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Rural Blog: Repealing Medicaid expansion provision of ACA could leave more rural hospitals at risk

Repealing the Patient Protection and Affordable Care Act could lead to an increase in the number of vulnerable rural hospitals, Shawn Radcliffe reports for Healthline.

A report by the Chartis Center for Rural Health found that in states that expanded Medicaid in 2014, 36 percent of rural hospitals had a negative operating margin in 2015, compared to 47 percent in states that didn’t expand the program. When it comes to the worst category of operating margins (less than negative 5 percent) 18 percent were rural hospitals in Medicaid-expansion states, compared to 30 percent in non-expansion states.

The North Carolina Rural Research Program says 80 rural hospitals have closed since 2010, and Chartis lists 673 rural hospitals as being vulnerable, Radcliffe reports.

Before Medicaid expansion, hospitals still treated uninsured patients, but weren’t paid for the care provided, Radcliffe notes.

“By increasing the number of people with health insurance, the Medicaid expansion directly benefitted rural hospitals.” Dr. Daniel Derksen, director of the Arizona Center for Rural Health, told Healthline that in states that expanded Medicaid, “we saw two important trends—reduction in uncompensated charity care and a reduction in the number, or the velocity, of the rural hospital closures.”

Rural hospitals in the 19 states that chose not to expand Medicaid were more vulnerable, Radcliffe writes. Of the 80 hospitals listed by the North Carolina Rural Research Program 60 are in states that didn’t expand Medicaid, led by 13 in Texas, seven in Mississippi, six in Tennessee and Georgia and five in Alabama. (Kaiser Family Foundation map: Medicaid expansion states)

Republican Sen. Lamar Alexander of Tennessee, chairman of the Senate health committee, told Politico last week that Congress will not only continue the Medicaid expansion, but broaden it.

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The Rural Blog is a digest of events, trends, issues, ideas and journalism from and about rural America, from the IRJCI, based at the University of Kentucky. The Institute for Rural Journalism and Community Issues is an extension program for rural journalists and news outlets. It takes no positions on issues and advocates only for strong news coverage, responsible commentary and things that make them possible, such as open-government laws. For more information see www.RuralJournalism.org.

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