Risks to rural hospitals grab big headlines in Arkansas

The lead story in today's Arkansas Democrat-Gazette is about the perils that Trump's "One Big, Beautiful Bill Act" poses to rural hospitals in the state.  Here's an excerpt from the feature by Neal Earley, which provides some excellent explanatory reporting: 

Rural hospitals in Arkansas will have to ready themselves for some major changes coming in the next few years that could mean savings for the federal government but fewer people with health care coverage.

The changes are part of the One Big, Beautiful Bill Act the U.S. House of Representatives passed on Thursday. It includes key changes to Medicaid and health care for low-income Americans that are projected to reduce federal spending on the program by $1 trillion over 10 years and lead to an increase in the number of uninsured people...

But some hospital officials worry the work requirements and bi-annual eligibility checks would mean a drop in coverage for many, shifting the cost burden to providers.

“You can take people off the rolls, but they’re still going to come to the (emergency room),” said Shelby Brown, administrator of Southwest Arkansas Regional Medical Center in Hope. “And small rural hospitals like we are in Hope, Arkansas — we don’t have the volume to absorb more people without insurance.”

The Kaiser Family Foundation says 813,000 Arkansans are enrolled in Medicaid, and 41% of those live in rural areas. 

Cuts to Medicaid would be felt more acutely by rural hospitals, as they don’t have the type of patient volume that suburban and urban hospitals have that could help them absorb a drop in revenue, Brown said.

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Arkansas already attempted to implement work requirements in 2018, but it led to about 18,000 Arkansans losing coverage. In 2019, a federal judge struck down the requirement.

While the new requirement is designed to eliminate waste and force those who are able to seek health insurance through their work, Bo Ryall of the Arkansas Hospital Association said prior experience has shown health care providers are the ones who will observe the financial hit, saying, “Arkansas’s prior experience with work requirement enforcement and frequent re-determinations increased uncompensated care in hospitals.”

The story also quotes Stacy Harberson, CEO of Howard Memorial Hospital in Nashville, AR:

[R]ural hospitals (are) already operating at such a thin margin it could be very detrimental.