Rural lobbyists say state officials need to put aside political differences, expand Medicaid

Twenty-one states, mostly in the South, have declined to expand Medicaid under federal health reform, though the federal government would pay the entire cost of expansion for the first three years and at least 90 percent after that. The reform law gradually reduces "disproportionate share" payments to hospitals that have rely on Medicaid and Medicare, because the authors thought nearly everyone would have insurance. But the Supreme Court let the states opt out of expanded Medicaid. "Rural lobbies are pushing these states for the expansion, saying that without it, many of their hospitals could close," Susanna Capelouto reports for NPR.

Much has been written about how hospitals in those 21 states are struggling, especially in rural areas. In rural Tennessee, hospitals have cut employees and services, while rural Georgia blames the loss of three rural hospitals and the potential to lose 15 more on the lack of expanded Medicaid. Rep. Sharon Cooper, R-Marietta, chair of the House Health and Human Services Committee, told Jonathan Shapiro of Atlanta's WABE-FM, “There are some of those rural hospitals that need to close,” because they have so few patients.

UPDATE: Cooper "said Wednesday that closing rural hospitals is an 'unthinkable proposition' and 'would have serious consequences on the affected community, hurting it economically and limiting access to acute care for Georgians'," the Atlanta Journal-Constitution reports.

Jonathan Oberlander

States need to put aside their political differences and help people in need, said Jonathan Oberlander, a professor of social medicine at the University of North Carolina. He told Capelouto, "It's one thing to be opposed to Obamacare ideologically. But when that opposition means that the state is not extending Medicaid and is threatening the finances of your local hospital, you're going to see the Medicaid expansion in a very different light."

Sen. Dean Burke (R-Ga.), a physician, disagrees, telling Capelouto: "Increasing Medicaid doesn't necessarily make things better. You know, we need to increase jobs so that we get more people with regular insurance. And that will be where we can make a difference." But it's hard to rely on new jobs in areas that can't keep the existing ones, as Maggie Elehwany of the National Rural Health Association told Capelouto: "The poorest areas in this country in the Deep South, in Appalachia, in certain pockets in the west, boy, a lot of those—really a tremendous amount of those—are the states that are opting not to expand Medicaid." (Read more) (Advisory Board Council graphic: Information as of Dec. 20, 2013)