Rural Hospitals in Greater Jeopardy in Non-Medicaid Expansion States
In crime novelist
So you can forgive
The closings were the latest in a trend that has seen 21 rural hospitals across
Lyle, who is CEO, can't help wondering whether his
"Most assuredly," he replied when asked whether he could envision his central
It's not just
Neither state has expanded Medicaid eligibility to more of its low-income residents under the Affordable Care Act, also known as Obamacare. In fact, the closures and at-risk hospitals are heavily clustered in the 14 states that have not expanded.
Those state decisions not to expand have deprived rural hospitals, which already operate with the slimmest of margins, of resources that could be the difference between survival and closure.
That is why Lyle and administrators of other rural hospitals in
"It would mean a fair number of people we see who have no insurance would have insurance," Lyle said. "And for us, a dollar is better than no dollar."
In
Without that money, many rural hospitals in
By shedding those services, the hospitals diminish their reason for existing, said
The office of Republican
But not everyone believes Medicaid expansion is the answer to the problems facing rural hospitals. "Medicaid is as likely to prop up inefficient and wasteful hospitals as anything else," said
Another rural hospital in
"I'm not saying we would have closed the day after the election," said
The additional taxes will bring the hospital an estimated
"Medicaid expansion," Willmann said. "That is one of the key things we could do to help us deal with the tough financial demands we face."
Burden of Uncompensated Care
As envisioned by the ACA when it passed
Initially, the federal government paid 100 percent of the health care costs of the expansion population. The federal share falls to 90 percent in 2020.
To date, 36 states plus
Instead, many of those low-income residents remain uninsured or underinsured in plans with high deductibles and copayments.
But that doesn't mean people don't receive health care. Without health insurance, low-income people are less likely to get preventive care, which often results in worsening health conditions that frequently bring them to hospitals where they are guaranteed treatment. Under federal law, hospitals must stabilize and treat anyone showing up at the emergency room, regardless of their ability to pay.
Rural hospitals, like their urban counterparts, are forced to absorb those costs. But unlike bigger hospitals, their patient volumes and operating margins are so low that "uncompensated care" burdens can be crippling.
For instance, Willmann said his hospital's uncompensated tab last year was about
According to the
A 2018 study in the journal Health Affairs found that the rate of closures of rural hospitals increased significantly in non-expansion states after 2014, when states began implementing the expansion. At the same time, closure rates decreased in expansion states.
'99 Other Wounds'
Many administrators of rural hospitals are quick to say that Medicaid expansion alone will not solve their financial problems. Rural hospitals faced steep challenges long before the ACA.
Rural Americans tend to be older, in poorer health and less insured than those living elsewhere, the latter resulting in a greater share of uncompensated care for rural hospitals. Because of declining populations in rural areas, hospitals there often have empty beds, which means less revenue.
"It's been a long, slow bleed," said
Automatic federal budget cuts beginning in 2013 (known as sequestration) reduced Medicare reimbursements, which are a particularly important source of revenue for hospitals.
"You can put a Band-Aid on, but you still have 99 other wounds," Willmann said.
Elehwany, of the
The loss of rural hospitals not only means patients having to travel longer distances to the next medical providers, but the closures also can often have a crippling effect on the local economy.
A
Willmann was relieved voters in his district supported the measure to create a hospital taxing district, but he acknowledged that it wasn't a good deal for his county's taxpayers. Their federal taxes help pay for the expansion in other states but not in
"Basically, you're asking them to pay twice," he said.
Rural hospital officials appear not to have the slightest hope that the deep red
"There is no likelihood of Medicaid expansion in
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