States that refused
Obamacare's Medicaid expansion are hemorrhaging hospitals in rural areas.
BY LUKE
DARBY
Roughly 20 percent of Americans live in rural areas, including
more than 13 million children, according to the last U.S. census. And,
according to research and reporting by the Pittsburg Morning Sun and
its parent company, GateHouse Media, those people have been steadily losing
access to hospitals for years.
In
Oklahoma, Georgia, South Carolina, and Mississippi, at least 52 percent of all
rural hospitals spent more money than they made between 2011 to 2017. In
Kansas, it's 64 percent, and five hospitals there shut down completely in that
time. Since 2010, 106 rural hospitals have closed across the country. (Another
700 are "on shaky ground," and about 200 are "on the verge of
collapse," according to Gatehouse.) Of those 106 that closed, 77 were in
deep red states where local politicians refused the Obama administration's
Medicaid expansion that came about as a result of the Affordable Care Act.
In
short, the federal government provided funds to expand coverage for Medicaid, a
program that helps pay for health care for low income patients. But the
expansion was optional, and 14 Republican-controlled states rejected to take
the money. The only state that bucked this trend was Utah, where rural
hospitals were among the most profitable in the country thanks to a policy
of shifting funds and
resources from urban hospitals. Only 14 percent of rural hospitals operated at
a loss and none shut down over the same time period.
The
number of rural hospitals has been shriveling for some time now: more than 200
rural hospitals closed between 1990 and 2000, according to a report from
the Office of Health and Human Services.
Since rural areas have been losing hospitals for decades already,
every additional closure is more devastating. And even the hospitals that
remain open are struggling to stay fully staffed. According to the Health
Resources and Services Administration, rural parts of the U.S. need an additional 4,022 doctors to
completely close their coverage gaps.
Just
refusing the Medicaid expansion alone doesn't completely account for the
hundreds of rural hospital closures across Republican-controlled states. For
one thing, medical treatment and technology has gotten more advanced. Dr. Nancy
Dickey, president of the Rural and Community Health Institute at Texas A&M,
told Gatehouse, "Most of what we knew how to do in the 1970s and 1980s
could be done reasonably well in small towns. But scientific developments and
advances in neurosurgery, microscopic surgery and the like required a great
deal more technology and a bigger population to support the array of technology
specialists." As a result, the number of services that rural hospitals
offered started to shrink, while at the same time rural populations dwindled as
both jobs and young people moved away. What's left were older, poorer
populations that needed more medical care and had less money to pay for it. In
that situation, hospitals can't generate enough revenue to stay open, let alone
enough to pay the salaries of even new doctors, who carry an average of $200,000 in student debt.
Still,
if the state legislatures and governors had accepted the money, billions of
dollars could have gone to improving insurance coverage and propping up the
hospitals' bottom lines. In a health-care industry where the average CEO pay
is $18 million a year, hospitals have to produce
a lot of money to justify their existence to shareholders. The Medicaid
expansion was one of the few lifelines available to rural Americans, and their
politicians snubbed it.
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