Hurting hospitals

Proposed budget cuts would be catastrophic for rural communities.

Zaida Morales and some friends from Spring Woods High School had stopped at a neighborhood food truck one day in late January 2016, when a drunk driver lost control of his truck and slammed into her, crushing her against a car and severely injuring both of her legs. She was rushed to Ben Taub Hospital’s trauma center, where a team of highly trained specialists began the treatments that over two months and 14 surgeries would save her legs. On graduation day this year, she walked across the stage to collect her diploma.

We tell Zaida’s story as a cautionary tale, a warning to the Republicans in the U.S. Congress and the Texas Legislature that draconian cuts to the Affordable Care Act, Medicaid and a wide range of other health-care programs will have a devastating impact on hospitals, not only big-city facilities like Ben Taub but smaller, rural hospitals all across the state. Zaida’s story has a happy ending because Ben Taub is open and fully staffed with a trauma team 24 hours a day, seven days a week. Maintaining that level of life-saving care is essential to everyone, rich or poor.

These services aren’t cheap, and hospitals have for years been struggling to balance their budgets while continuing to absorb rapidly escalating costs despite cuts in public funding and insurance reimbursements. The biggest shortfall is in caring for uninsured patients. Medicaid and uncompensated care reimbursements cover only 66.7 cents for every dollar Texas hospitals spend on Medicaid patients, according to a report by the Texas Department of Health and Human Services.

The budget stress diminished as more patients gained insurance under the ACA, but its replacement, the American Health Care Act, which passed the U.S. House last month, will throw millions back onto the rolls of the uninsured and cut $834 billion from Medicaid over 10 years. The Trump administration’s proposed budget would slice another $610 billion, and the 85th session of the Texas Legislature cut $1 billion in state Medicaid funding.

These cuts will be difficult for big-city charity hospitals like Ben Taub, but for small rural communities, they would be catastrophic. The rate at which these hospitals have been shutting their doors has escalated dramatically over the past decade, according to research from iVantage Health Analytics, and Texas leads the pack. Since 2013, 16 of our rural hospitals have closed. Of the 163 remaining, about one-third are vulnerable to closure. Add the Trump administration’s proposal to eliminate several programs designed specifically to help rural hospitals — on top of fewer insured patients under the AHCA — and the hospital closures will escalate.

Local, rural hospitals are the life-blood, literally, of many of these communities. Trauma specialists speak of the “Golden Hour,” that window in which critical patients have the best chance of surviving if they can get to a hospital. When rural hospitals close, patients suddenly find themselves many miles from the nearest emergency room. The result: While only 20 percent of our citizens live in rural communities, they account for 60 percent of trauma deaths.

Emergency care is only part of that life-blood. The populations these hospitals serve are often older, poorer and sicker, more likely to suffer from chronic conditions such as diabetes, heart disease, high blood pressure and, increasingly, drug addiction. Hospitals are their best source of care, sometimes the only nearby source.

We have a simple message for all of the Republican officials who want to take a meat ax to the entire range of public health programs. There may come a day when you or a loved one will suffer a critical trauma through no fault of your own and need top-notch emergency care. If you are in Washington, D.C., or Austin or Houston, you may be in luck. But if you are driving across West Texas on Interstate 10, you may find yourself in the kind of medical desert where many of our citizens live, where the nearest emergency room is well beyond that Golden Hour.

When rural hospitals close, patients suddenly find themselves many miles from the nearest emergency room. The result: While only 20 percent of our citizens live in rural communities, they account for 60 percent of trauma deaths.