The number of Americans who have health coverage under the Affordable Care Act continues to grow, but a new analysis finds that, especially in rural states, there are many who still can’t gain access to affordable insurance. All states were given the option to expand their Medicaid programs, but many did not, and according to Jon Bailey, director of the rural public policy program at the Center for Rural Affairs, those were mostly states with large rural populations.

“Then the converse is true for states that have a higher portion of their population in urban areas. They’re more likely to have expanded Medicaid,” Bailey said. “So if you live in a rural area, in a state that has a high rural population, it’s less likely that you’ll get the benefits of the Medicaid expansion.”

In Iowa, the Medicaid program is being expanded this year, increasing eligibility to those who earn up to 100 percent of the poverty level, or about $11,500 a year.

In rural states where there was no expansion there’s a significant coverage gap of low-income workers who earn too much to qualify for Medicaid, but not enough to receive tax credits under the new heath insurance marketplaces. Bailey said that coverage gap, percentage-wise, is about as large as the group of people whose policies didn’t comply with the ACA, where action was taken to let them keep what they had.

“Congress introduced bills. The president came up with a plan to solve the problem for a year,” he said. “That group of people is almost equal to the people in this coverage gap who have no insurance options at all, and really very few people are talking about how to resolve those people’s problems.”

Nationally, nearly 1.8 million rural and small-city residents are in the coverage gap.

(Iowa News Service)