Unin­sured num­bers de­cline in ru­ral Conn.

New Haven Register (Sunday) (New Haven, CT) - - NEWS - By Macken­zie Rigg

Con­necti­cut saw one of the big­gest drops in the unin­sured rate among low­in­come adults liv­ing in ru­ral ar­eas and small towns com­pared to other states, ac­cord­ing to a na­tional study re­leased this week.

The unin­sured rate for low-in­come adults (be­low 138 per­cent of the fed­eral poverty level) has fallen since 2008-09 in nearly all states, but small towns and ru­ral ar­eas of states, in­clud­ing Con­necti­cut, that have ex­panded Medicaid have seen the sharpest de­clines, ac­cord­ing to the study by the Ge­orge­town Univer­sity Cen­ter for Chil­dren and Fam­i­lies and the North Carolina Ru­ral Health Re­search Pro­gram. The study ex­am­ined the sta­tus of in­sur­ance cov­er­age for low-in­come adults in the 46 states with sig­nif­i­cant ru­ral pop­u­la­tions.

The unin­sured rate for this pop­u­la­tion dropped sharply from 35 per­cent to 16 per­cent in ru­ral ar­eas and small towns (iden­ti­fied as “non-metro coun­ties” in the study) of Medicaid ex­pan­sion states com­pared to a de­cline from 38 per­cent to 32 per­cent in non-ex­pan­sion states be­tween 2008-09 and 2015-16.

In Con­necti­cut, the unin­sured rate in its sole non­metro county, Litch­field, fell from 32 per­cent in 2008-09 to 9 per­cent in 2015-16.

Non-metro coun­ties in the re­port are de­fined as hav­ing no ur­ban cen­ters or no cen­ter with more than 50,000 peo­ple. The other seven Con­necti­cut coun­ties — Fair­field, Hart­ford, New Haven, Tol­land, Mid­dle­sex, Wind­ham and New Lon­don — are con­sid­ered metro coun­ties.

“I am aware Medicaid ex­pan­sion has made a tremen­dous im­pact on cov­er­age in Con­necti­cut,” said Pa­tri­cia Baker, pres­i­dent and CEO of the Con­necti­cut Health Foun­da­tion. “I had no idea that our ru­ral rate would go from 32 per­cent unin­sured to 9 per­cent. That’s a stun­ning find­ing.”

Joanne Bor­d­uas, CEO of the Com­mu­nity Health and Well­ness Cen­ter of Greater Tor­ring­ton, a com­mu­nity health cen­ter that serves res­i­dents in Litch­field County, ac­knowl­edged that hav­ing in­sur­ance makes ac­cess­ing health care much eas­ier.

But, said Bor­d­uas, a lack of in­sur­ance is only one rea­son peo­ple may not get pre­ven­tive health care or man­age their chronic con­di­tions. Other fac­tors in­clude ac­cess to healthy food, hous­ing and trans­porta­tion.

In the seven metro coun­ties in Con­necti­cut, ac­cord­ing to the study, the unin­sured rate for low-in­come adults fell from 22 per­cent to 11. For all coun­ties, the change was 23 per­cent to 11.

Fac­ing un­cer­tainty

Sher­man res­i­dent Linda Yan­none is one of the peo­ple who lives in a metro county and who ben­e­fited from Medicaid ex­pan­sion in Con­necti­cut. Sher­man, a small, ru­ral town, is in north­ern Fair­field County.

When Yan­none’s hus­band lost his job at a car deal­er­ship in 2006, they lost their health care cov­er­age too. And although they bought pri­vate health in­sur­ance, the cost of pre­mi­ums drained their sav­ings and they had to stop pay­ing for it. This was es­pe­cially dif­fi­cult be­cause Yan­none is a

cancer sur­vivor and lives with lu­pus, an au­toim­mune dis­ease.

“I was fac­ing com­plete un­cer­tainty about how I was go­ing to care for my­self go­ing for­ward,” she said, adding that she was forced to pay for her health care out-of-pocket, which meant ra­tioning her med­i­ca­tions at times and ac­cept­ing free care when it was of­fered.

All that un­cer­tainty changed when Yan­none be­came el­i­gi­ble for HUSKY D, the state’s ex­panded Medicaid pro­gram.

Medicaid ex­pan­sion

Con­necti­cut ex­panded Medicaid un­der the Af­ford­able Care Act in mid-2010. This ex­tended cov­er­age to low-in­come adults who did not have mi­nor chil­dren and were not dis­abled. This was only a par­tial ex­pan­sion — it cov­ered peo­ple earn­ing up to 56 per­cent of the poverty level, with a slightly higher in­come limit for Fair­field County.

The state then ex­panded el­i­gi­bil­ity to 138 per­cent of the fed­eral poverty level on Jan. 1, 2014. On this date, “gen­er­ous” fed­eral fund­ing first be­came avail­able for ex­panded Medicaid cov­er­age, ac­cord­ing to the study.

Be­fore the ex­pan­sion, most low-in­come adults who did not have mi­nor chil­dren did not qual­ify for Medicaid. There was a sep­a­rate state-funded pro­gram that pro­vided med­i­cal as­sis­tance for very low in­come peo­ple who had ex­tremely limited as­sets, called state-ad­min­is­tered gen­eral as­sis­tance, known as SAGA. It cov­ered roughly 46,000 peo­ple who were then moved into Medicaid.

Medicaid has played a key role in low­er­ing the per­cent­age of Amer­i­cans who lack health in­sur­ance. Na­tion­ally, the unin­sured rate for all Amer­i­cans un­der the age of 65 (adults and chil­dren) fell dra­mat­i­cally be­tween 2010 and 2016 from 18.2 per­cent to 10.4 per­cent, ris­ing slightly to 10.7 per­cent in 2017, ac­cord­ing to the study.

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