Health Insurance Coverage

Because many Southern states have refused Medicaid expansion, 15% of working-age Southerners lack health insurance, compared to only 11% of working-age Americans in non-Southern states.

Lack of health insurance coverage by county, 2018-22 (5-yr average)

Percent of population age 19-64

Sources: Census Bureau’s American Community Survey 2018-22 and Kaiser Family Foundation.
Notes: North Carolina has high uninsured rates because Affordable Care Act (ACA) Medicaid expansion only just started Dec. 1, 2023. Wisconsin has relatively low uninsured rates (despite not adopting ACA Medicaid expansion) because Wisconsin has partially expanded Medicaid, under a Medicaid waiver, to include all adults under 100 percent federal poverty level.[1] If Wisconsin were to adopt the ACA Medicaid expansion, coverage would extend to nearly all adults with incomes up to 138% of the federal poverty level.

The impacts of climate change are inextricably connected to poorer health outcomes.^[2] Between 2016 and 2020, heat-related weather events caused an estimated 290,000 excess hospital visits per summer, costing roughly $1 billion annually.^[3] Americans without health insurance bear the brunt, as they often have limited access to healthcare and financial resources, leading them to forgo treatment for pre-existing conditions.^[4] In 2010, the Affordable Care Act began to dramatically reduce the number of uninsured people across the country through Medicaid expansion and new subsidies for health insurance “marketplaces.” 10 states (6 of them in the South) have still not adopted Medicaid expansion.

Medicaid has a history of providing equity-focused programs, and a shift towards climate-focused policies could help mitigate climate-related inequities. Oregon was the first state to use Medicaid coverage for the distribution of air filters, cooling units, and generators to protect from air pollution and extreme temperatures.^[5],[6],[7] Replicating best practices at the state and local level are crucial to supporting vulnerable communities.

1. Norris, L. (2023, November 2). Medicaid eligibility and enrollment in Wisconsin. Healthinsurance.org. https://www.healthinsurance.org/medicaid/wisconsin/

2. U.S. Environmental Protection Agency. (2022, March 20). Climate Change and Human Health. https://www.epa.gov/climateimpacts/climate-change-and-human-health

3. Woolf, S., Morina, J., French, E., Funk, A., Sabo, R., Fong, S., Hoffman, J., Chapman, D., & Krist, A. (2023, June 27). The Health Care Costs of Extreme Heat. Center for American Progress. https://www.americanprogress.org/article/the-health-care-costs-of-extreme-heat/

4. U.S. Environmental Protection Agency. (2022b, March 21). Climate Change and the Health of Socially Vulnerable People. Www.epa.gov. https://www.epa.gov/climateimpacts/climate-change-and-health-socially-vulnerable-people

5. Shattuck, P., Haley, C., & Cross, E. (2023, July 19). The Untapped Potential of Medicaid to Reduce Greenhouse Gas Emissions. The Commonwealth Fund. https://www.commonwealthfund.org/blog/2023/untapped-potential-medicaid-reduce-greenhouse-gas-emissions

6. Salas, R. N., Friend, T. H., Bernstein, A., & Jha, A. K. (2020). Adding A Climate Lens To Health Policy In The United States. Health Affairs, 39(12), 2063–2070. https://doi.org/10.1377/hlthaff.2020.01352

7. Shattuck, P., Cross, E., Cappalli, C., Ayyagari, R., Haley, C., Harrison, E., Mcglone, M., & Quince, V. (n.d.). Innovative Ways State Medicaid Programs Can Address the Health Equity Aspects of Climate Change. Retrieved January 27, 2024, from https://www.cms.gov/files/document/innovative-ways-state-medicaid-programs-can-address-health-equity-aspects-climate-change.pdf