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Rural hospitals brace for financial hits or even closure under Republicans' $1 trillion Medicaid cut

Rural hospitals brace for financial hits or even closure under Republicans' $1 trillion Medicaid cut

OMAHA, Neb. (AP) — Tyler Sherman, a nurse at a rural Nebraska hospital, is used to the area's aging farmers delaying care until they end up in his emergency room.
Now, with Congress planning around $1 trillion in Medicaid cuts over 10 years, he fears those farmers and the more than 3,000 residents of Webster County could lose not just the ER, but also the clinic and nursing home tied to the hospital.
'Our budget is pretty heavily reliant on the Medicaid reimbursement, so if we do see a cut of that, it'll be difficult to keep the doors open,' said Sherman, who works at Webster County Community Hospital in the small Nebraska town of Red Cloud just north of the Kansas border.
If those facilities close, many locals would see their five-minute trip to Webster County hospital turn into a nearly hour-long ride to the nearest hospital offering the same services.
'That's a long way for an emergency,' Sherman said. 'Some won't make it.'
Already struggling hospitals would be hit particularly hard
States and rural health advocacy groups warn that cutting Medicaid — a program serving millions of low-income and disabled Americans — would hit already fragile rural hospitals hard and could force hundreds to close, stranding some people in remote areas without nearby emergency care.
More than 300 hospitals could be at risk for closure under the Republican bill, according to an analysis by the Cecil G. Sheps Center at the University of North Carolina at Chapel Hill, which tracks rural hospital closures. Even as Congress haggled over the controversial bill, a health clinic in the southwest Nebraska town of Curtis announced Wednesday it will close in the coming months, in part blaming the anticipated Medicaid cuts.
Bruce Shay, of Pomfret, Connecticut, fears he and his wife could be among those left in the lurch. At 70, they're both in good health, he said. But that likely means that if either needs to go to a hospital, 'it's going to be an emergency.'
Day Kimball Hospital is nearby in Putnam, but it has faced recent financial challenges. Day Kimball's CEO R. Kyle Kramer acknowledged that a Senate bill passed Tuesday — estimated to cut federal Medicaid spending in rural areas by $155 billion over 10 years — would further hurt his rural hospital's bottom line. Roughly 30% of Day Kimball's current patients receive Medicaid benefits, a figure that's even higher for specific, critical services like obstetrics and behavioral health.
'An emergency means I'm 45 minutes to an hour away from the nearest hospital, and that's a problem,' Shay said. And he and his wife wouldn't be the only ones having to make that trip.
'You've got, I'm sure, thousands of people who rely on Day Kimball Hospital. If it closed, thousands of people would have to go to another hospital,' he said. 'That's a huge load to suddenly impose on a hospital system that's probably already stretched thin.'
Experts say the bill's $50 billion fund for rural hospitals isn't enough
Rural hospitals have long operated on the financial edge, especially in recent years as Medicaid payments have continuously fallen below the actual cost to provide health care. More than 20% of Americans live in rural areas, where Medicaid covers 1 in 4 adults, according to the nonprofit KFF, which studies health care issues.
President Donald Trump's $4.5 trillion tax breaks and spending cuts bill, which passed Thursday, would worsen rural hospitals' struggles by cutting a key federal program that helps states fund Medicaid payments to health care providers. To help offset the lost tax revenue, the package includes $1.2 trillion in cuts to Medicaid and other social safety net programs — cuts they insist only root out fraud and waste in the system.
But public outcry over Medicaid cuts led Republicans to include a provision that will provide $10 billion annually to buttress rural hospitals over the next five years, or $50 billion in total. Many rural hospital advocates are wary that it won't be enough to cover the shortfall.
Carrie Cochran-McClain, chief policy officer with the National Rural Health Association, said rural hospitals already struggle to break even, citing a recent American Hospital Association report that found that hospitals in 2023 got nearly $28 billion less from Medicaid than the actual cost of treating Medicaid patients.
'We see rural hospitals throughout the country really operating on either negative or very small operating margins,' Cochran-McClain said. 'Meaning that any amount of cut to a payer — especially a payer like Medicaid that makes up a significant portion of rural provider funding — is going to be consequential to the rural hospitals' ability to provide certain services or maybe even keep their doors open at the end of the day.'
Kentucky is expected to be hit especially hard
A KFF report shows 36 states losing $1 billion or more over 10 years in Medicaid funding for rural areas under the Republican bill, even with the $50 billion rural fund. No state stands to lose more than Kentucky.
The report estimates the Bluegrass State would lose a whopping $12.3 billion — nearly $5 billion more than the next state on the list. That's because the bill ends Kentucky's unique Medicaid reimbursement system and reduces it to Medicare reimbursement levels.
Kentucky currently has one of the lowest Medicare reimbursement rates in the country. It also has one of the highest poverty rates, leading to a third of its population being covered by Medicaid.
Kentucky Gov. Andy Beshear, a two-term Democrat widely seen as a potential candidate for president in 2028, said the bill would close 35 hospitals in his state and pull health care coverage for 200,000 residents.
'Half of Kentucky's kids are covered under Medicaid. They lose their coverage and you are scrambling over that next prescription,' Beshear said during an appearance on MSNBC. 'This is going to impact the life of every single American negatively. It is going to hammer our economy.'
___
Haigh reported from Hartford, Connecticut.
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Rural hospitals brace for financial hits or even closure under Republicans' $1 trillion Medicaid cut
Rural hospitals brace for financial hits or even closure under Republicans' $1 trillion Medicaid cut

