Stubborn Opposition To Medicaid Expansion Is Forcing Hospitals In The Poorest States To Shut Down

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Hospitals in the nation’s poorest regions are becoming collateral damage in the ongoing political battle against the Affordable Care Act, as medical centers in states refusing Obamacare’s Medicaid expansion are being forced to slash their work forces and even close up shop entirely.

At least five public hospitals have shuttered their doors and many more are cutting staffing and services in non-Medicaid expansion states, according to Bloomberg. Three such hospitals have shut down in Georgia, while North Carolina and Virginia are experiencing similar closures. Patients who relied on the closed hospitals will be forced to make treks as long as 40 miles to receive the care they need from another facility.

The closures are tied directly to Republicans’ refusal to accept generous federal funding to expand Medicaid. And experts warn that even more closures may be on the horizon in poor states like Tennessee and Mississippi that have also refused the Medicaid expansion.

Safety-net hospitals serve areas with high numbers of poor and uninsured people, so they often have patients who can’t afford to pay for their treatments. These hospitals depend on federal money to make up for the uncompensated care costs. In an effort to cut national health spending, however, the health law reduced payments to these so-called “disproportionate share hospitals” (DSHs) by billions of dollars. Lawmakers figured that Obamacare’s Medicaid expansion — originally meant for every American living up to 133 percent of the Federal Poverty Level (FPL) — would mitigate the cuts’ effects, since patients would now be able to pay for their care through public insurance and hospitals wouldn’t need to be subsidized as heavily.

But not every state is actually expanding Medicaid. The Supreme Court ruled Obamacare’s Medicaid expansion to be optional, and about 26 states with GOP chief executives or legislatures have have refused to expand the program. Congress also rejected the Obama administration’s proposal to delay DSH payment cuts by a year to give safety net hospitals some breathing room while those states mulled whether or not expand Medicaid — and now, many hospitals in anti-expansion states are feeling the crunch.

The states that have refused the Medicaid expansion have some of the highest rates of uninsurance and poverty in the country. For instance, Texas, Louisiana, Florida, South Carolina, Mississippi, and Georgia are all among the top ten most uninsured states in America. Other non-expansion states like Oklahoma, Wyoming, Idaho, North Carolina, and Alaska have uninsurance rates higher than the U.S. national average of 21 percent. About one in five Americans residing in these states are living in poverty.