Thursday, March 15, 2018

Medicaid, integral to rural health care, faces uncertain future

Medicaid, the federal-state health insurance program for low-income Americans, is "part of the financial bedrock for rural hospitals" across America, Shefali Luthra reports for Kaiser Health News as part of "Medicaid Nation", a KHN series examining the program's reach and role.

Medicaid began as a medical program for the poorest Americans, but millions now rely on it. The program covers nearly 24 percent of rural Americans who aren't senior citizens, and pays for almost 45 percent of all U.S. births — 51 percent of rural births.

Some don't even know Medicaid is helping them: Medicaid reduces the amount of uncompensated care hospitals must provide, insulating them from worse financial problems and enabling some to stay open and keep services such as obstetrics. About half of rural counties don't have a hospital with an obstetric unit, since Medicaid compensation rates are lower for the expensive service, so it's often one of the first to be cut by cash-strapped hospitals.

When a hospital can stay afloat, not only is more medical care available in rural areas, but it provides hundreds, sometimes thousands of local jobs that are often critical to the local economy. The data backs this up: rural hospitals in states that expanded Medicaid are six times less likely to close than in states that didn't.

The benefit of Medicaid to rural communities has been a conundrum for rural residents, who tend to vote Republican even as GOP lawmakers consistently vote to reduce Medicaid costs and the number of people who have access to it. "In Ohio, many state lawmakers are pushing a cap on the state’s expanded Medicaid program — a controversial move that would almost certainly squeeze hospital revenue. Nationally, Republican leaders are weighing cuts to Medicaid, Medicare and other safety-net programs," Luthra reports. Still, a Republican-flavored Medicaid that includes work requirements for able-bodied recipients may make Medicaid expansion more palatable to conservatives.

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