Life expectancy in much of Appalachia, where poverty has kept a tight hold for generations, is lower than in Bangladesh or Vietnam, said Carolyn Miles, president and chief executive officer of Save the Children. “That’s a really shocking statistic,” she added.

…In 2016, 14.1 million children grew up in poverty nationwide. But that proportion is higher in rural areas, where 24 percent of kids live in poverty, compared to 19 percent of those in urban areas, according to a new report on rural poverty from Save the Children. That gap widened after the Great Recession, according to Census Bureau data, and remains most persistent for single-parent homes, children with disabilities and African-American children. In the latest report, Tennessee ranks 40th nationwide for states where childhood is most under threat. Nearly 1.5 million Tennessee children were enrolled in Medicaid in 2017. In Perry County, there were 2,078 children enrolled. Britton’s two sons were among them.

…After the Great Recession hit, Perry County, Tennessee, reported an unemployment rate of 29.8 percent, among the nation’s highest. People left if they were able or found jobs in Nashville or as far as Memphis — more than 140 miles away. Today, the jobless rate is much lower, at 4.2 percent, but 22 percent of the county’s nearly 8,000 residents live in poverty, according to the Census. Britton said the community needs more jobs that pay better so families like hers can thrive.

..Having health care coverage is one victory, but actually getting care is another story. The county has no pediatrician, so Britton either takes her sons to a nurse practitioner at a local walk-in clinic or drives 60 miles — twice the distance the federal government defines as reasonable access to care — to see a doctor. She forgoes her own health care “unless I feel like I’m dying.”

Tennessee legislators voted to set up work requirements for Medicaid recipients, joining a number of states, including Kentucky, Indiana and Arkansas, that have passed similar laws in recent months. …It is the latest in a series of moves nationwide to tighten access to Medicaid.

…In January, the Tennessee Justice Center estimated that more than 480,000 Tennesseans could lose Medicaid coverage under the state’s then-proposed work requirement. Bureaucratic red tape — not ineligibility — could pose an obstacle to access. And nationwide, 60 percent of 24.6 million current adult Medicaid recipients work at least part-time, according to the Kaiser Family Foundation.

…Health care advocates say work requirements will deny health care to people already vulnerable to the slightest shift in their economic equation, meaning they are more likely to neglect chronic conditions, end up in emergency rooms more often and ultimately cost the system more money.

…At his Tuesday ‘campaign’ rally in Nashville, President Donald Trump told the crowd that “wages are going up, and they’re going up fast. The forgotten men and women of our country are no longer forgotten.”

Britton isn’t as optimistic.

In rural America, tightened access to Medicaid means tough choices | PBS NewsHour

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