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Medicaid cuts (or no expansion of Medicaid) is pretty "no basis in reality" in a lot of rural areas.
The states who didn't allow for Medicaid expansion? Read this:
https://www.motherjones.com/politics/2018/07/rural-hospital-closures-trump-republicans/
But there’s another crisis linked to hospital closings: job losses. In many rural communities, the hospital is the largest employer. Brad Gibbens, a researcher at the University of North Dakota, estimates that when one shuts its doors, up to 25 percent of the surrounding region’s economy disappears. A cascading shortage of physicians and other health care professionals soon follows.
So why are so many hospitals closing? Carole Myers, an associate professor at the University of Tennessee-Knoxville who studies health care policy, says medical facilities in rural areas have long struggled thanks to sparse populations and high poverty rates. But the situation is significantly worse in the 17 states that have not joined Obamacare’s Medicaid expansion, most of them heavily rural. Those states have a higher rate of uninsured people, which means hospitals—which can’t turn anyone away from the emergency room—have to provide more uncompensated care.
According to a recent study from the Colorado School of Public Health, hospitals in states that did not expand Medicaid are six times more likely to close than hospitals in states that did, because they see more uninsured patients and provide more free care. “Not to say Medicaid in and of itself is profitable, but something’s better than nothing,” Richard Lindrooth, the lead author of the study, told Mother Jones. “It still pays better than uncompensated care.”
Most closures have happened in places where people came out in droves to vote for Donald Trump—and yet his administration hasn’t done much to turn the tide. Legislation sponsored by Rep. Sam Graves (R-Mo.) would expand funding and create more protections for rural hospitals. But the bill hasn’t gained much momentum: It has sat dormant in the House since 2015, though it was reintroduced last year. Meanwhile, in January, the Centers for Medicare and Medicaid Services reduced the reimbursements for a program that allows rural hospitals to buy drugs at significant discounts. And Republicans have suggested turning Medicaid into a block grant—a fixed amount of money doled out to states. Critics argue this system would just lead to more funding cuts as politicians wrestle over who gets what, potentially leaving hospitals worse off than before.
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