Rural Hospitals Hurt By Lack of Medicaid Expansion, Study Says

<img class="aligncenter wp-image-2432" src="" alt=" Rural hospitals injured by lack of Medicaid expansion, study says "width =" 390 "height =" 294 "/> This is not news that in rural areas of the country, people It is harder to get access to good health care, but new data suggests that opposition to a major part of the 2010 health review could add to the gap

The conclusion comes from a study published Wednesday in the journal Health Affairs, which analyzes how state decisions on the implementation of the Medicaid Expansion, a federal-state program for public health. insurance for low-income people, can influence the financial stability of hospitals. Nineteen states have chosen not to participate in the expansion.

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Rural hospitals have long argued that they were hurt by Medicaid's lack of expansion, leaving many of their patients without insurance coverage and compromising hospitals' ability to better serve the public. The study suggests that they have a point.

More specifically, researchers at the University of North Carolina at Chapel Hill found that rural hospitals had a better chance of making profits if they were in a state that was expanding Medicaid – while in the hospitals of the city, there was no improvement. to overall profitability. Overall, hospitals were earning more if they were in a state where more people were receiving coverage and where the level of unpaid care was decreasing.

In other words: all hospitals generally come out better under the Medicaid program, but rural hospitals are more concerned when the state expands coverage.

The study examined how Medicaid expansion affected hospital revenues, how many Medicaid patients they discharged, the unpaid care levels provided by hospitals, and how well the institutions did overall financially. He compared these effects in rural versus urban areas, through more than 14,000 annual hospital cost reports between January 2011 and December 2014, or one year after eligible states could expand their Medicaid programs.

In the expanding Medicaid states, rural hospitals saw a larger increase in Medicaid revenues than urban hospitals. Municipal institutions save a higher percentage than rural hospitals with the reduction of unpaid care, although this change "did not translate into improved operating margins of urban hospitals," notes L & # 39; study.

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A likely factor: Rural hospitals serve more low-income people – who were not eligible for insurance before, but who were covered after the law came into effect about health. And rural hospitals are historically more likely to operate at a loss than urban hospitals. Thus, the chance of seeing an increase in income is greater than in a hospital in the city.

This is important because hospital finances also matter to consumers. In rural communities, hospitals are often among the largest employers and the main source of health care. The financial constraint may affect the type of services offered by the institution.

"If you are [a hospital] in a state that has extended Medicaid, obviously, you will experience lower amounts of uninsured." Your bad debts and your charity have decreased, "said Brock Slabach, vice -principal chair of the National Association of Rural Health.He did not participate in the study, although he is familiar with the work of the research team. " Is [that expense] gone for nothing? No. But that helped. "

This is especially true for rural hospitals, says Kaufman, because they have narrower profit margins than urban ones. Any compression of the budget "will have more influence" and could limit the bids or the quality of a hospital.

Meanwhile, rural hospitals are already facing financial stress, Slabach said. More than 70 have closed since 2010. Even more are at risk of closure. Many hospitals in danger are in states without expansion.

How Medicaid affects rural and urban hospitals could influence other debates, the study's authors said. For example, the Health Act should also reduce disproportionate payments for health expenditures – money transfers that support hospitals that treat low-income people, often in rural areas.

"Hospitals rely on this funding to treat unpaid care," said Kaufman. In rural states that have refused to expand, unpaid medical treatment is a major financial hurdle for hospitals.

"The expansion of Medicaid is not a random event – it's very important to consider here," said Holmes, another author of the study. "These are states that have decided to do it.There may be other elements" involved


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