Wall Street Journal looks at rural hospitals' problems related to Obamacare, lack of Medicaid expansion

"Rural hospitals have long been under financial pressure from the rising cost of providing health care, the dwindling number of patients staying overnight and the shift of more profitable services like cardiac care to bigger medical centers," Valerie Bauerlein reports for The Wall Street Journal. "Now, the Obama administration, saying that some rural hospitals have been receiving subsidies they weren't meant to get, has proposed eliminating a further $2.1 billion in Medicare payments next fiscal year for hospitals designated as providing 'crucial access." (WSJ graphic)

Some rural hospitals in states that chose not to expand Medicaid under federal health reform have struggled to stay open. A rural Tennessee hospital recently announced it's shutting its doors, while four rural Georgia hospitals have closed in the past year. Because those states chose not to expand Medicaid, hospitals are losing government subsidies for providing care to the uninsured.

"Health advocates say a disproportionate number of working poor people who might qualify for Medicaid after an expansion live in rural areas and may have trouble getting treatment," Bauerlein writes. "Rural hospitals are particularly sensitive to changes in Medicare and Medicaid payments because about 60 percent of their revenue comes from the government, according to the American Hospital Association."

That's bad news for rural residents in places like Belhaven, N.C., where city leaders are trying to find $3 million to take over the local hospital from its owner, who has said the hospital will close this summer, Bauerlein writes. The hospital serves fewer than 20 people per day, but it is the town's largest employer, and the closest emergency room is 75 miles away. North Carolina didn't expand Medicaid. (Read more)