Is Obamacare’s Assault on Rural Health Care A Battle in the Larger War Against Rural America?
As I stared at blue sky above the pines on my property I knew my body was broken, and with a yelp slowly raised myself from the ground. I had taken my son’s dirt bike to get the mail, and on the way back to the house I decided to take a detour through the field to enjoy the beautiful Fall afternoon. As I rounded a turn in the corner of a grassy field I braked slightly, shifting my balance forward on the 125cc 4-stroke bike. At that moment the front tire hit a divot hidden by the grass, and I was sailing through the air, landing on the hard packed North Carolina clay on my shoulder. Amazingly my neck and head were pain-free, but I knew my shoulder was either dislocated or broken, and I worried that the pain in my side while breathing was symptomatic of a punctured lung. There was no dusting myself off from this one; I was going to need medical care and fast.
The two nearest hospitals were roughly 25 minutes away, and a 911 call to get an ambulance likely would bring it to an hour before I would reach either of them.
Both rural hospitals have issues. Their communities have been dying for decades, the textile industry that underpinned both having long ago left the area searching for cheaper labor in Latin American and Southeast Asia. One town resorted to tourism, playing up its ties as the site that inspired Andy Griffith’s fictional Mayberry in The Andy Griffith Show. The other town has been trying for years to become a small town known for its trendy restaurants and shops like nearby Blowing Rock, which itself was struggling to become more like trendy Asheville, a city that yearned to become North Carolina’s Sante Fe. But the popularity of the Andy Griffith Show has waned as its fan base aged and died along with Andy Griffith himself, and the City Fathers of the other town have ignored the new ideas that come with new residents, preferring to stick with the Old Boy Network for ideas, strangling growth. For example NASCAR was born only a few miles away from town, and hot rods, classic custom cars are still deeply revered here, yet the town banned cruising 10 years ago and killed the nightlife that had begun when teenagers and car enthusiasts had started hanging out in town.
The hospitals themselves have taken different paths. The one in Mayberry remains independent and small with a few dozen beds. It has a bad reputation based on several citations by the State for providing substandard care and its future is bleak. The other hospital built an entire new wing and emergency room in the expectation that the government would expand Medicare/Medicaid and that the hospital would be able to make money from higher reimbursements for providing care to the poor and elderly. It was a bad decision, and the hospital has been weighed down by the huge debt used to fund the expansion and the switch electronic medical records as Medicare/Medicaid reimbursements have been cut. It has since traded its independence for an “agreement” with one of the Mid-Atlantic’s largest for-profit hospital systems that is turning it into a referral hub for the hospital system. The system holds an option to buy the rural hospital but is in no hurry to exercise it. The hospital needs the health system more than the health system needs the hospital. While the local members of the hospital’s board may not understand that everyone else does.
I texted my son and he found me walking back to the house, holding my arm tightly against my body. I directed him to lock up the bike, put the dogs inside, and get my insurance card. One lesson I have been trying to teach him is the importance of keeping a cool head amidst trouble. As I’ve gotten older I’ve come to appreciate the value of this lesson. He then drove me about 35 miles to a large hospital that happens to be owned by the same hospital system that has the agreement with the rural hospital mentioned above.
I discussed my thinking with one of the doctors who treated me. He doubted whether the hospital had the skills needed to treat my injuries on a Saturday evening. “They likely would have transferred you here anyway,” he said. I would have wasted even more time as well as incurred the additional expense of 50 mile ambulance ride.
Most rural hospitals have staffing issues since they have to compete for the same medical professionals as suburban and urban areas. In the past this has meant rural hospitals paid more, and since Medicare/Medicaid reimbursed more for rural care they could afford it. Obamacare changed that; in order for the law to be budget neutral it built in cuts to medicare/medicaid that weren’t anticipated before the law’s adoption. The law has also increased penalties for re-admission, straining the budgets of rural hospitals even further. In the in-depth article “Rural Hospitals in Critical Condition“ USA Today reporters Jayne O’Donnell and Laura Ungar claim the Affordable Care Act aka Obamacare has damaged the survival of rural hospitals, pointing out that since 2010 over 40 rural hospitals have closed, forcing rural residents to drive long distances for medical care. O’Donnell and Ungar state the law’s requirements such as re-admission penalties and electronic health records added to the burden for rural hospitals.
“They set the whole rural system up for failure,” says Jimmy Lewis, CEO of Hometown Health, an association representing rural hospitals in Georgia and Alabama, believed to be the next state facing mass closures. “Through entitlements and a mandate to provide service without regard to condition, they got us to (the highest reimbursements), and now they’re pulling the rug out from under us.” (link)
Although painful and at least temporarily debilitating my injuries were not life threatening. But I’m reaching the age where my former life of a pack a day smoking, heavy drinking and bad eating habits are catching up with me, and a heart attack or stroke would not be considered unusual for a man of my age. In such an event every minute counts, and the USA Today article points out the importance of the Golden Hour where hearts and brains can be saved with medical intervention. Should the hospital in Mayberry disappear as seems distinctly possible, there will be people in its footprint who will have to travel for close to an hour to reach immediate medical care. Add in a 911 call to the volunteer fire department for pick up by an ambulance and the loss of the hospital, even a poorly performing one, would be disastrous for the local community just as its been in the towns discussed in the USA Today article. Rural living is hard enough, but take away the safety net of a decent hospital close by and living here becomes downright dangerous for some.
Is this what the Obama Administration wants? It’s not as if the administration has embraced rural America. It disdains its values and laughs at its traditions. Worse it has implemented policies that go well beyond cutting funds to rural hospitals, policies that tear at the very fabric of rural life itself.