Rural Health Care is suffering (and COVID-19 has made it worse)

In an article called “The South’s health care system is crumbling under Covid-19. Enter Tennessee” by Daniel Payne of Politico, the demise of heath care in more rural areas has been exacerbated by COVID-19.

A key reason is the closing of rural and small town hospitals that has severely impacted immediate health care. A key paragraph from this article is telling:

“Of the 50 counties with the highest Covid deaths per capita, 24 are within 40 miles of a hospital that has closed, according to a POLITICO analysis in late January. Nearly all 50 counties were in rural areas. Rural hospital closures have been accelerating, with 181 since 2005 — and over half of those happening since 2015, according to data from the University of North Carolina. But that may be just the beginning. Over 450 rural hospitals are at risk of closure, according to an analysis by the Chartis Group, one of the nation’s largest independent health care advisory firms.”

These hospital closings are not new nor did they just happen. The financial difficulties predate the passage of the Affordable Care Act. In essence, a significant portion of the cost of running these hospitals went toward indigent care, meaning people without insurance. In some cases, it was over 50% and even as high as two-thirds of the hospital budget. This meant some of the revenue may be reimbursed by the local county, but if the county was in financial trouble or this was a private hospital, the hospital was out of luck.

The ACA brought with it the expansion of Medicaid, should a state opt in to cover people. The federal government would reimburse the state those costs for three years and then drop to 90% thereafter. All but fourteen states have so expanded. Per the non-partisan Commonweath Fund, Medicaid expansion helps the state economy, rural health care and the people in those locations. Former Republican presidential candidate John Kasich called Medicaid expansion a “no brainer” when he was governor of Ohio.

And, these hospitals are usually a major employer in these towns. So, when one closes, a lot of revenue leaves the town budget and economy. Belhaven, NC Mayor Adam O’Neil, a Republican, pleaded with the state leaders to expand Medicaid, but to no avail. So, he walked to Washington, DC to plead his case there. It should be noted that North Carolina remains as one of the fourteen states who have not expanded Medicaid.

As a retired benefits consultant, manager and actuary, I know the ACA is not perfect and could use some shoring up. But, a key reason for the ACA is patients need access to care and hospitals need to get paid for services rendered. If a patient has health care insurance, he or she will seek more preventative measures to stave off problems. Plus, he or she will seek care if needed, rather than avoiding it.

All of the above greased the skids for a problematic response to COVID-19. Without hospitals close by, people would forego care until it was too late. Plus, coordination of care with doctors to do triage and offer vaccines is hindered.

The ACA is not perfect, but it has improved access care for many people. I have written before about some suggestions to improve it. Yet, in fourteen states, the ACA still has not been fully implemented and in many of those states, they lag other states on health care results per the Commonwealth Fund. Expansion of Medicaid could be a major step.

https://news.yahoo.com/public-health-disaster-shuttered-hospitals-110000044.html