Changes ushered in by the Affordable Care Act are putting the financial squeeze on smaller, rural hospitals and contributing to an alarming number of closures.
The Washington Post, in collaboration with Kaiser Health News, reported on this disturbing trend happening throughout the United States.
The specific changes brought about by the ACA that are hurting rural hospitals include its reduction of Medicare payments, the reduction of payments made to hospitals to cover the uninsured, and the high deductibles that are often part of ACA approved plans. In many cases, deductibles “are running between $2,500 and $5,000,” and people can’t pay them, said Maggie Elehwany, chief lobbyist for the National Rural Health Association.
One of the assumptions of the ACA is that states would all sign on with the federal government to expand Medicaid and share the costs; but 23 states have declined to take on the new, unknown financial burden.
The Post reports other factors contributing to hospital closures include:
…declining populations; disproportionate numbers of elderly and uninsured patients; the frequent need to pay doctors better than top dollar to get them to work in the hinterlands; the cost of expensive equipment that is necessary but frequently underused; the inability to provide lucrative specialty services and treatments; and an emphasis on emergency and urgent care, chronic money-losers.
The NRHA, representing over 2,000 rural hospitals and other health care facilities, stated that 48 hospitals have closed since 2010 and 283 are in trouble. In Texas alone, 10 have closed. Rural hospitals serve approximately half of the nation’s population.
Rural health care experts warn that the country could undergo a similar rash of closures as that experienced in the mid-eighties and early nineties following a change in how the federal government reimbursed Medicare billing to fixed payment amounts. That change favored large, efficient hospitals and hurt smaller, rural ones, which lacked the same economies of scale. The policy was amended in 1997 to make exceptions for smaller hospitals.
The ACA, passed with the intention of giving more access to health care, may have the unintended consequence of causing many communities throughout the United States to have less, unless changes are made.
This post originally appeared on Western Journalism – Informing And Equipping Americans Who Love Freedom