TALLAHASSEE, Fla. – Florida isn't one of the 33 states that expanded its Medicaid program under the Affordable Care Act, but if it had, more rural, low-income residents would have health insurance.

A new report from Georgetown University shows big coverage gaps in states without expanded Medicaid.

Anne Swerlick, a policy attorney and analyst with the Florida Policy Institute, says small towns in particular are missing out on the health and economic progress that access to care has brought in other states.

Instead, she says Florida is among a handful of states with high rates of uninsured low-income adults, in areas of greatest need.

"In rural areas, it's as high as 37 percent, versus 24 percent in the metro areas,” she points out. “In some Florida counties, like Columbia and Jackson counties, the rates are even higher, in the 40 to 42 percent range."

The report shows the uninsured rate for low-income adults has dropped in the last decade in nearly all states, but the sharpest declines have been in small towns and rural areas where Medicaid programs were expanded.

After wavering, Gov. Rick Scott and the Republican-controlled Legislature rejected expansion over cost concerns.

Study co-author Joan Alker, executive director of the Georgetown University Center for Children and Families, says there is actually savings through improved coverage rates and a more stable health care system.

"Really, it's a wiser use of taxpayer dollars to provide them with the primary preventive care that comes with having health insurance up front, so they don't get sicker and wind up in the emergency room," she points out.

Swerlick says across the state, many who are going without insurance are parents of young children.

"Florida has an extremely restrictive income limit for Medicaid eligibility for these parents,” he points out. “It's just 34 percent of the poverty level, which translates to $7,000 per year for a family of three."

Non-metro counties in Florida with the largest share of uninsured adults in 2015 and 2016 were Columbia, Jackson, Putnam, Okeechobee and Suwannee counties.


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Mother's Day is fast approaching and an Arizona mom wants women of all ages to make sure they are prioritizing their heart health.

Nearly 45% of women age 20 and older are living with some form of heart disease and do not know it.

Sharla Fisher was in her late 30s when she received her first pacemaker. She said she always lived an active and healthy lifestyle but would experience occasional blackouts. It was not until she sought medical attention experts determined she had an abnormally low heart rate and blood pressure and was later diagnosed with neurocardiogenic syncope, also known as vasovagal syncope.

"It is not a fatal condition by any means," Fisher explained. "But what becomes fatal is this happened to me while I was driving with my children on the freeway. This has happened to me when I'm flying cross-country, in a cab in the middle of a city I don't know at one o'clock in the morning."

Fisher added in talking with her doctor, they determined a pacemaker would help regulate her cardiovascular system. Fisher shares her story to inspire other women to take heart health seriously. This year's American Heart Association Go Red for Women Luncheon will celebrate women like Fisher and share vital information to keep women healthy. The event will be on May 8 at the Westin Kierland Resort and Spa in Scottsdale.

Fisher pointed out after receiving her pacemaker, things still did not feel right. She wound up in the emergency room while traveling and was diagnosed with cardiac tamponade, which is when there is excess fluid in the sac surrounding the heart. Doctors informed her she would need open-heart surgery, prompting Fisher to call her children and say goodbye.

"Because I didn't know how we would make it out of this procedure, and, like I said, my organs had already started shutting down," Fisher recounted. "Obviously I am here, so there is a good story that comes out of all of this, but it was then that it really opened my eyes to women and heart disease."

Megan Stuff is this year's Phoenix Go Red for Women chair and said she has been having discussions about heart health with her young daughters who are 8 and 12 years old.

"We have to start these discussions so that we really can break some of those statistics," Stuff stressed. "That is my goal for the luncheon is to just bring awareness and advocacy for cardiovascular disease in women and just start the conversation as early as possible."

Many residents of West Virginia are at risk of losing health care under a federal proposal to cut Medicaid funding by $880 billion.

Sen. Jim Justice, R-W.Va., and Sen. Shelley Moore Capito, R-W.Va., voted for the cuts.

Ellen Allen, executive director of West Virginians for Affordable Healthcare, said more than 500,000 Mountain State residents rely on Medicaid for health coverage.

"We've seen no interest in our legislators trying to make up the difference so they can keep health care intact for over a half a million West Virginians," Allen pointed out.

Allen added other states are also preparing for potential cuts and looking for solutions to fill in the gaps. More than 200,000 West Virginians lost Medicaid coverage after the end of pandemic era continuous coverage rules.

Allen explained 72,000 residents in skilled nursing facilities need Medicaid to pay for housing and care. She believes some facilities will shut down when faced with budget cuts.

"These are people who couldn't afford long-term care and policies," Allen explained. "Their families don't have the resources to support them. So what are you going to do with 72,000 people in skilled nursing facilities when Medicaid is not there to support it?"

State-supported home care for people with disabilities could also be at risk. According to the National Rural Health Association, slightly under half of the nation's rural hospitals are operating at a loss. Cuts to Medicaid would likely mean more rural hospital closures statewide.

The Alaska branch of the American Heart Association is helping save lives by teaching the use of cardiopulmonary resuscitation and automated external defibrillators in rural communities.

In a medical emergency, such as a heart attack, time and distance can be a formidable obstacle in rural Alaska for getting a patient to a hospital. The association said only about 10% of people who suffer a cardiac arrest outside a hospital will survive but access to CPR or a defibrillator can triple those odds.

Kristin George, executive director of the American Heart Association of Alaska, said it is all about keeping the blood flowing.

"The benefit of having CPR and AED education is restarting the heart," George explained. "If we can keep the blood flowing to the heart, then we're not losing any of the parts we need. The reason we do the education is to continue to keep that heart beating."

George noted by 2030, the association plans to visit more than 220 rural Alaskan villages. Each visit will include a hands-only CPR and AED skills session led by a LifeMed Alaska expert. Each town will get a CPR Anytime Training Kit, so residents can practice their skills and teach others.

George pointed out the goal is to increase the number of residents in Alaska's rural communities trained to provide chest compressions or apply an external defibrillator to restart a heart. She emphasized many remote villages in Alaska are detached from the state's road system, meaning it can take a long time for medical help to arrive.

"Any village that's out on the coast or anything like that is going to be pretty much unable to get there without a plane," George observed. "Or if you wanted to take the longest trek of your life and do it sled dog or by snow machine."

George added the Association has set a goal of doubling the survival rate from cardiac arrests in Alaska by 2030. The Foss Family Foundation and LifeMed Alaska are sponsoring the rural Alaska effort.