Pearl River      Rural America, the story goes in political rhetoric, is deep red.  When it comes to a many issues that might mean “in the red” from studies we have done on the operation of rural electric cooperatives.  Thart’s not all of course, and maybe not even the worst problem.  When there’s a close look at rural health care the red may come from the bleeding out of rural hospitals.

The status of rural hospitals is not just a local issue or a Southern issue.  In some dozen states the failure to expand Medicare for conservative ideological reasons is crippling hospitals and their communities, but the problem is everywhere.  I have friends in the New England area, who are debating moving to cities because they are too far from hospitals, and when they get there the hospitals are closing.  One report finds that “Over 100 rural hospitals have closed over the past decade, and nearly 700 additional rural hospitals — over 30% of all rural hospitals in the country — are at risk of closing in the near future.”  Those that are hanging in face staffing crises in keeping qualified doctors and experienced nurses.  A frightening amount of data is establishing that some surgical procedures are riskier in smaller hospitals, where doctors don’t have the repetitive experience that keeps skills up to date and improving.  Where rural hospitals are still open many have had to shut down maternity and ob-gyn practices because they aren’t profitable.  Many hospitals have been bought by private equity investment companies and the bottom line trumps any other health concerns for the community.  These kinds of fights are popping up in rural areas and smaller towns all over the country and in fact across the world.

And, then there’s the problem of Medicare Advantage sucking the life out of healthcare everywhere, but especially in rural hospitals.  As an editorial in the Times-Picayune stated clearly:

Medicare Advantage plans, which are offered by private companies  to Medicare-eligible individuals are proliferating across Louisiana and the nation.  But the plans generally pay hospitals 8-10% less in reimbursements than traditional Medicare and frequently they reject some claims outright.  That puts the squeeze on rural hospitals and their patients who need care…The Department of Insurance told [reporters] that more than half of Louisiana’s Medicare population has a Medicare Advantage plan.  For some inpatient cases, reimbursements for Medicare Advantage patients were 37% lower than for other Medicare patients.

A Chartis report cited in the same editorial found that “nearly 50% of the nation’s rural hospitals are operating in the red.”  A hospital director in rural northern Louisiana said that “Medicare Advantage is essentially an existential threat to rural facilities nationwide.”

I know I don’t need to remind anyone that this is a scam, where public dollars are being diverted from patients, they are designed to support, to fill the pockets of insurance companies.  It’s little wonder that an assassin can morph into a folk hero.  Doing more for rural hospitals would be a step in the right direction.

If it’s this bad in Louisiana, where under Governor John Bel Edwards, the state embraced the coverage offered to citizens and expanded resources for hospitals, especially rural facilities, offered by the Affordable Care Act, it’s simply unconscionable to imagine how bad it is in the countryside of the holdout states.  Conservative politicians like to harvest rural voters with one claim or promise after another, but they need to pay more attention to keeping them alive if they want to keep their votes.