How the US Healthcare System Starves Rural Hospitals

Healthcare is the central concern in the 2020 elections in all fifty states and US territories. This article reveals more information on states with hospitals which are in danger of closing and one key finding is that most of these states (all voted Republican in 2016) chose not to expand Medicaid with the 2010 Affordable Care Act are worse off.  Of these states only Kentucky, Pennsylvania, and Arizona  have recently implemented the Medicaid expansion under the provisions of the Affordable Care Act. This provision allows low-income persons to obtain healthcare. The rest of these states are limiting federal funding for their rural hospitals even though they are required by federal law to provide care regardless of an individuals ability to pay. Here is a table which shows those states with the greatest number of hospitals likely to close: (The Rural Health Safety Net Under Pressure: Rural Hospital Vulnerability, 2020)

40% likely to close	31-39% likely to close	26-30% likely to close	21-25% likely to close
Texas	Oklahoma	Wyoming	Nebraska
Mississippi	South Carolina	Kansas	Arizona
Missouri	Alabama	Kentucky	Pennsylvania
Florida		North Carolina
		Georgia

Of these states, only Kentucky has expanded Medicaid under the Affordable Care Act. The rest of the Methodology

The Charter Center for Rural Health used regression analysis, which is a type of statistical analysis using multiple variables to assess hospital viability and those criteria included: average age of patient, length of stay, case mix index, Medicare and Medicaid discharges, size of the facility, geographic area, and the age of the facility. In terms of financial measures, operating margins, revenue, occupancy, capital efficiency, and the state level of Medicaid expansion were also evaluated. 

Though a one percent increase in funding can reduce a hospitals chance of closure by three times that investment, this is not occurring. (The Rural Health Safety Net Under Pressure: Rural Hospital Vulnerability, 2020) One of the Charter Center’s regression models showed that states which adopted the Medicaid Expansion under the Affordable Care Act reduced the likelihood of hospital closure by 62% on average. Four hundred and fifty-three hospitals were identified as vulnerable to closure in the US.

When I researched other sources on vulnerability of US hospitals the results were similar and here are the findings from the 2020 Rural Hospital Sustainability Index by Guidehouse. (The Rural Hospital Sustainability Index, 2020)

State	Vulnerable Facilities	Proportion at risk of closure
Tennessee	19 of 28 hospitals	68% of rural hospitals are at risk
Alabama	18 of 30 hospitals	60% of rural hospitals are at risk
Oklahoma	28 of 47 hospitals	50% of rural hospitals are at risk
Arkansas	18 of 34 hospitals	53% of rural hospitals are at risk
Mississippi	25 of 50 hospitals	50% of rural hospitals are at risk
West Virginia	9 of 18 hospitals	50% of rural hospitals are at risk
South Carolina	4 of 9 hospitals	44% of rural hospitals are at risk
Georgia	14 of 34 hospitals	41% of rural hospitals are at risk
Kentucky	18 of 45 hospitals	40% of rural hospitals are at risk
Louisiana	11 of 30 hospitals	37% of rural hospitals are at risk

Larger hospital corporations are driving smaller stand-alone facilities into oblivion. Further, the US healthcare system treats the health of the nation like another product and the healthcare system like a capital enterprise, which as it turns out, doesn’t deliver the most efficacious healthcare. This means we are paying more for treatments that don’t deliver a commensurate improvement in patient health. As a society we should care about this as we would not accept a lesser quality product or outcome from any other consumer good and healthcare certainly is that.

Further, the Medicaid enrollment in rural areas is higher, so states which refuse to help their residents obtain healthcare by expansion of Medicaid under the Affordable Care Act are denying people access to care. Yet, rural people elected the current president who has vowed to gut the Affordable Care Act, an existing program for individuals to obtain medical care and to keep their hospitals afloat through improved cash flows. (Estes, 2020)

The pandemic grants from the federal government are now coming due and I think we can make a good case that rural hospitals should not have to repay the grants, as they are teetering on insolvency. Perhaps this is one issue in which Republicans and Democrats can agree, however, Senate Majority leader, McConnell has scoffed at providing further to assistance municipalities, hospitals, and individuals. The people of this diverse and hardworking nation deserve better.

And this is the healthpolicymaven signing off encouraging you not to sign blanket medical releases when you have medical procedures, do consent for which you agree and that which you decline. This article was written by Roberta E. Winter an independent healthcare analyst and journalist.

References

Estes, C. (2020, October 13). 1 of 4 Rural Hospitals Are At Risk of Closure And The Problem Is Getting Worse. Retrieved from Forbes.com: https://www.forbes.com/sites/claryestes/2020/02/24/1-4-rural-hospitals-are-at-risk-of-closure-and-the-problem-is-getting-worse/#72aa1c861bc0

The Rural Health Safety Net Under Pressure: Rural Hospital Vulnerability. (2020, February 1). Retrieved from Chartis Center for Rural Health: https://www.ivantageindex.com/wp-content/uploads/2020/02/CCRH_Vulnerability-Research_FiNAL-02.14.20.pdf

The Rural Hospital Sustainability Index. (2020, October 13). Retrieved from Guidehouse.com: https://guidehouse.com/-/media/www/site/insights/healthcare/2020/ruralhospitalsustainabilityindex0420_rev01.pdf