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Report: Rural States Stand to Lose Under GOP Health-Care Bill

A CBPP report says rural Iowans could lose access to coverage under the House-passed health-care plan. (Raymond Shobe/Flickr)
A CBPP report says rural Iowans could lose access to coverage under the House-passed health-care plan. (Raymond Shobe/Flickr)
May 17, 2017

DES MOINES, Iowa - While the country waits for the Congressional Budget Office's report on the Republican health-reform bill, research released Tuesday shows rural states such as Iowa stand to lose the most.

According to the Center on Budget and Policy Priorities, provisions in the American Health Care Act to restructure Medicaid and essentially end its expansion would undermine coverage in rural areas.

Jesse Cross-Call, a senior policy analyst in the center's health-policy division, said there are long-standing reasons Medicaid is particularly important to rural America.

"People who live in rural areas have lower incomes, do more contract work and are less likely to have an offer of employer coverage than people who live in nonrural areas," he said. "The Medicaid expansion has given these individuals a pathway to health coverage where, before the Affordable Care Act, one often did not exist."

The report also noted that under the Republican plan, tax credits for the purchase of health care through the insurance market do not adjust for geographic variations, which could hurt people in rural areas who typically pay higher health-care costs. In Iowa, 44 percent of Medicaid expansion enrollees live in rural areas.

Mary Wakefield, who served as acting deputy secretary of the U.S. Department of Health and Human Services, contended that the GOP plan will reverse the progress made under the Affordable Care Act, such as the substantial drop in the rate of uninsured rural, non-elderly individuals.

"From 17 percent insured in 2013 to 12 percent uninsured in 2015," she said, "and while those numbers may seem abstract, they have tangible impacts on access to care, on health and on financial security."

The American Medical Association, the American Nurses Association and the American Hospital Association are among groups that oppose the American Health Care Act. Wakefield noted that those groups did not have the opportunity to weigh in on the measure.

"As both a health-care professional and a former agency head," she said, "I was genuinely shocked to see the House develop, debate and pass legislation upending our health-care system without holding a single hearing to hear from these groups about their bill."

The CBO report on the American Health Care Act is expected to be released Monday. Its analysis of the earlier version estimated 24 million people nationwide would lose coverage.

The report is online at

Mary Kuhlman, Public News Service - IA