TN rural residents have most at stake in debate over Medicaid expansion

Residents of Tennessee’s small towns and rural areas have the most at stake in the debate over whether to expand Medicaid, according to a new report by Georgetown University’s Center for Children and Families and University of North Carolina’s NC Rural Health Project.

States that expanded Medicaid saw more than three times as large a decline in the uninsured rates for low-income adults living in rural areas and small towns than non-expansion states experienced for the period between 2008/09 and 2015/16.

In Tennessee, which has not expanded Medicaid, the uninsured rate for low-income adults in rural areas only declined by about 6 percentage points while metro areas of the state saw about a 12 point improvement over that period of time.

This follows the national trend where the uninsured rate for low income adults dropped sharply from 35 percent to 16 percent in rural areas and small towns in states that expanded Medicaid compared to a much smaller decline from 38 percent to 32 percent for states that have not expanded.

“Expanding Medicaid has had a very positive impact on small towns and rural communities,” Joan Alker, executive director of the Georgetown University Center for Children and Families and a Research Professor at the McCourt School of Public Policy. “Improved coverage rates typically translate to a more stable health care system and help rural areas and small towns maintain availability of health care providers in areas where shortages are all too common. Access to rural health providers is especially important to women of child-bearing age and those with chronic conditions such as asthma.”

The uninsured rate for Tennessee’s low-income adults is 29 percent for rural areas and small towns, and 25 percent in metro areas. Both areas of the state still have among the highest rates in the nation of uninsured, low-income adults. Medicaid expansion would reduce the uninsured rate for residents across the entire state; however, the most dramatic improvement likely would be felt in small towns and rural areas of Tennessee.

“We need to make sure that, no matter where they live, Tennesseans have access to the care they need to get and stay healthy,” said Michele Johnson, Executive Director of the Tennessee Justice Center. “This report shows that expanding Medicaid will make a difference, not just to families and individuals, but also by keeping rural hospitals open and providing critical access to care.”

The full report is available at