closures-threaten-access-report.pdf
“State and Territorial Data”. CDC. https://www.cdc.gov/nchs/fastats/state-and-territorial-data.htm
