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Wednesday Jan 09, 2019

Medicaid Expansion Could Be Key to Saving Rural Hospitals

As 2019 begins, and a new Congress convenes in Washington, D.C., health care issues loom large at the federal level and continue to be critical concerns in the states, as well. Health care was the most important issue(www.nbcnews.com) to voters in November's midterm elections, in part because many people worried about the uncertain future of the Patient Protection and Affordable Care Act (ACA) after several attempts by Congress to repeal the law.  

[hospital emergency sign]

The ACA affects all of us, not just individuals who aren't covered by insurance obtained through their job, spouse or parents. Medicaid expansion, one of the more controversial parts of the law, has been a life-or-death issue for many rural hospitals. I practice at a rural, nonprofit hospital in Alabama, and we have felt the effects of Medicaid not being expanded in our state. This past summer, our hospital drastically reduced staff and implemented several other cost-cutting measures to address financial shortfalls brought on by a large uninsured patient population and uncompensated care. This would undoubtedly have been prevented had Alabama expanded Medicaid. Many of the hospitals in our state and our state hospital association are actively supporting Medicaid expansion by lobbying the state legislature to address this critical issue.

Thirty-seven states have adopted Medicaid expansion programs(www.kff.org) since the ACA's implementation. Rural areas tend to have larger proportions of low-income populations that benefit from Medicaid expansion, so for those 37 states, it has meant that their more vulnerable citizens have had better coverage, more access to care, better affordability of care and better financial security among the low-income population. In fact, some rural areas in states that have expanded Medicaid have seen more than 20 percent reductions in uninsured populations.

Since 2010, 94 rural hospitals have closed(www.shepscenter.unc.edu) in the United States, and the vast majority of those have been in states that did not expand Medicaid through either the ACA or an alternative plan. Texas alone has seen 17 hospitals shuttered in the past nine years.

Conversely, Medicaid expansion has bolstered rural hospitals(ccf.georgetown.edu) in the states that have expanded coverage. This is important to remember when we consider that there are nearly 700 health care facilities that are vulnerable to closure.(www.ruralhealthweb.org)

The impacts of the closures go beyond the loss of access to care for patients in these rural communities. Often, a rural hospital is the first- or second-largest employer in a community, so when it closes, many jobs -- and insurance benefits of the employees -- are lost. According to the National Rural Health Association, hospitals are responsible for as much as 20 percent of a rural community's economy.

Uncertainty remains at the federal level. A divided Congress distracted by a government shutdown will likely mean a continued stalemate on meaningful legislation aimed at addressing any of the issues facing rural hospitals.

Uncertainty, in fact, is the key word. A federal judge in Texas declared the ACA unconstitutional in December. The law remains in effect pending appeal.

Meanwhile, the changing composition of state legislatures and the election of new governors could open the opportunity for additional states to expand Medicaid,(www.eastidahonews.com) while other states will debate whether to continue Medicaid expansion.(nbcmontana.com)

Although these issues do not have a simple fix, each of us can have an impact by getting involved in advocacy at local and federal levels. I have utilized the AAFP to help with my personal advocacy by joining the Family Medicine Action Network and attending the annual Family Medicine Advocacy Summit.

These AAFP programs have allowed me to both develop relationships with the offices of my state's legislative delegation and to keep up to date with ongoing advocacy issues at both the state and federal levels. The AAFP also has several resources to assist members in tackling state advocacy issues, including the Speak Out tool.

No matter how one gets involved, it will be important to play a role because many decisions that could affect the long-term trajectory of health care are being made right now.

Tate Hinkle, M.D., is a family physician in Alexander City, Ala. You can follow him on Twitter @bthinkle.(twitter.com)

Posted at 02:37PM Jan 09, 2019 by Tate Hinkle, M.D.

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