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Missouri FORUM | Missouris Rural Residents Need Better Health Care Options By Jen Bersdale , Aaron Griffin OP ED There are people all across Missouri who are struggling to access health care, but the situation is much worse for those living in rural communities and small towns. While about a quarter of Missourians living in metro areas like St. Louis and Kansas City are uninsured, 35% of those living in rural areas  the communities throughout most of our state  are uninsured. While the uninsured rate in big Missouri cities fell modestly after the Affordable Care Act was implemented, the rural uninsured rate has barely budged, according to a new report from researchers at Georgetown University and the University of North Carolina. Compare that to whats going on in some of our neighboring states. In Arkansas, the rate of uninsured adults in these rural communities fell from 45 percent in 2008-2009 to 22 percent in 2015-2016. In Iowa, it dropped from 27 to 15 percent. And in Illinois it fell from 29 to 12 percent. Yet here in Missouri, the uninsured rate for this group of rural residents is still stuck at 35 percent. What accounts for the difference? Medicaid Expansion. Illinois, Iowa, and Arkansas all agreed to expand Medicaid to adults who live just above the federal poverty level, with generous federal funding that would make it an economic boom for the state. Missouri has now rejected that opportunity for six years. Instead, the residents of Missouris small towns and rural communities are bearing the costs of an inadequate health care system. Missouris rural hospitals and community health centers are losing out on a reliable stream of revenue for treating working families, and some have closed. Southeast Missouri has been hit especially hard, losing both Twin Rivers Regional Medical Center in Kennett and Southeast Health Center of Reynolds County in Ellington. As one of the report authors points out, high uninsured rates have a ripple effect throughout rural health care systems, where shortages of health care providers are already far too common. Whats more, the lack of access to health care is sapping the economic vitality of these communities. Studies show that workers with health coverage are more likely to show up for work regularly. They are less likely to go bankrupt from medical debt. And they are more likely to have children who are covered, giving the next generation a better chance at success in school and life. Nationwide, the rates of uninsured adults dropped by an average 19 percentage points in rural areas and small towns in states that accepted the Medicaid expansion, according to the study from Georgetown Universitys Center for Children and Families and UNCs Rural Health Project. The rate fell just 5 percentage points, on average, in non-expansion states. Missouris small towns and rural communities lagged even further behind, with nearly no decrease in the uninsured rate. Missouris rural families deserve better. Missouri still has the opportunity to expand Medicaid, and it will be our rural communities that benefit most. Missouri has many elected officials who are proud to represent and advocate for their rural areas and small towns. These leaders should be driving the push to expand Medicaid and lower health insurance costs to help their communities thrive. Copyright (C) by the Missouri FORUM. The Forum is an educational organization that provides the media with the views of state experts on major public issues. Letters should be sent to the Forum, P.O. Box 211, Jefferson City, MO 65102-0211. () TOP