Winnipeg Free Press

time9 hours ago

  • Winnipeg Free Press

Rural hospitals brace for financial hits or even closure under Republicans' $1 trillion Medicaid cut

OMAHA, Neb. (AP) — Tyler Sherman, a nurse at a rural Nebraska hospital, is used to the area's aging farmers delaying care until they end up in his emergency room. Now, with Congress planning around $1 trillion in Medicaid cuts over 10 years, he fears those farmers and the more than 3,000 residents of Webster County could lose not just the ER, but also the clinic and nursing home tied to the hospital. 'Our budget is pretty heavily reliant on the Medicaid reimbursement, so if we do see a cut of that, it'll be difficult to keep the doors open,' said Sherman, who works at Webster County Community Hospital in the small Nebraska town of Red Cloud just north of the Kansas border. If those facilities close, many locals would see their five-minute trip to Webster County hospital turn into a nearly hour-long ride to the nearest hospital offering the same services. 'That's a long way for an emergency,' Sherman said. 'Some won't make it.' Already struggling hospitals would be hit particularly hard States and rural health advocacy groups warn that cutting Medicaid — a program serving millions of low-income and disabled Americans — would hit already fragile rural hospitals hard and could force hundreds to close, stranding some people in remote areas without nearby emergency care. More than 300 hospitals could be at risk for closure under the Republican bill, according to an analysis by the Cecil G. Sheps Center at the University of North Carolina at Chapel Hill, which tracks rural hospital closures. Even as Congress haggled over the controversial bill, a health clinic in the southwest Nebraska town of Curtis announced Wednesday it will close in the coming months, in part blaming the anticipated Medicaid cuts. Bruce Shay, of Pomfret, Connecticut, fears he and his wife could be among those left in the lurch. At 70, they're both in good health, he said. But that likely means that if either needs to go to a hospital, 'it's going to be an emergency.' Day Kimball Hospital is nearby in Putnam, but it has faced recent financial challenges. Day Kimball's CEO R. Kyle Kramer acknowledged that a Senate bill passed Tuesday — estimated to cut federal Medicaid spending in rural areas by $155 billion over 10 years — would further hurt his rural hospital's bottom line. Roughly 30% of Day Kimball's current patients receive Medicaid benefits, a figure that's even higher for specific, critical services like obstetrics and behavioral health. 'An emergency means I'm 45 minutes to an hour away from the nearest hospital, and that's a problem,' Shay said. And he and his wife wouldn't be the only ones having to make that trip. 'You've got, I'm sure, thousands of people who rely on Day Kimball Hospital. If it closed, thousands of people would have to go to another hospital,' he said. 'That's a huge load to suddenly impose on a hospital system that's probably already stretched thin.' Experts say the bill's $50 billion fund for rural hospitals isn't enough Rural hospitals have long operated on the financial edge, especially in recent years as Medicaid payments have continuously fallen below the actual cost to provide health care. More than 20% of Americans live in rural areas, where Medicaid covers 1 in 4 adults, according to the nonprofit KFF, which studies health care issues. President Donald Trump's $4.5 trillion tax breaks and spending cuts bill, which passed Thursday, would worsen rural hospitals' struggles by cutting a key federal program that helps states fund Medicaid payments to health care providers. To help offset the lost tax revenue, the package includes $1.2 trillion in cuts to Medicaid and other social safety net programs — cuts they insist only root out fraud and waste in the system. But public outcry over Medicaid cuts led Republicans to include a provision that will provide $10 billion annually to buttress rural hospitals over the next five years, or $50 billion in total. Many rural hospital advocates are wary that it won't be enough to cover the shortfall. Carrie Cochran-McClain, chief policy officer with the National Rural Health Association, said rural hospitals already struggle to break even, citing a recent American Hospital Association report that found that hospitals in 2023 got nearly $28 billion less from Medicaid than the actual cost of treating Medicaid patients. 'We see rural hospitals throughout the country really operating on either negative or very small operating margins,' Cochran-McClain said. 'Meaning that any amount of cut to a payer — especially a payer like Medicaid that makes up a significant portion of rural provider funding — is going to be consequential to the rural hospitals' ability to provide certain services or maybe even keep their doors open at the end of the day.' Kentucky is expected to be hit especially hard A KFF report shows 36 states losing $1 billion or more over 10 years in Medicaid funding for rural areas under the Republican bill, even with the $50 billion rural fund. No state stands to lose more than Kentucky. The report estimates the Bluegrass State would lose a whopping $12.3 billion — nearly $5 billion more than the next state on the list. That's because the bill ends Kentucky's unique Medicaid reimbursement system and reduces it to Medicare reimbursement levels. Kentucky currently has one of the lowest Medicare reimbursement rates in the country. It also has one of the highest poverty rates, leading to a third of its population being covered by Medicaid. Kentucky Gov. Andy Beshear, a two-term Democrat widely seen as a potential candidate for president in 2028, said the bill would close 35 hospitals in his state and pull health care coverage for 200,000 residents. 'Half of Kentucky's kids are covered under Medicaid. They lose their coverage and you are scrambling over that next prescription,' Beshear said during an appearance on MSNBC. 'This is going to impact the life of every single American negatively. It is going to hammer our economy.' ___ Haigh reported from Hartford, Connecticut.

