North Carolina is among 14 states that have not enacted Medicaid expansion, and some advocates claim expansion could save rural hospitals. Yet, others say the potential impact is overstated by advocates.
According to the Civitas Institute, 77 of 106 rural hospital closures have been in states without Medicaid expansion.
Yet, state Rep. Lee Zachary (R-Yadkinville) said that one statistic isn't enough to show a need for Medicaid expansion.
“There has been a long term trend of rural hospitals across the nation closing, mostly from either demographic reasons (not enough sick people to fill the beds) [or] because of people moving to more populous areas, and the expansion or non-expansion of Medicaid does not seem to be related,” Zachary said.
According to a report on rural demographics, all but two of the 14 states that have not enacted Medicaid expansion are also among the top 23 most rural states.
One of the reasons for the trend of rural hospital closures may be better access to health care in more populated areas. Other hospitals in metro areas nearby to rural residents tend to have better technology, more doctors and better facilities. So, money made available through Medicaid expansion might simply go to the larger hospitals – along with the rural patients – rather than the rural hospitals.
“I don’t think it will save rural hospitals and I don’t think it will cause more closures either because the reasons these hospitals close is complicated,” Zachary said.
Medicaid expansion might also add to the struggle for access in an already struggling health care system. The increased need for physicians across the country has resulted in doctor shortages in many hospitals, especially rural hospitals.
“With the increase in demand for medical care that is free or subsidized, doctors will be busier and Medicaid patients will have a harder time than they do now finding a doctor who can/will treat them,” Zachary said. “Also, the Medicaid reimbursements for doctors do not cover their costs and they can only take so many Medicaid patients without going out of business.”
Access to health care and the complexities of paying for Medicaid bring with them uncertainty among lawmakers. The increased demand for state-funded health care brings into question how funding for the new policies will affect a state that has just recently nailed down a good system for paying for those already on Medicaid.
“Expanding Medicaid will get us back into the problems we had earlier in this decade,” Zachary said. “Expanding a government program means tax increases, whether on the federal level, the state level or both, because somebody has to pay for it.”