February 12, 2020

How not to save rural health care

Recently, Gov. Jim Justice called for the creation of a task force to address West Virginia’s rural health systems. It’s a timely idea. Hospitals from the northern panhandle to the southern coalfields are facing a sea of troubles, from bankruptcies to layoffs to outright closings.

It’s a nationwide problem. According to researchers at the University of North Carolina, since 2005, 163 rural hospitals have closed around the country. Of those, 121 have closed since 2010. Last year saw the highest number of closings since 2005, with 19 hospitals closing their doors.

According to a national investigation by GateHouse Media, another 700 are “on shaky ground,” and around 200 are “on the verge of collapse.”

Looking at national trends, 72 percent of rural hospitals that closed did so in states that chose not to expand Medicaid.

As scary as things are here, they’d be a lot scarier if the state hadn’t made the decision to expand Medicaid back in 2013 to working people earning up to 138 percent of the federal poverty level. In 2018 alone, the expansion brought over $900 million to the state.

That money didn’t go to buying junk food or Mountain Dew. It went to providing preventive care, treatment for acute and chronic diseases, injuries and, when necessary, treatment for recovery from addiction. It also helped shore up health care providers, from hospitals to community health centers to physicians to nurses to other health care workers. And that means supporting local jobs and economies.

Here’s a modest proposal: While we’re trying to figure out how to make our rural health system better, let’s not make things worse by messing with Medicaid.

Unfortunately, a bill introduced in the legislature would do just that. House Bill 4018, if enacted, would make a bad situation worse by imposing reporting requirements on people covered by the program. The bill does nothing to actually promote employment — most of the people covered are already working. Instead, it creates another level of paperwork, bureaucracy and surveillance, wasting time and resources that could be better spent on getting and keeping people healthy.

The bill is similar to a failed policy enacted in Arkansas that was fortunately struck down in federal court. Before being shut down, the program needlessly cut off between one-fourth and one-third of people in the program, with no positive effect on employment.

Not only that, but it unnecessarily wasted taxpayer money. An audit by the nonpartisan Government Accountability Office (GAO), an investigative arm of congress, found the reporting requirement wound up costing that state $26 million. That added up to an unnecessary $152 in excess overhead costs for each person enrolled in the program.

If something like this was tried in West Virginia, assuming it would stand up in court (with all those associated costs) and assuming similar results, this would mean that somewhere between 40,000 and 53,000 of the approximately 160,000 beneficiaries would lose coverage. That means people not getting needed health care. And that means a proportional reduction in the $900+ million the expansion now brings to the state, not to mention millions in additional costs.

It’s a good thing to create a task force to figure out solutions. But for all kinds of reasons, let’s not make a tough situation worse by pulling the plug on rural health care’s life support system.

(This ran as an op-ed in the Charleston Gazette-Mail.)

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