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AFT Nurses and Health Professionals: A Union of Professionals.

On Healthcare and Hospitals in Rural America: A Perfect Storm

As the U.S. Senate considers its version of the American Health Care Act, rural voters and their elected Representatives should anticipate a perfect storm of budget cuts, hospital closures and job losses hidden in the bill's proposals.

The cuts in the proposed AHCA will be devastating for Americans in rural communities who already struggle to get the care they need.

* Rural residents already have a harder time getting the healthcare they need because there are fewer providers, greater poverty and fewer insurance options in rural locations.

* The uncertainty around whether the GOP will fund "subsidies" for health coverage is causing many insurers to leave the marketplaces. Entire counties in states like Ohio will be without any insurers in the independent market.

* Eliminating the tax credits provided by the Affordable Care Act would put health coverage out of reach for many Americans, particularly rural residents.

More rural hospitals would close, and local economics would suffer if the American Health Care Act is signed into law.

* Rural hospitals already face greater challenges, operating with smaller profits or larger losses than suburban or urban hospitals. Rural hospitals are generally in areas with higher poverty rates, lower levels of insured populations and a higher percentage of government payers.

* When a rural hospital closes, it has a double impact on the community. The hospital may be the only major healthcare provider available and one of the region's few large employers. Some predict that more than 600 hospitals could close if the AHCA is signed into law, eliminating tens of thousands of stable healthcare jobs, which are an anchor in rural economies.

* If the proposed budget cuts to community services are made, hospitals would become the place of last resort for healthcare, with sicker patients seeking basic care in emergency rooms as they did before passage of the ACA in 2010.

If Congress cuts Medicaid, many residents in rural communities could lose the only coverage they have.

* Nearly 1.7 million rural Americans gained coverage through Medicaid expansion--and that coverage is at risk if the AHCA passes.

* Because rural residents rely more heavily on public insurance, the AHCA would hit Americans living in rural communities the hardest, particularly targeting poor residents, ages 50-64, and those with pre-existing conditions. In extreme cases, the amount an older consumer might owe for a plan could exceed that person's annual income.

* Cutting Medicaid makes fighting the opioid crisis even more difficult, if not impossible, because poorer patients could lose their healthcare coverage, and the AHCA could allow insurance companies to eliminate coverage for all addiction services.

Resources and background facts On hospitals: -facilities/ -face-closure-if-gopreverses-medicaid-expansion/#1ac1ce353e91

Researchers from the University of North Carolina at Chapel Hill found that rural hospitals saw an improved chance of turning a profit if they were in a state that had expanded Medicaid. iVantage research points to 673 facilities that are now vulnerable or at risk for closure in 2016, according to Michael Topchik, senior vice president at iVantage Health Analytics, who wrote, "We estimate that if this group of 673 hospitals were to close, 11.7 million patient encounters would be at risk, and lead to a potential loss of 99,000 healthcare jobs, 137,000 community jobs and $277 billion to the GDP."

On rural residents and access to care in states:

The Washington Post on AHCA and mental health coverage

The GOP plan and rural health

The Republican proposal might knock all 16,000 of these Alaskans out of insurance markets. -creditaptc/?currentTimeframe=0

In the most extreme example, Alaskans in the Obamacare exchanges currently receive tax credits at rates double the average for the rest of the country, a number that reflects the scarcity of coverage in Alaska and the demands of covering an almost entirely rural state.

The Center on Budget and Policy Priorities explains how GOP Medicaid cuts could harm rural Americans. Nearly 1.7 million rural Americans gained coverage through the Medicaid expansion in at least eight expansion states (Alaska, Arkansas, Iowa, Kentucky, Montana, New Hampshire, New Mexico and West Virginia).

The National Rural Health Association outlines the impact of President Trump's budget for the rural health safety net.

The Washington Examiner reports that about 700,000 people in Ohio took advantage of the ACA's Medicaid expansion.

According to a 2014 study by Truven Health Analytics researchers, Medicaid paid for nearly one-quarter, or $7.9 billion of $31.3 billion, of projected public and private spending for drug treatment in 2014.


What It Is and Why It Matters to You

Medicaid covers those who need it most. It is the single largest source of public health insurance in the U.S., covering nearly 70 million Americans. Jointly funded by the federal government and states, Medicaid provides health insurance coverage to Americans with limited financial resources. The federal share varies by state from a floor of 50 percent to a ceiling of 74 percent.

Medicaid covers kids. Medicaid and the closely related Children's Health Insurance Program together cover more than one in three American children (34 million). (1) Medicaid also provides at least $2.5 billion annually to support school-based healthcare services like school nurses, speech pathology, occupational therapy and psychology--services that research shows are linked to better education outcomes for students.

