Want Idaho’s rural hospitals to stay open? Legislature must keep Medicaid expansion | Opinion
Idaho lawmakers are closing in on a self-imposed deadline of Jan. 31 to re-evaluate Medicaid expansion in Idaho, which voters overwhelmingly passed by initiative.
If lawmakers care about the fate of rural hospitals — or about the patients those hospitals serve — they should leave the program unaltered.
Medicaid expansion covered the working poor, people making between 100% and 138% of the federal poverty level. Those people had fallen into an unplanned gap in the Affordable Care Act, making too much to qualify for traditional Medicaid but not enough to qualify for subsidies for private insurance.
That coverage has changed the landscape for rural health care in Idaho, said Brad Huerta, CEO of Lost River Medical Center, a rural critical access hospital with clinics in Arco and Mackay.
“I’m hopeful that as the Legislature meets, if they start looking at scaling back Medicaid, they take a good hard look at what that really means,” said Huerta. “(Expansion) is good for Idaho; it is good for rural communities. You should expand it, frankly, if you care about rural areas.”
Earlier this month, the Mississippi State Medical Association warned lawmakers there — who continue to refuse Medicaid expansion — that half of rural hospitals are on the brink of closure, according to the Mississippi Free Press.
That’s in line with a national pattern.
Though today fewer than one-quarter of states (representing less than a third of the population) have refused to expand Medicaid, those states account for nearly three-quarters of rural hospital closures since the passage of the ACA, according to a September report by the American Hospital Association.
Idaho, which has Medicaid expansion, isn’t facing a spate of rural hospital closures. Huerta doesn’t find that surprising.
Hospitals rely on a large number of patients to be able to make enough to cover bad debt for patients who can’t pay.
“We’re so reliant on volume,” Huerta said. “That’s how hospitals are paid.”
But rural areas by definition have smaller populations. That means less patient volume. One expensive patient with no means to pay can represent a much larger burden for a rural hospital than for a large urban hospital because that one patient could be a much larger percentage of total costs.
And disproportionately patients in rural areas don’t have the means to cover their care.
“Rural communities tend to be poorer communities,” Huerta said, particularly the area his hospital serves. “We have some of the highest poverty rates in the state.”
Huerta said he’s seen positive steps toward bending the health care cost curve post-expansion. More patients are coming in for routine care or for treatment early in a disease process. In many cases, that means a patient can be successfully treated before a disease becomes more complicated — and more expensive.
So in cases where it’s hard to collect, the bills are smaller.
“It’s a lot easier to write off $20 than $10,000,” Huerta said. “We’ve seen a dramatic decrease in bad debt.”
Idaho doesn’t just have a few rural hospitals. The vast majority of its hospitals are rural, and the vast majority of Idaho’s landmass (though not necessarily its population) is served by rural hospitals.
All that adds up to hospital closures. And rural hospitals closing means rural people dying. If you have a heart attack or a stroke, the time it takes you to get to the ER can be the difference between full recovery, permanent disability or death. And the farther the hospital is, the longer it takes to get there.
The stakes of lawmakers’ decision for Idaho’s rural population are clear, Huerta said.
“If you want those hospitals to stay open, then there’s really no other option than to keep Medicaid expansion,” he said.
This story was originally published January 25, 2023 at 4:00 AM with the headline "Want Idaho’s rural hospitals to stay open? Legislature must keep Medicaid expansion | Opinion."