Medicaid, food aid recipients worry about safety net cuts in bill sent to Trump
Medicaid, food aid recipients worry about safety net cuts in bill sent to Trump

Winnipeg Free Press

time18 hours ago

  • Winnipeg Free Press

Medicaid, food aid recipients worry about safety net cuts in bill sent to Trump

JEFFERSON CITY, Mo. (AP) — Supporters of the sweeping tax and spending legislation that Congress has sent to President Donald Trump say the changes to Medicaid, food aid and other programs will encourage personal responsibility and halt those scamming the system. Critics of the bill, given final congressional approval Thursday, say the requirements will upend lives. Here's a look at what people are saying about the bill. Work requirements added for accessing more federal benefits To enroll and stay on Medicaid, many ages 19 through 64 would be required to work, go to school or perform at least 80 hours of community service a month. The Medicaid work requirement would apply to people in 40 states who are enrolled through expanded access that states agreed to put in place since 2014. Ten states, including Texas and Florida, did not expand the program. For the Supplemental Nutrition Assistance Program, or SNAP, which already requires adults ages 18 to 55 to work, working would become mandatory for many until they turn 65. For both benefits, there would be exceptions, including for parents who are caregivers to children under age 14. Most people covered by Medicaid already meet the work requirement or qualify for an exception. The requirements are sparking worry for some enrollees Theresa Gibbs, who lost her job as a school bus driver, is enrolled in both Medicaid and SNAP. She likely would be exempt from the work mandate because she has three children under age 14. But Gibbs said she is applying for jobs anyway. 'I don't think people should just live off the state if they're perfectly capable to work,' said Gibbs, 34, of Jefferson City, Missouri. But the changes worry others. Amanda Hinton, 39, of St. Martins, Missouri, receives Medicaid and SNAP benefits. She puts in enough hours at a part-time gas station job to likely meet the new requirements but is concerned should her fibromyalgia, which causes pain and fatigue, keep her from working for a time. 'I'm panicked. I mean I have some chronic health conditions that are not curable, and I rely on my medication to help me just get through the day,' she said. 'And without my Medicaid, I couldn't afford these.' Brittany Phillips, 32, of Greensboro, North Carolina, said being on Medicaid has helped her stay afloat both financially and health-wise while she works a temporary, remote medical services job paying about $600 weekly. 'I do believe that Medicaid should be available for everyone regardless of who they are — regardless of capacity, faculty — everyone should have Medicaid,' she said. It's not just the work requirement; it's also the paperwork The nonpartisan Congressional Budget Office estimates that 11.8 million fewer people could have health insurance by 2034 because of the changes, which also include booting off non-citizens who are not in the U.S. permanently and legally. And that doesn't include those who could lose coverage for other reasons. Advocates say that even people who are covered by exceptions to the work requirement could lose their Medicaid coverage. One major reason is a requirement that people's eligibility would be assessed at least every six months. 