Health Insurance Coverage
In all 7 Southern states that have refused Medicaid expansion, 15% or more of the working-age population is uninsured.
Lack of health insurance coverage by state, 2021
Percent of population age 19-64
Sources: Census Bureau’s American Community Survey 2021 and Kaiser Family Foundation. Note: Wisconsin has partially expanded Medicaid (under a Medicaid waiver) to include all adults under 100 percent federal poverty level, but did not adopt the ACA expansion.
Starting in 2010, the rates of the uninsured dramatically dropped with the implementation of the Affordable Care Act. Despite substantial federal subsidies, seven states in the deep South (AL, FL, GA, MS, NC, SC, and TN) have not adopted Medicaid expansion. As a result, 15% of working-age Southerners lack health insurance compared to 11% in the rest of the United States. In Texas, 24% of the working-age population lacked coverage, as did 18% in Florida, Georgia, and Mississippi. In comparison, only 3% in Massachusetts were without coverage.
People without health insurance are less likely to get the medical care that doctors advise for them. When they are injured they don’t get the follow-up care they need, and those that have chronic conditions often go untreated until they appear in emergency rooms. Hospitals in communities with high rates of uninsured patients become financially strapped, and high uninsurance rates have led to many closures of rural hospitals across the South.1,2 Those uninsured individuals that do get medical treatment are likely to incur medical debt. By February 2022, credit bureau data revealed that nearly 1 in 5 Southerners had medical debt, compared to about 1 in 10 non-Southerners (Medical Debt).
“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/
