Double vulnerability? Examining the effect of living in nonmetropolitan areas within non-expansion Medicaid states on health status among working-age adults in the United States, 2022–2024
Objective: To examine whether living in nonmetropolitan areas within a state that has not expanded Medicaid is associated with poor/fair self-reported health status among working-age adults in the United States.
Methods: We analyzed data from the 2022-2024 Current Population Survey (n=220,601, ages 25-64). Self-reported health was dichotomized as having reported poor/fair or good/very good/excellent health status. We produced a four-level measure of the overlap between residential and policy contexts indicating whether the respondent lived in a metropolitan or nonmetropolitan area within a state that had or had not expanded Medicaid coverage by 2023. Hierarchical linear models, were fit following a logisctic distribution to examine the association between our measure of residence-policy overlaps and poor/fair self-reported health status while accounting for individual and state-level characteristics.
Results: About 3.7% of respondents resided in nonmetropolitan areas within non-expansion states. Approximately 11.4% of respondents reported poor/fair self-reported health, with respondents living in nonmetropolitan areas within non-expansion states having the highest rates of poor/fair self-reported health status (18.1%). Living in a nonmetropolitan area within non-expansion states was associated with higher probability of reporting poor/fair self-reported health status for the overall population and by sex.
Conclusion: In this nationally representative and racially diverse sample, we found that individuals residing in nonmetropolitan areas in non-expansion Medicaid states were more likely to report poor/fair self-reported health status. This effect was present for the majority of the population subgroups. Our findings underscore the double vulnerability faced by populations living in these residence-policy overlaps and the need for targeted interventions.
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| Work Title | Double vulnerability? Examining the effect of living in nonmetropolitan areas within non-expansion Medicaid states on health status among working-age adults in the United States, 2022–2024 |
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| License | CC BY 4.0 (Attribution) |
| Work Type | Article |
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| Publication Date | April 10, 2025 |
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| Deposited | May 17, 2025 |
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