In Medicaid expansion, small Idaho hospitals see a potential lifeline
After years of stalled debate in the
Without expansion, "I don't know that we would be here five years down the road," said
The hospitals are where about 20,000 people can go for medical help. They're two of
"And that sounds dramatic, and ... I hate to even say that, but we have had three years in a row of a negative bottom line," Bonner said. "I'm a finance person, so that scares me to death. And now I'm in the CEO position going, 'It's my ultimate job to make sure that we keep these hospitals in our communities, and without the reimbursement that we need to be able to operate, that's going to be harder and harder to do.' "
At least 87 rural hospitals in the
But hospitals closing isn't a new phenomenon. Medicare even pays more for care at "critical access hospitals" in rural areas because it's harder to keep them afloat -- and they're sometimes the only hospital for hundreds of miles. Closures abated for a couple of decades before they came roaring back after the Great Recession.
For example,
Bonner said if her hospitals were to close, patients may have to drive two hours to get to the nearest hospital.
'Huge piece of the puzzle'
National researchers described cases where Medicaid expansion in other states aided small hospitals there.
"There is no question that hospitals are seeing less bad debt. Particularly rural hospitals have a lot to gain," said
The Clearwater/St. Mary's system is independent and employs about 250 people in each of its communities, Bonner said.
It provides
"Last year, we lost over
If even half of the unpaid care was covered by Medicaid, it would mean the hospitals and clinics could break even or make enough of a profit to replace old equipment or add a new bay to the tiny ER.
"But primarily, those people would have better health, too, because they would go in for their preventative services, and they would have regular visits with their primary care physicians, which saves cost down the road, and it also allows for them to be healthier," she said. "For example, a colonoscopy seems really expensive to somebody that makes
There are other stressors on rural hospitals like Bonner's, but lack of insurance in high-poverty rural
"Rural health care as a whole is getting tighter and tighter and harder and harder to stay alive," Bonner said. "But this is a huge piece of the puzzle."
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