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Like us at Perspective reported, although the version of the Senate of the Republican Budget Reconciliation Bill should be much more moderate than that of the Chamber, Regarding health care, it is more extreme. This surprised many Republicans, some of whom now want changes. And they are all highlight the same area of concern. It would be “potentially really bad for rural hospitals,” said senator Josh Hawley (R-MO) The Wall Street Journal. This “will harm our rural hospitals and injure them significantly,” said senator Jim Justice (R-WV). Senator Susan Collins (R-ME) expressed “concerns about the effect on rural hospitals of her state”.
All this is certainly true. The Senate cuts the supplier taxA way for states to obtain more federal funding for their Medicaid programs, as well as the cuts of houses that have been analyzed as leading to at least 11 million people in fewer people on Medicaid rolls, deeply harm the 700 rural hospitals and more Already risky of closure.
But it is an overly narrow setting. The entire network of health care providers would have strong pressure and perhaps collapse.
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Indeed, each node of the system is interdependent. If the 190 estimated rural hospitals In a recent report by the For American Progress Center as collateral damage to closed republican cuts, all their patients must find treatment for other health care providers. Many of these new arrival patients are likely to be uninsured (many have thrown Medicaid or Obamacare by the Republicans), crushing the finances of the hospital and potentially add more closures above.
This means overcrowded hospitals and overloaded staff, in addition to serious difficulties for patients traveling long distances for care. “The Budget of the Republican Senate accelerates the collapse of the rural hospital which is underway, such as jet fuel on a fire,” said Alex Lawson of Social Security Works, who works directly on health care problems in Washington. “Hospitals that are not close will be those that people will drive four hours to access. The quality of health care of all in this country will fall. “
Hospitals have obtained a crisis to the next for years. Between the cocovated pandemic 2020 and 2024, 36 closed rural hospitalsOn the heels of 136 closings During the previous decade. 16 others have closed this yearsuggesting an acceleration of the trend, and Hundreds of others are at risk.
If the whole hospital does not close, non -profitable emergency services are often closed first. “I have spoken to many hospitals worried about having to close maternities,” said Chiquita Brooks-Lasure, who led the Centers for Medicare & Medicaid Services (CMS) in the Biden administration. In California only, 56 hospitals ended maternity care Since 2012, and the maternity desert crisis has been acute.
The situation is worse, said Brooks-Lasure, in states that have not expanded Medicaid, suggesting that the program is a lifeline for hospitals, providing a constant flow of paid complaints for insured patients. Indeed, Medicaid is often the largest element of line in the budgets of accounts to be received for nursing homes, rural hospitals and maternity rooms, as an anthony Wright of Families USA noted at the rampart. A letter To the Republican leaders citing data from the Sheps Center for Health Services Research of the University of Caroline du Nord notes that 213 rural hospitals serve a disproportionate part of Medicaid patients.
While hospitals sometimes complain about low Medicaid reimbursement rates, the government has in the past compensated that with “state -led payment provisions” which increase the levels of what commercial insurance pays. This is attacked in the version of the finance committee of the Senate of the bill, reducing these reimbursement recharges at Medicare levels.
Hospitals are legally required to take care of patients in an emergency, regardless of their ability to pay. And other emergencies occur when more people are not insured and do not make care until they absolutely need it, which is still aggravated if patients should travel for hours to get care. Unpaid care is strengthened in states with greater proportions of their populations which are not guaranteed and seriously damaging hospitals’ budgets.
Taking nearly $ 1 dollars of the health system will magnify this problem across the country. And the Medicaid cuts which create more assured patients, as well as the creation of potentially millions of unwanted Thanks to the changes in the affordable care law, are terrible for hospitals. According to the Robert Wood Johnson Foundation, unpaid care Increase by $ 204 billion During the next decade, if the version of the bill in the bill is adopted; Remember that the Senate bill is even worse. Much of this burden would be thrown into already trembling hospitals.
For those who maintain that the cuts are really to state the Medicaid programs and not hospitals, the ways in which states will take care of these cuts would probably not be by simply providing more money than they have. They will modify the registration rules, so fewer people remain in the program, to reduce reimbursement payments to hospitals and other suppliers. These two options would harm the hospital finances directly.
“These discounts will pass on emergency services as they become the family doctor to millions of newly uninsured people,” said Rick Pollack, president and chief executive officer of the American Hospital Association, in a statementAdding that “the proposal will force hospitals to reconsider services or potentially close, especially in rural areas”.
Brooks-lassure explained what it really means When a hospital closes, recalling a closure when it was at the CMS. “The first thing we had to do is make sure that the people of this hospital are moved to a place where they can get care. You might have people in serious situations and move them is a deadly proposal. ”
Another factor is how the loss of an anchor hospital affects local savings. A hospital can be the largest employer in a small town. If he closes, the whole city can move away, contract local and regional finances and by tightening residents who do not have the resources to move.
In the longer term, the closure of rural hospitals forces patients to spend hours going to the nearest care center and, in some cases, leaves them without access. “I was in Colorado and we led from one state to the other to go to the hospital,” said Lasure. “They said to me:” The road you have driven, one over three days of the year, you cannot overcome this road “,” due to the weather or another complication. When the nearest hospital is through the rocky and snow, you really have no ability to get care.
Being at times far from a hospital also means that families are more likely to avoid routine care. And in emergency events such as heart attacks or accidents, distance can make the difference between life and death.
People will eventually do what it takes to get medical treatment if they need it. This means that families altering the tests like having to pay to spend the night near a hospital which is far from your home, or deposit a loved one and not be able to visit them during an prolonged hospital stay.
It also means that hospitals that would be “sure” of the cuts will feel the effects. They will have more patients, and more uninsured patients, to manage. And they cannot manage the figures they see now. There is already a crushed more than 187,000 doctors During the next decade, according to a November 2024 report on the analysis of the National Center for Health WorkForce.
“There is no exhaust for this,” said Lawson. “The health system is super complex. You cannot do something on one side and expect it to have no effect in the other.”
Many in the community of health providers have collected alarms on the republican bill. America’s Essential Hospitals, a coalition of more than 300 security security hospitals, has sent a message to the Perspective From his CEO Bruce Siegel, who said that “the cuts would threaten the health and well-being of millions of Americans and harm the essential hospitals that serve as community life.” State hospital associations, in a Letter to the leaders of the Senatenoted that some of the payments that the Senate finance committee attacked represent 20% of the global income from a hospital.
Like Jonathan Cohn underlinesHospitals at risk of closure are mainly in communities dominated by Republicans at the district level. But democratic areas are also at risk. The leader of the room minority, Hakeem Jeffries (D-NY), conducted an action “Save our hospitals” yesterday in a Brooklyn hospital. And in the County of Los Angeles, more than 40% of the population is registered in Medi-Cal, the statement program of the State, according to the analysis of the Berkeley Labor Center.
Representative Chris Deluzio (D-PA), which represents parts of rural communities outside Pittsburgh, said that he had heard hospital groups by his state. “They are in difficulty as it is,” he said. “If these Medicaid cuts occur, the facilities and the services will be on the blockage, not only in my district, but throughout the Pennsylvania.”
The health care system as it is today reflects a fragmented patchwork of suppliers and insurance systems, which are poorly equipped to manage a shock of this magnitude. Medicaid is extremely popular Because it works for the poor without further outlet and fills shortcomings that allow many hospitals to survive. There is no doubt that, as Brooks-Lasure said, the biggest damage will be suffered “in places that are the worst for hospitals.” But that will not stop there, and if you think you are isolated from the pain, you probably go wrong.