Medicaid assists senior and Americans with disabilities. Nearly 10 million seniors and Americans with disabilities who are eligible for Medicare also qualify for Medicaid. That is, 14 percent of Medicare beneficiaries are "dual eligibles." Medicare has significant out-of-pocket requirements, and many seniors and individuals with disabilities have low incomes and modest savings. In 2013, half of all Medicare beneficiaries had incomes below $23,500. (2) Medicaid helps these people pay their Medicare premiums and out-of-pocket costs to ensure they have access to the care they need.

By almost any measure, Medicaid expansion has been a win for patients, providers, and taxpayers. Under the Affordable Care Act (ACA), states have the option to expand Medicaid to cover adults under 65 earning less than 138 percent of the federal poverty level. It's a great deal for states: The federal government paid 100 percent of costs of newly eligible beneficiaries through 2016 and will pay 90 percent hereafter. The 32 states that expanded Medicaid coverage to nearly 16 million Americans have consistently outperformed nonexpansion states. Expansion states have lower patient medical debt, lower hospital uncompensated care costs, and lower marketplace premiums. (3)

Republican proposals would cause a state fiscal crisis and limit access to care. Repealing Medicaid expansion under the ACA is the tip of the spear of Republican proposals to cut Medicaid funding. Proposals come in two forms: the block grant and the per capita allotment. While there are important differences between the two, both are designed to reduce the financial obligation of the federal government to fund its share of the Medicaid program. The Republican budget plan for 2017 (if it had passed) would have cut federal Medicaid funding by $1 trillion over 10 years. By the 10th year, federal funding for Medicaid and the Children's Health Insurance Program would have been one-third less than under current law. (4) These policies would force states to compensate for reduction in the federal share, limiting enrollment, cutting benefits and/or reducing already low rates to healthcare providers. Safety-net hospitals that service a large share of low-income patients would come under additional financial duress, and many other hospitals could decide to withdraw from the Medicaid program altogether, limiting patient access to care.

Organizations Opposing the American Healthcare Act/ Better Healthcare Act


* Alliance for Healthcare Security

* Alliance for Retired Americans

* American Academy for Family Physicians

* American Bridge

* American College of Physicians

* American Congress of OB/GYNs

* American Diabetes Association

* American Medical Association

* American Medical Women's Association

* American Hospital Association & Federation of American Hospitals:

* American Cancer Society Cancer Action Network

* American Federation of Teachers

* AFT/Nurses and Health Professionals


* American Federation of State, County, and Municipal Employees

* American Federation for Suicide Prevention

* American Health Care Association (AHCA)

* America's Hospitals and Health Systems

* American Medical Association

* American Medical Student Association

* American Osteopathic Association

* American Nurses Association

* American Public Health Association

* Asian & Pacific Islander American Health Forum

* Association of American Physicians and Surgeons

* Catholic Health Association of the United States

* Center for American Progress

* Center for Medicare Advocacy

* Cystic Fibrosis Foundation

* Children's Defense Fund

* Children's Hospital Association

* Community Catalyst

* Consumers Union

* Doctors for America

* Families USA

* Federation of American Hospitals

* Feminist Majority

* National Disability Rights and Network

* HIV Medicine Association

* Leadership Conference on Civil and Human Rights

* Medicare Rights Center

* MomsRisings


* Sister Simone Campbell, NETWORK Advocates for Catholic Social Justice

* National Association of Psychiatric Hospitals

* National Committee to Preserve Social Security and Medicare

* National Council of LaRaza

* National Disability Rights Network

* National Medical Association

* National Nurses United

* National Partnership for Women and Families

* National Physicians Alliance

* National Committee to Preserve Social Security & Medicare

* National Center for Transgender Equality

* National Education Association

* National Women's Law Center

* Network for Patient Advocacy

* Our Revolution

* Planned Parenthood

* Service Employees International Union

* Young Invincibles


Kaiser Family Foundation. "Children's Health Coverage: Medicaid, CHIP and the ACA." March 2014. Accessed: -coverage-medicaid-chip-and-the-aca/

Kaiser Family Foundation. "Poverty Among Seniors: An Updated Analysis of National and State Level Poverty Rates Under the Official and Supplemental Poverty Measures." June 2015. Accessed: -analysis-of-national-and-state-level-poverty-rates-under-the-official-and-supplemental-poverty-measures/

Luojia Hu et al. "The Effect of Patient Protection and Affordable Care Act Medicaid Expansions on Financial Well-Being." The National Bureau of Economic Research. April 2016; David Dravove et al. "Uncompensated Care Decreased at Hospitals in Medicaid Expansion States But Not at Hospitals in Nonexpansion States." Health Affairs 35(12). December 2016; Aditi P. Sen and Thomas DeLeire. "The Effect of Medicaid Expansion on Marketplace Premiums." ASPE Issue Brief. September 2016. Accessed: https://aspe.

Edwin Park. "Medicaid Block Grant Would Slash Federal Funding, Shift Costs to States, and Leave Millions More Uninsured." Center on Budget and Policy Priorities, November 2016. Accessed: -federal-funding-shift-costs-to-states-and-leave
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Publication:The Pulse
Date:Aug 1, 2017
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