Poverty rates are generally higher in rural areas than in urban centers. Also, residents of rural Indiana are more likely than their urban neighbors to be self-employed or working for a small business without employer-sponsored health insurance. They are, therefore, more likely to be uninsured or underinsured.

As written, the Affordable Care Act would expand Medicaid eligibility to all adults below 138 percent of the federal poverty level. The U.S. Supreme Court, however, ruled that states could not be compelled to participate.

That decision means that more than 100,000 Hoosiers who fall below 138 percent of the federal poverty level, such as a family of three earning less than $26,344 annually, will still struggle to find affordable health insurance if the state declines to participate in the Medicaid expansion.

Medicaid provides a crucial healthcare safety net for those rural residents most in need. And the expansion of Medicaid would bring in several billion dollars from the federal government by 2020, potentially financing the creation of over ten thousand ongoing Indiana jobs. Moreover, expanding Medicaid will help alleviate some of the costs of uncompensated care for the uninsured, reducing premiums for those with private insurance.

More than 10,000 healthcare jobs, lower insurance premiums for the currently insured and access to affordable healthcare coverage for over 100,000 hard-working Hoosiers, many of whom lack coverage today, all speak in favor of expanding Medicaid in the state, for rural Indiana in particular.

The Center for Rural Affairs, www.cfra.org, was established in 1973 as an unaffiliated nonprofit corporation under IRS code 501(c)3. The Center for Rural Affairs was formed by rural Nebraskans concerned about family farms and rural communities, and we work to strengthen small businesses, family farms and ranches and rural communities.