Monday, January 20, 2014

Rural hospitals struggle in the age of partial Medicaid expansion

"Rural Regions Lobby for State Medicaid Expansion" is the headline for Susan Capelouto's report on NPR today.  Here are some excerpts:
Hospitals in rural America are adjusting to many new requirements under the Affordable Care Act. For those in states that are not extending their Medicaid roles, that task is even more challenging. Rural lobbies are pushing states for the expansion, saying without it, their hospitals could close.
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CAPELOUTO: In America, no one gets refused services at an emergency room. And to help rural hospitals cope with taking care of the uninsured, they get what's called Disproportional Share, or DISH payments, from the federal government.
The Affordable Care Act was supposed to reduce that payment under the idea that everyone would have insurance or be on Medicaid. But Georgia is one of 20 or so states that decided to opt out of Medicaid expansion once the Supreme court gave them permission to do so. It's a major worry for the Rural Health Association, which lobbies for the 20 percent of Americans who live in rural areas.
Maggie Elehwany is a lobbyist for the Rural Health Association:
MAGGIE ELEHWANY: The poorest areas in this country in the Deep South, in Appalachia, in certain pockets in the west, boy, a lot of those - really a tremendous amount of those - are the states that are opting not to expand Medicaid. 
CAPELOUTO: Georgia decided against Medicaid expansion, even though the federal government pays 100 percent of the cost for three years and 90 percent thereafter. Governor Nathan Deal argues that it's foolish to believe the feds will keep paying that 90 percent and worries that states will be left to carry the burden in the long run.
For now, DISH payments have recently been extended for two more years.  As Capelouto notes, however, if the failure to expand Medicaid ultimately leads to the closure of rural hospitals, a lot of conservative politicians from rural areas may not look so attractive to their anti-Obamacare constituents.  
P.S.  On a somewhat related note, it was fun to see President Obama's shout out for Kentucky in his State of the Union address on January 28  Here's an excerpt from WKYT's coverage of the speech. 
"And if you want to know the real impact this law is having, just talk to Governor Steve Beshear of Kentucky, who's here tonight. Kentucky's not the most liberal part of the country, but he's like a man possessed when it comes to covering his Commonwealth's families," said Obama about [Kentucky Governor Steve ]Beshear and the commonwealth.
As I've noted before on this blog, Kentucky has been a widely acclaimed leader in the implementation of the Affordable Care Act, especially in relation to rural populations.  

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