All Right Folks, Lot of Blogs on Tap Today, Starting With Lack of Medicaid Expansion in the Red States Is Killing People.
Stacey Abrams’ Twitter is full of tweets on the Lack of Medicaid Expansion is Closing Hospitals. How Deaths Due to Lack Of Hospitals Will Affect the Future.
So, let’s back up a bit to the ACA and Medicaid Expansions…quick refresher for folks.
There are more than 2 million people across the United States who have no option when it comes to health insurance. They’re in what’s known as the “coverage gap” — they don’t qualify for Medicaid in their state, and make too little money to be eligible for subsidized health plans on the Affordable Care Act insurance exchanges.
Wright’s inability to get a subsidized policy on Healthcare.gov is related to how the Affordable Care Act was originally designed. People needing insurance who were above the poverty line were supposed to be funneled via the federal and state insurance exchanges to private policies — with federal subsidies to help make those policies affordable. People who were under the poverty line were to be funneled to a newly-expanded version of Medicaid — the public health insurance program that is jointly funded by states and the federal government. But the Supreme Court made Medicaid expansion essentially optional in 2012, and many Republican-led states declined to expand. Today, there are 12 holdout states that have not expanded Medicaid, and Mississippi is one of them.
As is FL, GA, KS, South Dakota, The Carolinas, Wisconsin and Wyoming.
So, basically these Red States so “F you poor people, you don’t need hospitals or insurance, just eat your vitamins and drink you Ivermectin and you’ll be fine”
Now, what has been the fallout of this on a national level. Rural hospital closures, lots of them, and now ones in major cities like Atlanta. But let’s start with the rural ones first.
We’re going to start with some data that was gathered in 2018. This is a scientific type paper so I urge you to read the whole thing but here’s the relevant bits.
The large increase in closures in nonexpansion states in 2013 occurred at a time when DSH payments were expected to be phased out. From 2012 to 2013 the closure rate increased from about 0.45 to just over 0.90 closures per 100 hospitals in nonexpansion states, whereas the rate remained at about 0.45 in expansion states. After 2014, the closure rate in expansion states declined but remained relatively high in nonexpansion states.
Exhibit 3 displays odds ratios from the logit analysis of the probability of hospital closure. The association of the ACA Medicaid expansion and the probability of closure in the difference-in-differences specification was measured using the odds ratio of the Post*Expansion State interaction. In the full sample, hospitals in expansion states were over six times (OR: 0.155), or about 84 percent, less likely to close than hospitals in nonexpansion states. This reduction in closure probability remained significant in the rural and urban subsamples.
Our analysis of hospital closures in the period 2008–16 reveals that the ACA’s expansion of eligibility for Medicaid for childless adults was associated with significant reductions in the probability of hospital closures. The results reported in exhibits 3 and 4 were stronger for rural hospitals, which also experienced significantly improved total, operating, and Medicaid and uncompensated care margins related to the ACA’s Medicaid expansion. We posit that the primary mechanism that underlies the relationship between hospital closures and Medicaid expansions is the substitution of utilization by patients with Medicaid coverage for utilization by uninsured patients. The financial benefit from this shift in utilization improved hospitals’ financial margins and enabled them to remain in business.
So, as of four years ago it was already apparent that states not expanding Medicaid would see a lot more deaths due to inability to get to a hospital. Yet Rural America is happy to keep voting GOP. As usual.
Now, to be clear, we’re not talking a few hospitals here or there, but hundreds of them.
More than 500 rural hospitals are at immediate risk of closure due to financial losses, according to a report from the Center for Healthcare Quality and Payment Reform. Another 300 rural hospitals are at high risk of closure due to either low financial reserves or because they rely heavily on revenue from sources beyond patients, such as government aid.
Together, nearly 900 rural hospitals — 40% of the nation’s rural hospitals — are facing a risk of closure, the group estimates.
More than 130 rural hospitals have closed over the past decade.
One would think when this many hospitals close down people in rural America would wake the fuck up.
But let’s be real here, most people in cities wouldn’t think this would affect them, just folks in the sticks. Weeeelllll, not so much.
Atlanta, GA Wellstar is closing Atlanta Medical Center, which services a lower income primarily black area. It is a 460 bed hospital and people are beyond pissed off. Wellstar closed other hospitals too, once again in poor areas.
after Wellstar also closed its smaller hospital, Atlanta Medical Center South in East Point, in April. At that time, Wellstar CEO Candice Saunders told the Atlanta Journal-Constitution that sending East Point patients to other hospitals including AMC in Atlanta was part of the plan to transition to a better model of care
And GA is being hit with hospital closures all over the state.
Eight rural hospitals have shut down in Georgia over the past 10 years, and more than a dozen others face dire financial struggles, but news of the Atlanta closure brought the trend to the capital city — and the thick of the campaign trail.
And here’s where things get questionable…
As a nonprofit hospital system, Wellstar pays no taxes with the expectation it will work for the public good.
