Anne Swerlick
September 26, 2018

Florida Small Towns and Rural Areas Are Disproportionately Hurt by Florida's Failure to Expand Medicaid

This post was last updated on September 29, 2021. As new policies are announced, FPI will update this page.

As Florida’s response to COVID-19 takes front and center, concern grows for low-income families who struggle to take precautions against the spread of the virus. Although Congress has passed the Families First Coronavirus Response Act to address, at least in part,  the public health crisis and economic fallout from COVID-19, many barriers continue to keep struggling families from accessing the assistance they need during the pandemic. As Florida initiates policies implementing the Act and addressing other barriers to the safety net, FPI will update this form. When available, hyperlinks are provided to agency documents or statements that provide greater detail  about the new policy.

On March 22, 2020, FPI and 44 other organizations sent a letter to Governor DeSantis, leadership in the Legislature and agency heads to urge action on 47 specific policy changes to reduce unnecessary barriers for Florida’s safety net programs in response to the COVID-19 pandemic. See the letter here.

While Medicaid expansion would reduce the uninsured rate for residents across the entire state, the most dramatic improvements would likely be felt in small towns and rural areas of Florida.

According to a report released today by the Georgetown University Center for Children and Families and the University of North Carolina’s NC Rural Health Research Project, states that expanded Medicaid saw more than three times the rate of decline in uninsured rates for low-income adults living in rural areas and small towns than non-expansion states between 2008/2009 and 2015/2016.

While Florida has one of the highest rates of uninsured residents in the country, the hit on rural areas and small towns is even greater. The uninsured rate for low-income Floridians in these areas is 13 percentage points higher than metro areas (37 percent vs. 24 percent). And in some Florida counties, like Columbia and Jackson, the rates are even higher, in the 40 to 42 percent range.

Multiple factors account for these differences. Generally, rural residents have lower incomes, so they can’t afford private insurance. It’s also more difficult to find work in rural areas, and thus residents can’t access employer-based insurance. Likewise, higher rates of disability prevent many residents from working.

These rural residents include parents of minor children. They represent about 25 percent of the low-income adults who would benefit from expansion. That’s because Florida has incredibly stringent income eligibility limits– just 34 percent of the poverty level or $7,000 per year for a family of three. So, thousands of Florida parents remain uninsured.

When parents are covered, children benefit- they are more likely to be insured and go to the doctor for preventive care. Moreover, the entire family has financial protection against large medical debt and bankruptcy.

Besides the benefits of residents gaining coverage with Medicaid expansion, entire rural communities would profit. Rural hospitals would be substantially more financially secure, preventing closures and the loss of a major local employer.

Let’s not forget that higher rates of uninsured translates into more human suffering, costly serious illnesses and premature deaths. By not expanding Medicaid, Florida residents of rural areas and small towns are carrying a larger share of this burden.

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