If Medicaid Expansion and the protections provided by the ACA are stripped away in agricultural states such as North Dakota, thousands of our rural residents will be placed at risk. Some of the ACA protections prevent insurance companies from denying coverage if you have pre-existing conditions like diabetes, cancer, heart disease, hypertension, COPD and more.

According to the Kaiser Family Foundation, nearly one in four rural Americans receives health coverage through Medicaid. When legislators in North Dakota, both Republicans and Democrats, came together to expand Medicaid for our state, they gave an important lifeline to members of rural communities and our health care facilities. Thanks to Medicaid Expansion, between 2013 and 2016, the uninsured rate in North Dakota dropped from 12.1 percent to 8.9 percent. In states that expanded Medicaid, people residing in rural areas also saw better health outcomes due to increased screening and early detection of diseases.

Medicaid Expansion has been very important for rural North Dakotans. Fifty-eight percent of the people who benefited in the first couple of years of expanded Medicaid lived in rural North Dakota. This is due in part to the fact that there is traditionally a higher level of poverty and lower incomes in the rural areas. People in rural North Dakota rely heavily on their hospitals and clinics to access quality health care. In cities, access to health care can be measured in blocks; in rural areas it is measured in miles. Maintaining viable health facilities is critical to small-town North Dakota.

Before Medicaid Expansion, rural hospitals and clinics were often left with the bill when patients without coverage could not pay. Under Medicaid Expansion, there was a large drop in their uncompensated care costs. These uncompensated costs are left to the hospital if people cannot pay their bills. States that expanded Medicaid saw a 47 percent drop in uncompensated costs, while states that did not expand Medicaid only saw an 11 percent drop. In order for rural citizens to access quality health care, rural hospitals and clinics need to remain open. By increasing the numbers of rural people with insurance, Medicaid Expansion has pumped about $27 million more into rural health infrastructure. This helps keep facilities open, improves the health of rural North Dakotans, and helps the rural economy.

It is clear that the ACA and Medicaid Expansion strengthened rural health care and should be recognized as an important tool in the fight for better care. I hope lawmakers and government officials work to further strengthen the law and keep these crucial protections that are so important to our rural communities.

Johnson is president of the North Dakota Rural Health Association

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Johnson: Rural North Dakotans depend on the ACA and Medicaid Expansion