Medicaid Expansion Drastically Cut Arkansas Rural Uninsured Rate

New report shows one of the nation’s sharpest declines in rural uninsured rates


LITTLE ROCK — Arkansas’s decision to expand Medicaid has paid off for residents of small towns and rural areas, according to a new report by Georgetown University’s Center for Children and Families and University of North Carolina’s NC Rural Health Project.

The uninsured rate for low-income adults living in small towns and rural areas of Arkansas dropped from 45 percent in 2008/2009* to 22 percent in 2015/2016*, the report shows. That 23-percentage-point drop – cutting the uninsured rate by half – is one of the sharpest declines in the country, behind only Colorado, Nevada, Kentucky, Oregon and New Mexico.

Arkansas’s result follows a national trend showing that, in states that expanded Medicaid, low-income adults living in small towns and rural areas saw their uninsured rates improve from an average of 35 percent to 16 percent. Meanwhile, those in non-expansion states saw only modest improvements to their uninsured rates – from 38 percent to 32 percent uninsured.

“Expanding Medicaid has had a very positive impact on small towns and rural communities,” said 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.”

Rural areas tend to have higher rates of uninsured people. As the report shows, in many Medicaid expansion states, the gaps between non-metro and metro areas in the uninsured rate for low-income adults have largely been eliminated.

It’s not just people in small towns and rural areas who benefited, however. The uninsured rate for low-income adults living in urban areas dropped from 47 percent to 21 percent during the same time period.

“Arkansas elected officials showed real leadership in becoming one of the few Southern states to expand Medicaid. Their constituents are better off for their decision to look beyond the politics of the day and choose the path best for Arkansas,” said Rich Huddleston, executive editor of Arkansas Advocates for Children and Families. “We urge today’s policymakers to look to these phenomenal results and to take steps to ensure that Arkansans keep their coverage.”

The report looks at a time period before the state implemented new requirements that those enrolled in Medicaid record their work hours in an online reporting system. This month, more than 4,000 people lost their health insurance when they didn’t fulfill the reporting requirement.

The report shows that, in many states that have not yet expanded Medicaid, residents of their small towns and rural areas will disproportionately benefit if the state decides to expand. States with the highest rate of uninsured adults in rural areas are South Dakota, Georgia, Oklahoma, Florida, Texas, Alabama, Missouri, and Mississippi. Rural areas in these states would benefit the most from a decision to expand Medicaid. Some of the states with the biggest coverage gaps between rural and urban areas are Virginia, Utah, Florida, and Missouri.

“Overall, the experience of Medicaid expansion states demonstrates the great opportunity for states that have not yet expanded Medicaid,” said Jack Hoadley, lead author of the report. “Not only do they have the chance to reduce the number of uninsured adults overall, but they have a significant opportunity to bring down the uninsured rate in small towns and rural areas and narrow the gap in many states between metro and rural areas.”

Many states that have not yet expanded Medicaid have sizeable rural populations including Idaho, Mississippi, Nebraska, Oklahoma, South Dakota and Wyoming.

The full report is available here.

*The report uses an average of two years of data to increase the accuracy of the estimates.


Arkansas Advocates for Children and Families is a statewide, non-profit child advocacy organization established in 1977. Our mission is to ensure that all children and their families have the resources and opportunities to lead healthy and productive lives and to realize their full potential.