News that Paul Ryan and the Republican-led U.S. House of Representatives want to roll back the Affordable Care Act’s Medicaid expansion has rural hospitals facing a huge financial hit with hundreds of health facilities already facing closure.
There’s already been a wave of rural hospital closures, particularly in states that didn’t expand Medicaid coverage for poor Americans. Now, taking those federal funds away from states means already thin margins will turn to losses.
President Donald Trump speaks at the Conservative Political Action Conference (CPAC), Friday, Feb. 24, 2017, in Oxon Hill, Md. (AP Photo/Alex Brandon)
In recent years, an increasing number of states with rural populations that supported the presidential candidacy of Donald Trump opted to expand Medicaid under the ACA such as Iowa, Louisiana and Montana, according to the Kaiser Family Foundation.
Even without an effort to repeal the Affordable Care Act, more than 670 rural hospitals are at risk for closure, according to The Chartis Group , which released a study earlier this month at the Rural Health Policy Institute. The group examined hospital performance across nine measures, including a population health metric that shows impact on their communities and a loss of 137,000 “community jobs” including 99,000 jobs in healthcare, the Chartis Group report said.
“Medicaid expansion, while not nationally adopted, has been particularly important for rural Americans, many of whom have received health coverage under the ACA for the first time,” said Michael Topchik, national leader at The Chartis Center for Rural Health and senior vice president at iVantage Health Analytics. “Rural hospitals, many of which are operating on razor-thin margins, saw a statistically significant improvement of their bottom line in Medicaid expansion states.”
The ACA expanded Medicaid with 31 states plus the District of Columbia opting to do so through a generous federal funding formula that increased coverage to an additional more than 9 million Americans. About 70 million Americans are covered by Medicaid and its related health insurance for children and low-income adults.
“The ACA was a win-win in rural America, and any repeal-replace effort will need to take the progress in these areas into account or risk jeopardizing the availability of healthcare for the 62 million living in rural America,” Topchik added.
But Ryan and Republican House leadership seek to end the generous federal match that under the ACA used 100% federal dollars from 2014 through last year to pay for the expanded benefits. The federal match under the ACA gradually dwindles to 90% federal dollars by 2020, but is still better than the standard federal match of between 50% and 75% that existed before President Barack Obama signed the ACA into law.
Continued from page 1
A draft of the Ryan-led House plan, first reported by Politico last week, says the ACA’s Medicaid expansion would be eliminated in 2020.
Rural hospitals were already being hit hard financially in recent years since many aren’t part of larger multi-hospital systems and therefore don’t have leverage with the insurance companies that pay them. Increasingly, states that administer Medicaid are contracting with health insurance companies like Aetna, Anthem, Centene, Cigna and UnitedHealth Group to manage health benefits of poor Americans.
Rural hospitals also aren’t as well-capitalized as larger medical centers to pay for the latest in medical technology or electronic health record systems. There have been 80 rural hospitals close since 2010, the University of North Carolina Sheps Center for Health Services Research says in its running tally.
By eliminating the Medicaid expansion and proposing block grants that could lead to less funds for hospitals, rural hospitals say any replacement of the ACA needs to consider the plight of these facilities.
“The laudable goals of the Affordable Care Act have not been fully realized for rural patients and providers,” said Maggie Elehwany, vice president of government affairs and policy at the National Rural Health Association. “We hope to work with Congress to stop the catastrophic rural hospital closure crisis as they either amend or replace the ACA. Rural Americans deserve access to affordable care.”
This article was sourced from http://valanews.com