Congress and the Obama administration are doing little to help struggling rural hospitals

Hospitals in rural areas continue to close or struggle to remain open, leaving an aging population with few resources to seek medical care, Shannon Muchmore reports for Modern Healthcare. The problem, especially bad in states that refused to expand Medicaid, is getting little help from Congress, where bills have been introduced but have little chance of passage. The Obama administration hasn't helped either, proposing "tightening the definition of a critical-access hospital and cutting their reimbursements, which are currently slightly higher than other hospitals." (Photo: Page Memorial Hospital in Virginia's Shenandoah Valley is in danger of closing because of Medicare cuts and the state's refusal to expand Medicaid)

"While the Affordable Care Act has allowed millions to gain access to health insurance, rural hospitals continue to face reimbursement cuts and practice-of-medicine regulations that administrators say do more harm than good. In the U.S., nearly 2,000 hospitals are rural and 1,333 qualify as critical access," Muchmore writes. Travis Clark, president of Page Memorial Hospital in Virginia's Shenandoah Valley, "said the federal government has helped hospitals such as his in the past. But they are now in need of special programs and grants that will allow rural providers to do more than just survive." In Shenandoah Valley the population over age 65 has increased 28 percent in the past decade and the poverty rate is up 21 percent.

"Maggie Elehwany, vice president of government affairs for the National Rural Health Association, said significant Medicaid cuts in the past few years have been suffocating rural hospitals," Muchmore writes. "Since 2010, 55 rural hospitals have closed and that rate is escalating. More than 280 report being at the edge of closure. In 2013, more than one-third of rural hospitals were operating at a deficit, she said."

"The worst financial hits have come from cuts to Medicare's bad-debt program and disproportionate-share hospital payments," Muchmore writes. "Sequestration, which slapped a 2 percent across-the-board cut on Medicare payments, hit rural areas with their older populations especially hard. Rural hospitals rarely have the option of shifting costs to the privately insured. The 20 states that have not yet expanded Medicaid eligibility under the ACA tend to be more rural states with Republican governors. These states also have residents who tend to be older, poorer and sicker, Elehwany said."