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Tuesday, July 30, 2019

Rural hospitals struggling most in states where lawmakers declined Medicaid expansion under the Affordable Care Act

People living in the most politically conservative areas of rural America are seeing local hospitals “founder and close” because their state lawmakers opposed expanding Medicaid under the 2010 Patient Protection and Affordable Care Act, says a story by a GateHouse Media reporting team. Of the 106 rural hospitals that have closed since 2010, 77 are in states that haven't expanded Medicaid.

“Fiercely conservative and inherently distrustful of the federal government, state politicians balked at picking up 10 percent of the Medicaid expansion cost [as of 2020] and repeatedly expressed fears that Washington bureaucrats would renege on generous Obamacare funding, leaving states to cover an ever increasing share of the healthcare burden,” Michael Braga, Jennifer F. A. Borresen, Dak Le and Jonathan Riley reported for Gatehouse.

John Henderson, who heads The Texas Organization of Rural & Community Hospitals, told GateHouse he supports the Medicaid expansion his state did not accept. “The irony to me is that we’re paying federal income taxes to expand coverage in other states. We’re exporting our coverage and leaving billions of dollars on the table.”

Hospital closures affect “farmers and farm workers, small business owners and their employees, the old and infirm,” the story notes. “More than half of all rural hospitals in Mississippi, South Carolina, Georgia and Oklahoma lost money from 2011 through 2017. In Kansas, the bloodletting was even more widespread. Two out of three rural hospitals in the state operated in the red during the seven-year period. Five were forced to shut down.”

The GateHouse reporters analyzed financial data from 2,200 rural hospitals to see which ones are losing money and could close under the financial strain. The reporters also looked at academic studies and interviewed hospital officials and other experts in the field. They wrote:
Rural America is in the midst of a deep and prolonged crisis that resulted in 106 hospital closures since 2010. Nearly 700 more are on shaky ground, and nearly 200 are on the verge of collapse right now, according to reports from Massachusetts consulting firm iVantage Health Analytics and the Sheps Center for Health Services Research at the University of North Carolina in Chapel Hill.
Hospitals faring the worst are mainly in states that refused to expand Medicaid. Those states account for 77 of the 106 closures over the past decade. They also are home to a greater percentage of money losing facilities and lower collective profit margins.
“At the bottom of the pack is Kansas, where Gov. Sam Brownback’s conservative politics reigned for eight years. Seventy of its 109 rural hospitals lost money from 2011 through 2017, and seven ranked among the 20 worst performing rural hospitals in the country. Hospitals in nearby Oklahoma did not perform much better, and the same can be said for many states in the Deep South.
But one state, whose residents only recently voted to expand Medicaid, bucked the national trend. Thanks to sacrifices made by urban hospitals and their willingness to work with their small town counterparts, rural hospitals in Utah were among the most profitable in the country from 2011 through 2017. Only 14 percent lost money during the period and not one was forced to shut down.”

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