A Forgotten Population: Rural Hospitals Brace Themselves for Repeal of Obamacare
Medical facilities in rural areas, which contain some of the oldest, poorest, and sickest populations, have been struggling to survive for decades, but as the repeal of the Affordable Care Act looms nearer, these facilities question their ability to weather its impact.
The ACA didn’t come without its burdens, implementing regulations that compounded administrative costs for financially stressed rural hospitals. But for many facilities, new sources of revenue due to the increase in Medicaid (for states that chose to expand) and an insured population of 1.7 million rural Americans brought necessary relief.
Especially vital to these communities, the 340B drug program provides 1,100 rural facilities access to medication at reduced or no cost covered by drug companies.
This reduction in medication cost allows hospitals to direct their savings to other programs, such as with the Cass Country Memorial Hospital in Atlantic, Iowa, which is able to spend more on its Behavior Health Unit — “one of two critical access hospitals in the state that offers psychiatric services,” explained Morning Consult.
As Congress moves forward with motions to dismantle the ACA, rural hospitals, such as Bridgton in Maine, might be forced to reduce its services. Loss of insurance for the 8% of Bridgton’s patients covered through the Marketplace would result in a decrease in revenue, causing job cuts at what is the community’s largest employer.
Senator Angus King of Maine explains the domino effect of ACA’s repeal:
“Stripping tens of thousands of people of their health insurance is not only going to put lives at risk, but it’s also going to jeopardize the financial stability of rural hospitals. And that will only make health care services for people, especially those who live in rural areas, more difficult to obtain and more difficult to afford — and it will also… result in hospitals closing or downsizing, employees losing their jobs, and local economies suffering.”
Ironically, most of these rural communities under threat voted for Trump, an advocate of ACA’s removal. This disconnect is especially prominent in Pennsylvania, a state that played a pivotal role in Trump’s victory –with 625,000 people enrolled in the ACA’s expanded Medicaid program, almost half of these resident reside in rural areas according to Andy Carter, president of the Hospital and Healthsystem Association of Pennsylvania.
Yet another concern in these communities is the distance with which citizens will be forced to travel if nearby facilities close. For many, the next closest hospital could be hundreds of miles away — a significant distance in an emergency situation.
Without a replacement for the ACA, more rural hospitals will join the ranks of the eighty that have closed since 2010 and the 673, one third of rural hospitals, operating at a loss and on the brink of closure.
It’s all too easy for urban Americans to ignore the concerns and wellbeing of our rural counterparts, because the impact on these communities is at a literal distance from us. But if we continue to marginalize these citizens, we will remain in a cycle of their seeking candidates that offer them attention during a campaign but who quickly forget about them upon reaching office.
For many rural Americans, the repeal of the ACA could be a life or death situation.