'Every additional paper someone has to submit separately from their application,' said Deborah Steinberg, a senior health policy analyst at the Legal Action Center, 'you lose people.' Julia Bennker, who runs an in-home daycare in Eau Claire, Wisconsin, relies on SNAP and Medicaid and has had paperwork issues under existing Medicaid requirements. She said that earlier this year, she didn't have health coverage for a month after she was told her forms were late — though she believes she submitted them on time. That meant going a month without therapy and needing to reschedule another appointment with a prescriber. Some of the conditions that would trigger exceptions — mental illness or substance use disorder — are not currently tallied in Medicaid computer systems. 'It's not like you wave a magic wand and everyone who should be exempt is exempt,' said Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness. States will face pressure – and deadlines – to revamp their programs State health care and social services agencies will have to rework their computer systems to account for the various changes while also dealing with federal funding reductions. That's cause for concern for some health care advocates. The legislation requires all states to shoulder more of the administrative costs of SNAP starting in 2027 and, for the first time, could force some states to pay for a portion of food assistance benefits starting in 2028. States also must implement the Medicaid work requirement by 2027. 'It will be a very tight and difficult timeline for many of these states,' said Sophia Tripoli, senior health policy director at Families USA, a health care advocacy organization. 'There's a huge cost burden on states from the administrative side just to stand up these systems.' Julieanne Taylor, a lawyer at the Charlotte Center for Legal Advocacy in North Carolina, said her organization's clients already face delays in verifications for the food program. 'To add more to them, it's going to be a disaster,' she said. 'It's going to cause people to drop off because they're like, 'I don't want to have to do this every year or every six months.'' Rural hospitals could face financial struggles The bill could also put rural hospitals at financial risk, experts say, because it seeks to cap the taxes that states impose on hospitals and other health care providers in a way that boosts Medicaid funding. The nonprofit KFF, which studies health care issues, estimates that Medicaid spending in rural areas would decrease by $155 billion over the next decade under the bill. 'While there are already a number of small and rural hospitals that are vulnerable,' said R. Kyle Kramer, CEO of Day Kimball Hospital in Putnam, Connecticut, 'it's going to lead to a lot of closures.' The bill includes a $50 billion fund to partially offset those reductions. Planned Parenthood would lose federal money Federal taxpayer money is already barred from paying for abortions in most cases. Wednesdays Columnist Jen Zoratti looks at what's next in arts, life and pop culture. The bill would also ban federal funds going to Planned Parenthood, the nation's largest abortion provider, for other purposes like family planning programs and cancer screenings. The group says that one-third of its roughly 600 clinics across the U.S. could face closure as a result of the legislation, and that states where abortion is legal would be hardest hit. At least one other group says it also stands to lose funding because of the provision. Maine Family Planning has 19 sites and subcontracts with other health care organizations, including Planned Parenthood, to provide services at other locations across the rural state. ___ Mulvihill reported from Cherry Hill, New Jersey. Susan Haigh in Hartford, Connecticut, and Gary D. Robertson in Raleigh, North Carolina, contributed to this report.

Massachusetts advocates fear Trump's bill will unravel health safety net in Obamacare's model state
Massachusetts advocates fear Trump's bill will unravel health safety net in Obamacare's model state

Winnipeg Free Press

timea day ago

  • Winnipeg Free Press

Massachusetts advocates fear Trump's bill will unravel health safety net in Obamacare's model state

