Not enough
Medicaid expansion, medical debt, and cost avoidance in rural American Indian and Alaska Native households
Bibliographic Data
| ID | 19431634 |
|---|---|
| Authors | Sean Hubbard (0000-0002-1546-193X, The Center for Health Policy and College of Public Health at The University of North Texas Health Science Center in Fort Worth Fort Worth Texas USA, corresponding author) |
| Year | 2025 |
| Volume | 41 |
| Issue | 1 |
| Pages | e12925-e12925 |
| Publication date | 2025-01-01 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | The Journal of Rural Health (JOURNAL) |
| Journal identifiers | ISSN: 0890-765X • E-ISSN: 1748-0361 |
| Publisher | Wiley (PUBLISHER • GB) |
| DOI | 10.1111/jrh.12925 |
| PMID | 39865768 |
| OpenAlex | W4406848892 |
| Language | EN |
| Citations received | 2 |
| References cited | 37 |
PURPOSE: Despite expanding health insurance coverage under the Patient Protection and Affordable Care Act (ACA), many Americans struggle with financial barriers to health care. Medicaid expansion was meant to help alleviate these barriers, particularly for rural communities, but has shown mixed results. The American Indian and Alaska Native (AI/AN) community, which faces both racial and geographic disparities, is a group that should benefit from Medicaid expansion. This paper examines differences in medical debt and cost avoidance for rural American Indian and Alaskan Native households in Medicaid expansion and nonexpansion states. METHODS: This study uses data from the National Financial Capability Study in binomial logistic regression models to examine whether AI/AN households in rural areas are more likely to have medical and engage in cost avoidance than their urban counterparts. FINDINGS: The results show no differences between Medicaid expansion status but do find a higher likelihood of medical debt for those living in rural areas. The results also show a higher likelihood of medical debt and cost avoidance for those living farther from Indian Health Services (IHS)/Tribal health care facilities. DISCUSSION/CONCLUSIONS: The results indicate that rural AI/AN individuals continue to face financial barriers to health care despite the expansion of Medicaid under the ACA. This suggests that rural AI/AN individuals are seeking care outside of the IHS/Tribal system due to limited access to IHS providers. Addressing these barriers may require policies and programs focusing on rural AI/AN communities
Business · Debt · Demographic economics · Economic growth · Economics · Environmental health · Health care · Health equity · Logistic regression · Medicaid · Poverty · Rural area · Socioeconomics · Food Security and Health in Diverse Populations · Healthcare Policy and Management · Healthcare Systems and Reforms · Medicine · Finance
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Triadd
| Unique citing works | 2 |
|---|---|
| Citations per year | 2 |
| Citation span | 2025 - 2025 (1) |
| Citation velocity | recent |
| Highly cited | No |
| Citation types | Neutral: 2 |