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Southern States Suffer from High Uninsured Rates, Limited Access to Healthcare, Systemic Racism, and Medical Debt–But There is Hope in Medicaid Expansion

The Problem with Southern Healthcare 

Generations of Southern poverty are reflected in health outcomes across the region. The South has the highest uninsured rate in the nation, highest accumulations of medical debt, and some of the highest rates of chronic disease in the nation. 


Systemic racism has made a bad situation even worse for Black and Brown communities, creating sharp disparities in maternal mortality rates, diabetes outcomes, and COVID-19 morbidity and mortality.


To make a tough situation worse, an increasing number of the rural hospitals that serve large swaths of the South are closing down, unable to meet operating costs as uninsured and underinsured patients are unable to pay for care. 


Urgency Created by COVID-19

COVID-19 has exposed and exacerbated existing health disparities and made Southern healthcare reform more imperative than ever. Countless families have lost loved ones and face the continued economic consequences of lingering illness; hundreds of thousands more have accumulated massive amounts of medical debt from extended hospital stays without insurance. Now, many Southerners are skipping doctor visits to avoid accruing additional medical bills, which will only further hurt healthcare outcomes as neglected medical problems exacerbate themselves in the future. 


Nearly two years of emergency aid has strained state budgets to respond, but they still have a range of tools, resources, and best practices to draw upon to strengthen their health infrastructure, including both Medicaid and the public health system. 

Making Positive Changes through Medicaid Expansion

Southern states are well poised to make major advances in health. The Biden Administration has indicated it will focus on shoring up and improving the Affordable Care Act, possibly through greater partnerships and incentives for states to strengthen health coverage for vulnerable populations, especially through Medicaid expansion. 


The federal government would cover up to 90% of Medicaid expansion, meaning the 12 states that have yet to expand Medicaid coverage are leaving a sizable amount of federal money on the table that could be leveraged to increase health coverage, create jobs, and stimulate the economy.


Southern States are eligible for large amounts of federal aid due to high poverty and uninsured rates; the federal government is eager to help. Accepting Medicaid expansion incentives in the American Rescue Plan will jumpstart healthcare access, and through that, health equity. 


As long as Southern states lack access to Medicaid expansion, they are being economically behind the states that have taken advantage of this program to uplift their communities. 

Making Positive Changes through Medicaid Expansion

To learn more about how Southern states can improve the healthcare policy landscape, read the full report “Health Policy Opportunities in the Southern States” by Southern Economic Advancement Project (SEAP).

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