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Changes in tax plan, ACA could have 'devastating effect' on rural poor mortality rate

December 1, 2017

Tonya Neaves


Higher taxes and more expensive health care could have “a devastating effect on the rural poor and those on Indian reservations,” said Tonya Neaves, director of the Centers on the Public Service at George Mason University’s Schar School of Policy and Government.

Neaves, who has studied non-metropolitan “mortality penalties” for the past decade, along with colleagues at Mississippi State University and the University of Memphis, said that lack of access to health care, and the consequences thereof, is one of the most pervasive health disparities for the rural poor.

That access has been put in jeopardy this year, first through the Republican Congress’ attempt to repeal the Affordable Care Act, and now through an amendment to the Senate tax bill that would, over time, lead to higher taxes on lower-income individuals and repeal the ACA’s individual mandate.

Rural mortality penalties are complicated by the size of the United States and the substantial differences in social, political and economic characteristics between rural and urban places, she said.

That said, rural mortality disparities have steadily increased since 1990, averaging nearly 50 excess deaths per a 100,000 population, Neaves said. From, 2001 to 2004, that difference increased to more than 70, or 35,000 excess deaths each year.

“Changes in affordability, compounded by proposed tax changes that could impact household disposable income, could exacerbate this growing geographically based penalty that begins about 1990 and has become a significant aspect of the nation’s health,” she said.

Tonya Neaves can be reached at or 703-993-9377.

For more information, contact Buzz McClain at 703-727-0230 or

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George Mason University is Virginia’s largest public research university. Located near Washington, D.C., Mason enrolls 36,000 students from 130 countries and all 50 states. Mason has grown rapidly over the past half-century and is recognized for its innovation and entrepreneurship, remarkable diversity and commitment to accessibility.