Being private insurance geeks, we don’t usually write about Medicaid in this space. But every once in a while we have to highlight some important work.

Last year we helped document the plight of “bare counties,” largely rural areas of the country that were at risk of losing their sole marketplace insurance company. Luckily, every county ended up being covered for the year, but rural communities have long been plagued by high premiums and limited choices. In many of these places, Medicaid has become both a coverage and financial lifeline. An important new report by our sister center, the Center for Children and Families, examines the impact of Medicaid expansion on health coverage in rural areas and small towns.

Using county-level data, the report finds that Medicaid expansion states saw huge drops in the uninsured rate of low-income adult citizens after implementation of the ACA, and rural areas and small towns saw the sharpest decline. Here are some of the report’s other findings and conclusions:

• Low-income adult citizens (below 138 percent of the Federal Poverty Level) in the small towns and rural areas of expansion states went from a 35 percent uninsured rate to 16 percent uninsured between 2008/9 and 2015/16, whereas non-expansion states saw a much smaller drop in the uninsured rate of this population, from 38 percent down to 32 percent;
• Non-expansion states with the biggest coverage disparities when comparing metro areas to small towns and rural areas include Virginia and Utah. Virginia recently decided to expand Medicaid, while Utah residents will vote on a ballot initiative this fall that may result in expansion, giving them the opportunity to address these disparities;
• In eight states that have not expanded Medicaid, more than one-third of their low-income adult uninsured population lives in a small town or rural area. This means that these states (South Dakota, Georgia, Oklahoma, Florida, Texas, Alabama, Missouri, and Mississippi) have the opportunity to greatly improve their coverage for this population as well as positively impact their hospitals and providers serving non-metro areas.

You can read the entire report here.