Year of Publication



Public Health

Date Available


Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Dr. Richard Ingram

Committee Member

Dr. Rachel Hogg-Graham

Committee Member

Dr. Lars Peterson


The Affordable Care Act (ACA) was a groundbreaking moment in the United States healthcare system. It affected many different aspects of the system, including access to primary care professionals. Primary care professionals provide a key role in American’s health, especially when it comes to preventative care. With one-third of Americans experiencing barriers to such access, a solution is desperately needed to increase said access. These barriers are especially profound in low-income, underserved areas such as the Appalachian regions of Georgia, Kentucky, Tennessee, and West Virginia. The ACA attempted to increase access via Medicaid expansion; however, not all States expanded their Medicaid services. Through the analyzing of data from the Area Health Resource File (AHRF), fluctuating trends emerged across variables that are related to primary care professionals in the States that expanded Medicaid and the States that did not expand Medicaid. A secondary purpose of this project was to examine trends in women’s healthcare. OBGYN services are declining in areas of Appalachia. Analysis of the AHRF data supported this finding. Gaps continue in rural Appalachia and women’s healthcare. Increased research and policy initiatives are needed to fully understand the solutions needed for said gaps.

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