Obamacare could have helped hospital
The death certificates for Jenkins Medical Center in Millen and Georgia’s six other now-moribund rural hospitals would list lots of contributing factors, chief among them a population too small to support the costs of running an all-purpose facility. Rural populations are declining, while the cost of medical care rises. Congress has cut Medicaid and Medicare benefits, and that’s felt at every hospital, as they depend on government reimbursements.
But somewhere on the list of contributing causes should appear this word: partisanship. Here, as in 18 other states controlled by Republicans, the decision to turn down Medicaid expansion as a protest against Obamacare helped seal the fates of vulnerable hospitals. Maps marking hospital closings nationwide show the states that turned down Medicaid expansion have disproportionate numbers of shuttered hospitals.
No question more government reimbursement for care that’s otherwise not covered would have helped Jenkins’s financial picture. So it is, too, in Savannah, where Memorial University Health Center would have seen less red ink in its budget.
Under the Affordable Care Act, states that agreed to raise the income ceiling for Medicaid eligibility covered millions more people than states that did not. This was a huge help to hospitals, as they got paid for caring for more people with little income, people not likely to be able to pay for their own care. If they’d been poorer, they could have qualified for Medicaid under the old rules. With a little more income, they would have qualified for subsidies under the ACA’s health care marketplace. The ACA planned to cover the gap by offering Medicaid expansion for those patients caught in the middle. But when the U.S. Supreme Court said that states could turn down the offer, most Republican-led states said thanks, but no thanks.
If Georgia officials had said yes, an estimated 650,000 more people would have qualified for Medicaid, people who now have no health care coverage, many of them in low-wage, no-benefit jobs such as waitressing. As for paying for Medicaid for so many more people, the ACA requires the federal government to cover the entire cost from 2010 through last year in states that accept the expansion. Those states start kicking in to help this year at 5 percent, but will never pay more than 10 percent under the law, and that won’t happen until 2020.
In Georgia, as in other no-thanks states, lawmakers and hospital experts are trying to hammer together some other way to handle that coverage gap without linking it to the O-word. If they meet certain criteria, they can qualify for more federal help under Social Security.
In the years since the ACA’s enactment, some states that signed on for the Medicaid expansion have complained that it will cost more than they expected. But states that said no are seeing hospitals shutting down, especially in rural areas, at greater rates.