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Trump’s base in rural America could be disproportionately hurt by Medicaid cuts

A truck drives through downtown Welch in rural West Virginia, a state President Trump won in a landslide. More than half the children in West Virginia receive health coverage through Medicaid. (Spencer Platt/Getty Images)

The Affordable Care Act's Medicaid expansion disproportionately benefited rural Americans over their urban counterparts, according to a new report, and President Trump's proposed cuts to the program could negatively affect millions of them who have come to rely on it for coverage.

The ACA, better known as “Obamacare,” led to an 11 percent decrease in the number of uninsured rural Americans in states that chose to participate in Medicaid expansion, a linchpin of the law, according to the new report by the Georgetown University Center for Children and Families.

That improvement was higher than in urban areas, which saw the uninsured rates drop by 9 percentage points. In states that did not participate in the Medicaid expansion, the decrease in uninsured rates in rural areas and small towns was smaller, at 6 percent.

Trump's strong base of support in small town and rural America is often credited with his 2016 election victory. But those voters could stand to lose the most if the president's health-care overhaul is signed into law.

Many of the states where more than half of rural children and those living in small towns received health coverage through Medicaid broke for Trump during the election, including Arkansas, Mississippi, Florida, South Carolina, Arizona, North Carolina, Georgia, Louisiana, Alabama and West Virginia

In a place of need, an unhealthy contradiction

The report also notes that the share of rural children who rely on Medicaid for coverage is higher than in urban areas. In 2015, the report states, 45 percent of children living in small town America were enrolled in Medicaid. That compares to 38 percent of urban children. The report states that 16 percent of rural adults and 15 percent of urban adults received health coverage through Medicaid.

“The role of Medicaid in small towns and rural areas grew considerably between 2008-2009 and 2014-2015 and contributed to a reduction in the total number of uninsured,” write the report's authors.

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