BOSTON (AP) — In the state that served as the model for Obamacare, advocates and health care workers fear the Trump administration is trying to dismantle piece-by-piece a popular program that has provided insurance, preventive care and life-saving medication to hundreds of thousands of people. Provisions contained in both the Senate and House versions of the massive tax and spending cuts bill advancing in Congress — a centerpiece of President Donald Trump's agenda — could strip health insurance from up to a quarter of the roughly 400,000 people enrolled in the Massachusetts Health Connector, according to state estimates. The changes would create anew the coverage gaps state leaders were working to close when Massachusetts in 2006 became the first U.S. state to enact a law requiring nearly every resident to have health insurance, state officials say. Beyond the effect on residents' health, losing care could have broader repercussions — both for the program's finances and residents' ability to make a living. 'The idea of needing to unwind that now and pull back on that promise and commitment is really frustrating and heartbreaking and cruel and counterproductive,' said Audrey Morse Gasteier, executive director of Massachusetts' health insurance marketplace. Trump and Republican supporters in Congress say the changes, which include new documentation requirements and limitations on who can apply for tax credits to help pay for insurance, are necessary to root out what they call fraud, waste and abuse. The Affordable Care Act changes proposed in both versions of the bill, along with massive cuts to Medicaid and other programs, would eliminate roughly $1.1 trillion in health care spending over the next decade, according to the nonpartisan Congressional Budget Office. In Lawrence, a mill community of around 90,000 people on the Merrimack River, where more than 80% of the population is Hispanic or Latino, Kesia Moreta said she's already seeing people slip out of the state's health care network because of the Trump administration's aggressive effort to crack down on illegal immigration. Moreta, who manages a program created under the ACA that helps people sign up for coverage, said clients have been missing meetings out of fear that being enrolled for health insurance will harm their effort to stay in the U.S. legally. Recently, a father of a U.S.-born teenage son with epilepsy deleted every email related to his health plan and stopped answering calls from the Connector after watching reports about deportations on social media. When his son's medication ran out, Moreta said the father finally reached out, whispering over the phone, 'Is this going to get me deported?' 'That breaks our hearts,' Moreta said. Proposed changes More than 98% of Massachusetts residents have health insurance, the lowest rate of uninsurance in the country, according to the Massachusetts Health Insurance Survey. Vicky Pulos, an attorney for the Mass Law Reform Institute who helps low-income people gain access to health care, said Republicans who tried and failed to repeal the Affordable Care Act during the first Trump administration have decided to take it apart incrementally despite its growing popularity. 'It really seems like this is just a less transparent way of effectively dismantling the accomplishments of the Affordable Care Act in both Medicaid and the marketplace,' Pulos said. The changes, she added, 'will massively drive up the number of uninsured but without openly repealing the ACA.' Another provision included in both the House and Senate bills would require people applying for or renewing coverage to provide more documentation of their income, household size and immigration status to be eligible for premium tax credits when the state marketplace already has that information, which Morse Gasteier said would cause 'friction, red tape and delays.' The Trump administration has said the proposals will 'put a stop' to immigrants 'stealing taxpayer-funded health care benefits meant for American citizens.' No states use federal money to provide health insurance to people who are in the U.S. illegally. Some, like Massachusetts, use state tax dollars to do so to provide basic primary care services for a small population of vulnerable residents, like children. No undocumented immigrants receive insurance through the state marketplace. Of the 400,000 enrolled in the state marketplace, around 60,000 are noncitizens who are in the U.S. legally and would lose access to federal premium tax credits if either chamber's version of the bill becomes law. The number includes domestic violence and human trafficking victims, refugees, people granted asylum or humanitarian parole, temporary protected status and other work-authorized immigrants. Without the credits, premiums will cost upwards of $500 or $600 — an increase many people can't afford, Morse Gasteier said. Around half are green-card holders with an annual income of $15,000 a year or less. The remaining 40,000 people expected to lose coverage are U.S. citizens Morse Gasteier said could be stymied in applying or recertifying coverage by provisions like the increased documentation requirements. Fears of trust l ost Morse Gasteier said Massachusetts' marketplace worked 'tirelessly' to enroll vulnerable and hard-to-reach populations after the state program — formed under the leadership of then-Gov. Mitt Romney and known as 'Romneycare' — was created. She worries that if people hear help is no longer available, 'entire populations will just sort of give up on health insurance.' In addition to affecting residents' health, that could have an economic impact in the state. Immigrants with legal status enrolled in the state marketplace tend to be younger than the rest of the population, Morse Gasteier said. Their presence brings premiums down for others because they tend to be healthier. Wednesdays Columnist Jen Zoratti looks at what's next in arts, life and pop culture. In Lawrence, advocates who help people obtain insurance coverage though the ACA marketplace say the burden would fall disproportionately on people with chronic health issues like diabetes and chronic heart disease. The Greater Lawrence Community Action Council assists around 10,000 people a year with either signing up for or renewing health insurance. 'If you're not healthy, let me tell you, you can't work. If you can't work, you can't pay your bills. It's just as simple as that,' said GLCAC CEO Vilma Martinez-Dominguez. Moreta said one man who called her from the emergency room recently said he discovered his health insurance had lapsed. Moreta said she could help him renew it, and urged him to wait at the hospital. He told her not to do anything. He was leaving the hospital. She has no idea what became of him.

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