U.S. health care faces a hostile takeover
Congress has been famously unable to make a decision about the role of government versus the free market in health care financing. Unfortunately, their inability to move forward on financing is provoking an existential threat to actual health care infrastructure.
Financing is similar to blood. If blood does not circulate, the body dies. Financing is what pays for employee salaries, maintenance of buildings and equipment, and so much more. If the flow of finances is cut off, either by insurers pulling out of the system or by cuts to federal programs such as Medicaid and Medicare, employees are laid off, buildings are closed down and sold, and organizations die.
When the ACA (better known as Obamacare) was signed into law, several things happened. Many payment sources to clinics and hospitals were cut back or eliminated in the expectation that Medicaid expansion would cover the cost. Some of this Medicaid expansion occurred through states and some through purchase of insurance through Exchanges.
In rural areas where there are few large employers, an exceedingly high percentage of health care is financed through public sector sources: Medicaid, Medicare and grants. Grants were cut back, along with several other important funding streams.
Now, federal government has acted (and failed to act) in several ways that destabilize infrastructure:
The White House has ended subsidies to insurers who sell their products to low-income people through exchanges. To cover this cost, insurers will raise premiums beyond what is affordable for families at 100 percent to 250 percent of the federal poverty level (and perhaps for the rest of us, too), forcing them to drop their insurance. This will increase the amount of unreimbursed care that must be provided by clinics, hospitals and other providers, which forces them to lay off staff, close programs and cut back care.
Congress has failed to authorize funding for the new fiscal year for a variety of important programs. Seventy percent of the federal funds supporting Federally Qualified Health Centers (known by the majority of people as primary care clinics), several key Medicare and Medicaid funding streams to hospitals, and the Children’s Health Insurance Program (CHIP) have not yet been authorized. This withholds critical funding from hospitals, clinics and behavioral health providers. If it
is not quickly reinstated, many will close.
Congress has threatened, in its federal budget and through tax cuts, to dramatically cut back Medicare and Medicaid.
In urban centers, there are often two sets of health facilities, one of which serves the poor and one of which serves those with means. If the health care infrastructure for the poor is destroyed, those with the means to pay can still seek care. However, in rural America, the same clinics, hospitals and behavioral health providers serve everyone. If, for example, Española Hospital and Rio Arriba’s Federally Qualified Health Centers were to shut their doors, everyone in Rio Arriba would lose their providers.
Moreover, because health care makes up 25 percent of the total rural economy (as opposed to about 16 percent or less in urban communities), failure of health care threatens the collapse of the rural economy.
There is a reason Republican donors have targeted health care. It is an extension of vulture capitalism, where one company swallows another, liquidating workforce and assets to pay top management and a few shareholders big bonuses. The proposed tax cut for the ultrawealthy is nothing more than a scheme by a few unscrupulous billionaires to liquidate America’s health care system in order to pay themselves a one-time windfall, consequences be damned. It is a hostile takeover of our national infrastructure.
This is nihilism, and it must be stopped.
Reichelt is director of Rio Arriba County Department of Health and Human Services and coordinator of the Rio Arriba Community Health Council.