Health Care,  Stateside

A Republican I could vote for

It’s been several decades since I voted for a Republican (a circuit court judge in the 1970s), but if I lived in the small town of Belhaven, North Carolina, I’d have no problem voting to reelect the Republican mayor.

The Republican mayor of the small town of Belhaven, NC began a 273-mile walk to Washington, DC today to draw attention to the health care crisis threatening his rural coastal community following the closure of the area’s only hospital. Vidant Pungo Hospital served over 20,000 people in Beaufort and Hyde counties — a area of North Carolina with higher-than-average poverty rates and where many residents are uninsured.

After a prayer of blessing by NC NAACP President Rev. Dr. William Barber, Mayor Adam O’Neal set off on foot for the nation’s capital, where he plans to ask President Obama and Congress for help. On July 1, Vidant Health closed the 49-bed hospital for financial reasons, forcing residents of the Belhaven area to travel more than an hour to receive emergency care. The town had tried to take ownership of the hospital to prevent its closure, but negotiations broke down. Vidant has opened a clinic in Belhaven, but it doesn’t provide emergency care.

The mayor will stop in towns and cities along the way to deliver a message that puts him at odds with his party’s leadership: that expanding Medicaid under the Affordable Care Act could have prevented the hospital’s closing and the creation of a “medical desert.” North Carolina and 23 other states — all of them Republican-controlled and including most states in the South — have refused Medicaid expansion.

Although there’s no evidence that 48-year-old Portia Gibbs died due to the closure of Vidant Pungo Hospital, that can’t be ruled out.

Certainly there are people who have suffered unnecessarily and died due to the closure of rural hospitals.

By refusing to expand Medicaid, Republicans in these states (including here in Virginia) are not only allowing their tax money to be funneled to other states; they are making it impossible for many hospitals serving low-income rural areas to stay open.

As ThinkProgress reported:

Providers that serve a high number of poor and uninsured Americans, technically called “Disproportionate Share Hospitals,” often operate on a loss because their patients can’t always pay for their care. To compensate, the federal government offers reimbursements for those hospitals — but the Affordable Care Act changes the way the payments are structured. Because the health law intended every state to expand Medicaid, and therefore reduce the number of uninsured people who can’t pay their bills, the reimbursements for DSH hospitals have been reduced.

But if hospitals are located in states that continue to refuse Obamacare’s Medicaid expansion, that puts them in a difficult spot. They’re losing out on some of the federal government’s funding without making up the difference with an influx of insured patients.

This is by no means an unexpected consequence. For years, rural providers have been warning that failing to expand the public health program will put them in jeopardy. Last December, the Tennessee Hospital Association predicted that rural hospitals would be forced to start closing unless the state reversed its decision on Medicaid. The Rural Policy Research Institute sees the fight over this particular Obamacare provision as one of the most important issues facing its constituency.

Nonetheless, GOP-led states have remained steadfast in their opposition to Medicaid expansion. Rural hospitals are beginning to close in states like Georgia, North Carolina, and Virginia. These facilities are often located in areas where poor residents desperately need access to health services.

Continuing my laser-like focus on Obamacare in Kentucky– a Republican “red state” that accepted Medicaid expansion– the Kentucky Health News website reported in June:

Hospitals that most often treat the poor and uninsured are seeing fewer uninsured patients since the new health law’s expansion of Medicaid, Phil Galewitz reports for Kaiser Health News. Kentucky’s safety-net hospitals have also seen a drop in their uninsured patients.

Safety-net hospitals, which are often not paid for the billions of dollars it costs to care for the disproportionate share of poor and uninsured people they care for, will benefit most from the health law’s expansion to more than 13 million people this year, Galewitz writes.

Hospitals across the country had expected this outcome, but told Galewitz in interviews that it has happened “faster and deeper” than anticipated — “at least in the 25 states that expanded Medicaid in January.”

Kentucky is one of the states that agreed to the Medicaid expansion and has expanded health coverage to some 413,000 people, with 75 percent of them reporting that they did not have coverage before signing up on Kynect, the state’s health insuance exchange.