Medicaid cuts would hit rural hospitals hardest

Pemiscot Memorial Hospital in one of Missouri's
poorest counties (Side Effects Public Media photo)

For the hundreds of rural hospitals struggling to stay in business, health-policy decisions made in Washington, D.C., could make survival a lot tougher, Bram Sable-Smith reports for NPR.

"Since 2010, at least 79 rural hospitals have closed across the country, and nearly 700 more are at risk of closing," Sable-Smith notes. "These hospitals serve a largely older, poorer and sicker population than most hospitals, making them particularly vulnerable to changes made to Medicaid funding."

House Republicans' bill would cut Medicaid — the public insurance program for many low-income families, children and elderly Americans, as well as people with disabilities — by as much as $834 billion, Sable-Smith reports. "The Congressional Budget Office has said that would result in 23 million more people being uninsured in the next 10 years. Even more could lose coverage under the budget proposed by President Trump, which suggests an additional $610 billion in cuts to the program."

The House bill would end the Medicaid expansion in 2020; the Senate bill revealed Thursday would phase it out by 2024, but after that would tighten the funding formula in a way that would likely force states to limit eligibility or cut benefits, or both. All those would be problems for small rural hospitals that depend on Medicaid. A rural hospital closure goes beyond people losing health care, Sable-Smith explains. Jobs, property values and local schools can suffer.

"Relief for rural hospitals is not what is being debated in Washington right now." he says. "Under the GOP House plan, even states like Missouri that did not expand Medicaid could see tens of thousands of residents losing their Medicaid coverage."