"Policymakers, operating on tight budgets, must decide whether they are willing to spend more money on small hospitals serving a limited number of patients, hospitals that in most cases could not keep their doors open without government assistance," Walters writes. "But without them, people, inevitably, will die," such as Dannie Tiffin, who had to travel to 60 miles to the closest hospital—the hospital 30 miles away had recently closed—after he suffered a heart attack in 2014. Doctors say Tiffin, who died before arriving to the hospital, would most likely have lived if he had gotten to the hospital in time.
"Texas' rural hospitals have long struggled to stay afloat, but new threats to their survival have mounted in recent years," Walters writes. "Undelivered promises of federal health reform, payment cuts by both government programs and private insurers, falling patient volumes and a declining rural population overall have been tough on business—a phenomenon one health care executive called 'death by a thousand paper cuts.' Add to that Texas’ distinction as the state with the highest percentage of people without health insurance and you get a financially hostile landscape for rural hospital operators."
Texas, which is controlled by Republicans, chose not to expand Medicaid under federal health reform, and rural hospitals say they are paying the price for cost savings they didn't receive, Walters writes. "Federal health reform mandated penalties for hospitals that have too many patients re-admitted for follow-up care. Another program cracks the whip on hospitals where too many patients get sick during their stay. Federal sequestration, meanwhile, has meant a 2 percent across-the-board cut to Medicare payments."
"Rural hospitals took a further hit from the federal health law’s reductions in 'disproportionate share hospital' payments to hospitals with large numbers of indigent and uninsured patients," Walters writes. "And then there was the Texas Legislature’s 10 percent cut for Medicaid outpatient care in 2011." (Read more)