Obamacare repeal would hit rural America the hardest

The health of rural America is failing, and a repeal of the Affordable Care Act (ACA) without adequate replacement could prove disastrous. A December 2016 report from the Centers for Disease Control and Prevention showed that for the first time in 20 years, life expectancy in the United States has declined, particularly in small cities and rural areas, where people are dying at much higher rates. This shocking trend is driven in part by increasing mortality rates for white, working-class Americans, many of whom live in rural America. There is no better indicator of well-being than life expectancy, and reversals like this are unusual for wealthy nations where successive generations increase in longevity. This has remained true for vulnerable, minority populations in America, as blacks and Hispanics continue to make gains in life expectancy even while experiencing significant health disparities.This drop in life expectancy in rural areas is linked to higher rates of chronic illness, obesity, drug overdose, alcoholism, mental illness and suicide. Death rates are most notable for rural white women, who are now much more likely than their grandmothers to suffer from obesity, smoking and alcoholism. Rising rates of opioid addiction have resulted in an increase in drug dependency in newborns born to rural mothers. Further, dwindling industry in these communities limits access to both employment and to health care.Taken as a whole, Medicaid expansion through the ACA has resulted in critical gains toward improving rural population health by expanding insurance coverage and stabilizing rural hospitals.