Republican Medicaid cuts could shutter rural hospitals, maternity care | Potential Medicaid cuts could devastate America’s teetering rural health-care system and jeopardize Republicans’ political power among rural voters

# An example

> Jaylee Williams needed to find somewhere to deliver her son.

> The 19-year-old knew more about barrel racing on her horse Bet-n-pep than the complicated metrics of who takes what health insurance. But relief for Williams and her boyfriend, Xander Lopez, came when they realized Medina Regional Hospital — just 15 minutes from their home — accepted Medicaid, the federal-state program that covers medical costs for lower-income Americans. Provider groups an hour away in San Antonio had refused to take the insurance, she recalled while cradling little Ryker.

> “You never know when something could happen,” Williams said, with Lopez adding, “I have no idea where we would have gone” without Medina Regional Hospital.

> But the lifeline that the 25-bed critical-access hospital offered to Williams and Lopez could disappear in Hondo and other communities like it.

# Rural hospitals rely on Medicaid

> Rural hospitals across the United States fear massive Medicaid cuts favored by the Republican Party could decimate maternity services or shutter already struggling medical facilities in communities that overwhelmingly voted for Donald Trump.

> **Nearly half of all rural hospitals nationwide operate at a deficit, with Medicaid barely keeping them afloat.** Already, almost 200 rural hospitals have closed in the past two decades, according to the Cecil G. Sheps Center for Health Services Research, part of the University of North Carolina at Chapel Hill.

> Rural hospital leaders in Arkansas, Colorado, Kansas, Mississippi, Missouri and Texas who spoke to *The Washington Post* warned that the enormous cuts congressional Republicans are weighing could further destroy limited health-care access in rural America.

> Proposals to slash up to $880 billion over 10 years — which is expected to be accomplished largely by scaling back on Medicaid — would also impact those who do not rely on the program but do rely on the medical facilities that are financially dependent on the program’s reimbursements.

> “Every nickel matters,” said Benjamin Anderson, chief executive of Hutchinson Regional Healthcare System, which runs a rural hospital in Kansas. “It will cripple and close the health-care delivery systems that serve everyone.”

> **Public perception often associates the health-care safety net used by more than 1 in 5 Americans with the urban poor. But rural children and non-elderly adults are more likely to rely on Medicaid or the Children’s Health Insurance Program (CHIP) than those in metro areas**, according to the Center for Children and Families at the McCourt School of Public Policy at Georgetown University.

> The possible cuts are an “existential issue” for rural hospitals, said Alan Morgan, chief executive of the National Rural Health Association.

> “Medicaid cuts are going to result in rural hospital closures,” he said. “It’s just a question of how many.”

# Maternity deserts, political consequences, and saying the quiet part out loud

> Medina Regional Hospital sits in an 8,000-person agricultural town roughly an hour west of San Antonio, the drive between the two dotted with taxidermy signs, John Deere tractors and cattle. Per capita income comes in under $20,000 annually, according to the economic development director for the town.

> The facility’s chief executive, Billie Bell, had considered closing the unit serving expectant mothers a few years ago. It’s a service the hospital already loses money on, Bell said, as the vast majority of obstetrics patients are on Medicaid, which does not reimburse the facility dollar for dollar for care. She managed to keep the unit open because she feared adding to the maternity health-care deserts in a state that far outpaces the nation in rising rates of maternal deaths.

> The Republican Party suffered large congressional losses in 2018, the last time it tried Medicaid cuts, said KFF’s executive vice president for health policy, Larry Levitt, whose nonpartisan health-care research group surveyed Trump voters on Medicaid. Similar political reprisals could happen again, he warned.

> **“Rural America is Trump country,” Levitt said. “When they voted for Trump, I don’t think they expected cuts to their health care.”**

!ping HEALTH-POLICY&RURAL

Well hopefully some of these rurals will be smart and vote Democrat next time.

They voted for this. Then cheered about owning the libs, you think i actually can work it up in me to give a fuck about Cleatus and Billy-jo’s healthcare when they cheerfully voted to strip mine away?