On Thursday, the U.S. Senate unveiled its plan to replace Obamacare.
A key component of the bill deals with Medicaid, the federal program to provide health insurance to the poor and disabled.
There are some key differences in this plan and one passed earlier by the House. But one thing remains the same, Medicaid would be significantly changed. And that could mean trouble for Republicans because, a recent study shows, it could disproportionately hurt rural Americans.
The study was the work of the Center for Children and Families at Georgetown University and the NC Rural Health Research Program at UNC-Chapel Hill.
Here's how Jack Hoadley, a research professor at Georgetown, explains their findings: "So nationally we found that Medicaid really plays an increasingly critical role for children especially but adults as well in providing them a source of health care coverage."
This is true across the board. But even more so away from cities. Take children. "Nationally, we found that 45 percent of children have Medicaid coverage in small towns and rural areas compared to 38 percent in metro areas."
Their methodology was simple but time consuming. The group started by going through U.S. Census data for every county in the country. "And that allowed us to do county level estimates of the level of Medicaid coverage and the level of uninsurance and do it in two points in time, 2008 and 2009 on the one end and 2014 and 2015 on the other end."
Those two time windows weren't picked at random says Hoadley. "We wanted to be able to go in and look at what effect the Affordable Care Act has had and be able to look at both a before and an after point in time."
The fact that Medicaid helps a higher percentage of rural Americans did not surprise the team. After all, the types of jobs which come with health insurance benefits can be most easily found in cities. But the change in the number of uninsured, especially in states that expanded Medicaid coverage was a surprise. "We saw the cutting in half for the uninsured rate for adults in small towns and rural areas in expansion states, Medicaid expansion states, versus only a 6 percent drop in non-expansion states."
North Carolina did not take part in Medicaid expansion. And that showed up in the data says Hoadley. "The rate of uninsured adults in North Carolina was, at the first point in time, 28 percent. And then dropped to 20 percent. You know, nationally those levels for adults were 22 percent and 11 percent."
Their report was released before the Senate bill was unveiled. But after the U.S. House passed their own measure.
And the Senate plan largely follows the structure of its predecessor. There are large cuts in Medicaid funding and it would eliminate Medicaid expansion by 2024. And it would completely change the way Medicaid pays for health care. Currently it covers the cost of patients. But under the Senate plan, in 2020 states would be left with two choices: accept a capped amount of money or a set amount of funding per patient. Either way this could lead to fewer people being covered and more costs paid directly by the individual states.
But researcher Jack Hoadley notes it could also deliver a blow to rural economies because current Medicaid patients may need to pay more for their health care or hospitals and doctors may have to absorb the cost of treating those who cannot pay at all. "And so that's where this has not only an effect on people who are today on Medicaid and who may lose that coverage but also on the communities that they live in, whose health care institutions, hospitals, clinics and doctors are threatened."
We won't know the official estimated number of Americans affected by this new plan until the Congressional Budget Office releases its score of the bill next week.