Despite high rates of chronic disease and poor health outcomes in the American south region, only seven of the 17 states in the region have adopted the Medicaid expansion made possible by the Affordable Care Act.
Medicaid and CHIP (Children’s Health Insurance Program) eligibility levels in the South have also lagged behind other regions for many years, notes a Kaiser Family Foundation report.
As defined by the Census Bureau, the South includes a region stretching from Oklahoma, Texas, and Arkansas on the West to the Atlantic Ocean on the East, and northward to Delaware, Maryland, Kentucky, and West Virginia. More than 118 million individuals live in the South, over a third (37%) of the total U.S. population, and the region is growing rapidly.
Southerners as a group are more likely to have medical problems than those in the rest of the nation, says the Kaiser report. One in five (20%) adults living in the South reports fair or poor health status, compared to about 16% in other parts of the nation. The area has the nation’s highest rates for diabetes, obesity and infant mortality, as well as high rates of cancer-related death.
Southerners are more likely to be poor than those in other regions. Several of the states have among the highest poverty rates in the nation, and in four (Kentucky, Louisiana, Mississippi and West Virginia), at least one in five residents lives in poverty.
The South is home to a large share of the nation’s people of color; they make up 42% of the population in the South, compared to 36% in the rest of the United States. More than four in ten (41%) of all people of color reside in the South, including nearly six in ten of Blacks (58%). Blacks account for 19% of the Southern population, compared to 8% in the remaining areas of the country.
Southerners are more likely to be uninsured than individuals in the rest of the country. Among the total nonelderly population, 15% of individuals in the South are uninsured compared to 10% in the rest of the country.
Uninsured rates are lower for children than for nonelderly adults, but children and nonelderly adults in the South are still more likely to be uninsured than those in the rest of the country.
Medicaid and CHIP eligibility levels are more limited in the South compared to other regions.
The largest disparities in eligibility levels between the South and other regions are for parents and other adults, reflecting the fact that only 7 of the 17 Southern states have adopted the ACA Medicaid expansion to adults.
The expansion states generally have lower uninsured rates compared to those that have not adopted the expansion.
In the other 10 states, eligibility levels for parents remain low, and other adults without dependent children remain ineligible, regardless of their income.
Southern states that have adopted the Medicaid expansion experienced a larger decline in the uninsured rate between 2013 and 2014, when the ACA was implemented, than the 10 that have not adopted the Medicaid expansion.
The ACA Medicaid and Marketplace coverage expansions have the potential to extend health coverage to many currently uninsured Southerners, Kaiser says.
Based on current Medicaid expansion decisions, Kaiser estimates, 42% of uninsured Southerners are eligible for coverage. This includes 16% who are eligible for Medicaid and 25% who are eligible for tax credit subsidies for Marketplace coverage.
However, in the Southern states that have not adopted the Medicaid expansion, 17% fall into a coverage gap. They are poor adults who earn too much to qualify for Medicaid but not enough to qualify for premium tax credits, which begin at 100% of the federal poverty level. (The FPL is currently $11,770 per year for an individual, and $24,250 for a family of four.)
If all states were to expand Medicaid, the coverage gap would be eliminated and 61% of uninsured Southerners would be eligible for coverage, says Kaiser, with the share eligible for Medicaid increasing from 16% to 44%.
“While a broad array of factors contributes to the high rates of chronic disease and poor health outcomes in the South,” the report concludes, “ensuring individuals have health coverage that enables them to access preventive and primary care and ongoing treatment to meet their health needs can be an important step in addressing these disparities.”
