Americans are among the hardest-working people of the industrialized nations. But you can’t work if you’re sick. Common health issues can keep someone from working and impoverish them and their families.
Appalachians work hard and care for each other. Still, the tough jobs of the region leave many struggling with injury and illness: Coal miners, factory workers, construction workers, farmers, loggers, sawmill operators, truckers, warehouse workers, health care workers, and many others. Conditions like diabetic neuropathy of the feet, cardiac and lung problems, rheumatism, a bad back or hip, cancer, and many other common health issues can knock a person out of a job and the health care they need to keep working.
Medicaid supports people in tough times. The American economy is turbulent: Employers open and close. Recessions come and go. Most of us know and fear tough times because we can fall into them in so many ways. Perhaps we are hurt, sick, or otherwise disabled. Our jobs may not pay enough to buy employer or private health insurance. The jobs may be gone, and/or we lack a reliable car to take us to a job farther away. Perhaps we lost childcare. We may be taking care of ill family members.
Medicaid is particularly important in Central Appalachia because of the high disability rates. Back-breaking jobs are just one of the causes. Residents of very rural areas may not have a clinic or hospital close enough to get the care they need. Many people suffer from the toxic impacts of coal mining. Poverty, due to the loss of living wage jobs, often causes chronic diseases. The average age is higher than the nation’s because so many young people left. People with a disability or who are aging but not yet eligible for Medicare often lack health insurance. For them, federal programs like Medicaid are a lifesaver. For example, Medicaid is the primary payer for 63% of long-term nursing home residents.
In most congressional districts across Central Appalachia, more than 40% of adults have health coverage through the federal Medicaid program. Hover over a congressional district on the map below, and you will see the name of its congressional representative and the share of adults who depend on Medicaid in that district.
Figure 1: Over 40% of Adults in Many Central Appalachian Congressional Districts Rely on Medicaid for Health Care
Source: ReImagine Appalachia, Taken from data provided in Center on Budget and Policy Priorities, “36 Million People at Risk of Having Health Coverage Taken Away by Medicaid Work Requirements,” Updated February 5, 2025, at https://www.cbpp.org/sites/default/files/1-16-25health.pdf
Until recently, Medicaid mainly served children and single parents. It has only been 15 years since the federal health care system started offering health insurance to adults through the Affordable Care Act of 2009. Individual states had to pass legislation to accept federal money for expanding Medicaid to cover adults. Currently, 36 states, including Ohio, Pennsylvania, West Virginia, and Kentucky, have done so.
Today, Medicaid is an essential work support. Many who work jobs with modest pay or irregular hours—like in food and hospitality, construction, landscaping, timber, warehousing, and delivery—may not be offered health care insurance through their employer or can’t afford the plan provided. Medicaid is a lifeline for them. The graph below shows that about two-thirds of people enrolled in health insurance through Medicaid are working full or part-time.
Figure 2: Most Adults With Medicaid are Workers or Caregivers
Source: Reproduced from the Center on Budget and Policy Priorities, “36 Million People at Risk of Having Health Coverage Taken Away by Medicaid Work Requirements,” Updated February 5, 2025, at https://www.cbpp.org/sites/default/files/1-16-25health.pdf
The federal budget plan currently being considered by Congress could significantly change the Medicaid program by cutting hundreds of billions of dollars. This would drain the budgets of hospitals and health care centers, shrink services, eliminate health care jobs and reduce health care access in already underserved rural areas.
Health care is a big part of our lives and the regional economy. This spring, we should pay attention to the federal budget discussions. Deep cuts in funding for essential services will affect the health and wealth of workers, families, and communities throughout Central Appalachia.
Your congressional representatives always welcome your input.