7 rural hospital CEOs in N.C. call for Medicaid expansion

CEOs from seven rural hospitals in North Carolina met with Gov. Roy Cooper and state Health and Human
Services Secretary Mandy Cohen (center) Wednesday to support Medicaid expansion. (Photo by Taylor Knopf)

CEOs from seven rural North Carolina hospitals told Gov. Roy Cooper and Health and Human Services Secretary Mandy Cohen on Wednesday that expanding Medicaid would help them stay open, Taylor Knopf reports for North Carolina Health News.

Though the issues the hospitals face vary, there are many similarities: they're having a hard time recruiting doctors and other medical professionals, all of them have thin operating margins, and their budgets are increasingly strained because rural patients rely more heavily on emergency departments for care; many of those patients can't pay or are uninsured, so the hospital must eat the cost of care for those patients, Knopf reports. The CEOs also said that, because poor patients don't have access to urgent, primary or preventative care, problems that might have been dealt with relatively quickly and cheaply become expensive issues when the patients finally seek care at the emergency department.

"The consensus was that Medicaid expansion wouldn’t solve all their problems overnight, but they agreed it would go a long way to relieving pressure on their emergency departments and create a healthier patient population," Knopf reports.

The CEOs have reason to worry: six rural hospitals have closed since 2010, while 104 rural hospitals closed nationwide in the same time frame. Eighty percent of those nationwide closures happened in states that didn't expand Medicaid, Knopf reports. 

Greg Tung, a health economist from the University of Colorado, told Knopf that his research found that Medicaid expansion has helped hospitals stay open, and especially rural ones, which tend to be in more danger of closing. Helping a rural hospital stay open helps the local economy too, he said: "Rural hospitals are anchor institutions in their communities. They are kind of a pillar of the local community and the local economy, they provide a lot of skilled, well-paying jobs for that area . . . So when a rural hospital closes, it has a disproportionately large impact on that community, especially in comparison to an urban hospital closure."

Cooper said Medicaid expansion could pass in the state House right now if the Republican leadership allows it to come to a floor vote, but was less confident about it passing the state Senate. Some state Senate Republicans worry that the federal money to support Medicaid expansion might disappear, but Cooper said that hasn't happened so far in other states because it's such a popular measure. "They couldn't kill it," Cooper said,