Where health care fuels a rural economy

The New York Times ran this story a few days ago about a rural community where healthcare provision--and in particular the Baxter Regional Medical Center--is a huge economic engine.  I know the place well; it is Baxter County, Arkansas (population 41,513), about 50 miles from my own hometown, Jasper, Arkansas.  As the story by Patricia Cohen points out, this is a place rich in natural amenities that has drawn many retirees over the years.   (Thankfully, it's also drawn some highly qualified physicians who want to raise their families in a rural area.)

Cohen's angle in reporting on Baxter Regional Medical Center is that this is Trump Country, though his plan to repeal and replace Obamacare would endanger their jobs.

The hospital is the single largest employer, with 1,600 people paid to mop floors and code insurance forms, stitch wounds and perform open-heart surgery. 

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Across the country, the health care industry has become a ceaseless job producer — for doctors, nurses, radiologists, paramedics, medical technicians, administrators and health care aides. Funding that began flowing in 2012 as a result of the Affordable Care Act created at least a half-million jobs, according to an analysis by Goldman Sachs. 

In many rural areas, where economies are smaller and less diversified, the impact is magnified. ... But its significance has grown since the Affordable Care Act passed. The hospital alone has added 221 employees, a 16 percent increase, since 2011.

While health care accounts for about 12% of jobs nationwide, it is accounts for more than twice that--about 25% of jobs--here.  The share of jobs in the health sector is "roughly equal tot he share employed by the county's manufacturer and retailers combined." 

Of course, rural hospital closures have been rampant in recent years, but Baxter Regional has fared better than many, maintaining its ability to provide specialized services such as "neurosurgery and an emergency cardiac catheterization lab, the state’s first 3-D mammograms and magnetic resonance imaging."  Cohen explains how Baxter Regional is somewhat different from many rural hospitals--basically because it relies as much or more on Medicare than on Medicaid. Remember that much of the population are retirees.

The financial effect of the Affordable Care Act on the hospital has been mixed. The Medicaid expansion in Arkansas allowed residents earning 138 percent of the federal poverty level — $16,643 for an individual or $33,948 for a family of four — to buy private insurance paid for primarily by the federal government. That extended health care access to people in the hills and surrounding counties who had never been insured, and shrank charity-case costs. 

Indeed, the adult uninsured in Arkansas shrank 12.3% after the Medicaid expansion, "more than in early every other state."

But [the ACA] also reduced Medicare reimbursements, which cover the elderly. This trade-off left many hospitals ahead, but not Baxter Regional, which has an unusually large share of Medicare patients — 67 percent compared with a national average of 40 percent. 

The added $4 million in Medicaid payments did not make up for the $12 million lost through Medicare.

Cohen quotes Ron Peterson, the hospital's president and chief executive: 

We are the economic anchor of the community.  When we downsize, the whole community downsizes.

Another part of the story that resonated with me as a ruralist is the depiction of many members of extended families working at Baxter Regional.  You can see the local networks of kith and kin that help get people jobs--the rural lack of anonymity--just humming throughout this story.