However, Wellstar still makes a profit, and it makes more money from its hospitals outside of downtown.
So they pay no taxes, are still making a profit and are supposed to work for the public good yet they are closing several hospitals.
And they EVEN admitted that Medicaid Expansion would have helped things…
In a statement, Wellstar said it decided to shutter the hospital by Nov. 1 because it couldn’t find a “sustainable solution” to mounting costs. Executives added that Medicaid expansion alone would not have saved the facility from closing.
“While expanding Medicaid may have helped Atlanta Medical Center’s financial sustainability, it would not have changed this outcome,” the health system said in a statement to The Atlanta Journal-Constitution.
I want you to stop and read that bolded sentence again.. “it may have helped make it more financial sustainable but it wouldn’t have changed the outcome”. Say what? You’re a non profit hospital company who is supposedly closing hospitals due to lack of funds, yet you admit federal funds would help pay your bills but that “Would not change the outcome.” Let me guess, you’re outcome is higher profits EVEN THOUGH YOU ARE A NON-PROFIT? Yeah, we get you.
But backing away from corporate greed here and staying on topic.
The refusal of Red States to take Medicaid expansion money is basically the Republican Party committing manslaughter. They know more people will die as more and more hospitals close, they know that they will lose voters as this happens, but why don’t they care?
One- They know their voters are so brainwashed they won’t put two and two together and will somehow blame the Dems for this.
Two- They know that if they say “Well Medicaid Expansion will raise your taxes” they know their voters will immediately hate it and prefer to die on that hill, and not metaphorically.
And they did…
“One of the things that is lost on several people on the Democratic side is the fact that there’s this fountain of money that they claim exists from the Feds at a 90/10 split. True. But that 90/10 split is only temporary. The feds will not provide the states with when the 90/10 split will go back 2/3 and 1/3,” Jones said.
Jones says this means Georgia would be forced to raise taxes or cut spending on other programs.
“Even the Georgia Hospital Association claims Medicaid only reimburses to 88% of costs. You do not have to be an MBA from Wharton to understand you cannot run a business that’s only getting you back 88% of your costs,” Jones said.
One would think have 88% of your costs is better than 0% of your costs paid but okay.
Now, here’s where the GOP fucked up.
They’re killing people in cities now. “Yeah, but they don’t care because they’re black people who are poor.” Here’s the thing, lots of white people are poor, lots of white people live in urban areas that know black people who are poor. Georgia already proved that they would turn out to vote for Dems and Stacey Abrams is hammering this home on her speeches and twitter.
Kemp has kept his trap shut. Just like the GOP people who are scrubbing their sites of abortion rhetoric, Kemp knows this is bad.
Now…who is it that is trying to fix this gap that the GOP caused by not expanding Medicare? Yup, Democrats.
Today, as part of the Biden-Harris Administration’s ongoing effort to strengthen rural health, the Centers for Medicare & Medicaid Services (CMS) is releasing a new proposed rule protecting access to emergency care and additional outpatient services for people in rural communities. CMS is establishing the Conditions of Participation (CoPs) for Rural Emergency Hospitals (REHs). The proposed rule will allow small rural hospitals to seek this new health care provider designation and provide continued access to emergency services, observation care, and additional medical and outpatient services. In accordance with the statutory legislation, REHs will be eligible to receive payment for services provided on or after January 1, 2023. This is a significant step in building on the Administration’s efforts to reduce health care disparities and maintain access to services in rural communities.
To address these concerns, CMS is implementing a new Medicare provider designation called REHs, which will provide an opportunity for small rural hospitals and CAHs to right-size their service footprint and avoid potential closure so they can continue to provide essential services for their communities. The REH provider type was established by the Consolidated Appropriations Act of 2021 to address the growing concern over closures of rural hospitals.
And Bob Casey D and Grassley R are on it too (Yes Grassley is GOP but at least he’s trying to be useful.)
Sens. Chuck Grassley (R-Iowa) and Bob Casey (D-Pa.) are continuing their support for rural health care by introducing the Rural Hospital Support Act. Their bipartisan proposal seeks to permanently extend two key Medicare rural hospital programs and establish a new rebasing year — preventing closures that would disrupt access to care for individuals in rural communities. Grassley last led a successful reauthorization of these programs with Sen. Chuck Schumer (D-N.Y.) in the 2018 Bipartisan Budget Act.
So with GOP killing people in cities now, and cities tend to be more liberal, more and more people are going to be willing to go vote.
We’re already seeing this with women registering in droves to vote (subject of another diary)
The question remains, will enough people realize how politics affects them on every single level to not only vote this election, but the next ones?
We can hope.
In the meantime, more people in rural areas will die due to lack of care, more poor people will die, and yet day after day we’re forced to watch people attend Trump rallies and defend him.
At what point is enough going to be enough for the people who live in Red States to break out of their brainwashing and finally revolt against the very party that is killing them?
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