Rural Georgia hospitals could face trouble as Trump and other Republican leaders struggle with healthcare policy.
The push to repeal Obamacare has failed — for now — although Georgia Senators Johnny Isakson and David Perdue both voted for all three versions of the repeal Senate Republicans tried to push through late last month.
The Trump administration along with congressional leaders will have to figure out just how far they are willing to screw over Americans in order to uphold campaign promises to repeal the popular healthcare law. Certain policy changes of the Affordable Care Act were set to go into effect years down the road, some of which we are starting to see take effect now. So even if Congress can’t pass a repeal bill they can still tinker with how well-funded and effective the ACA is, as some provisions just begin to take effect.
As Ariel Hart and Tamar Hallerman over at the Atlanta Journal Constitution report, hospitals in Georgia that provide care to low-income and uninsured patients stand to lose millions of federal dollars intended to support safety net hospitals.
According to the Kaiser Family Foundation, Georgia safety net hospitals received almost $300 million from the federal Disproportionate Share Hospital program in 2016. Hart and Hallerman report that, under the current proposal, safety net hospitals in Georgia could lose nearly all of that federal subsidy by 2025. The Centers for Medicare and Medicaid Services are currently taking comments on their proposed strategy for managing those cuts online.
The Disproportionate Share Hospital program, or DSH, has historically helped to offset the costs safety net hospitals incur meeting their ethical and legal obligations to care for people regardless of their ability to pay.
The end of the DSH program was written into the Affordable Care Act, based on the law’s original requirement that all states expand Medicaid. With significantly fewer people unable to get health insurance, the thinking went, safety net hospitals would no longer be covering large numbers of people who didn’t have health insurance and couldn’t pay for care.
However after the courts overturned the provision of the ACA requiring states to expand Medicaid, there was never a change to the law sun-setting the DSH program. Once that ends, hospitals will be out millions of dollars they use to help make up the costs of providing care to uninsured people.
Rural hospitals serve as safety net hospitals in many parts of Georgia, where the uninsured rates can surpass 25 percent. As the Disproportionate Share Hospital program faces substantial cuts, lawmakers on the state and federal level are going to have to decide just what their priorities are. Is it more important to refuse to work on the Affordable Care Act or expand Medicaid at the cost of more rural hospitals being unable to financially stay afloat? More rural hospital closures would be devastating; Georgia alone has seen six hospitals close in the past seven years.
State lawmakers intermittently toss around ideas to expand access to care without actually expanding Medicaid. This takes the form of proposals to increase access to telemedicine in rural areas or talk of pursuing Section 1115 waivers, which could serve as an alternate path to getting more people on Medicaid.
However, as we already saw this year, state policymakers like to talk about healthcare — particularly rural healthcare — but little actually gets done.
Rural hospitals are on the line, as is the health of the Georgians who depend on all of the state’s safety net hospitals for care. Just how much are policy makers willing to sacrifice rural healthcare and the health of low income Georgians just to score a cheap political “win”? Is destroying the ACA really worth it?