Rural hospitals, many of which are already struggling against the financial tide, could be in dire straits under the American Health Care Act (AHCA), especially if sweeping cuts to Medicaid are approved.
New York Gov. Andrew Cuomo said in a conference call on Tuesday that the state, which participated in Medicaid expansion under the Affordable Care Act, has no room in its budget to make up for billions in lost Medicaid funding.
State projections estimate that New York would lose $2.4 billion each year after 2020, when the law would end Medicaid expansion, and much of that burden would be felt by rural facilities and other providers that treat large volumes of Medicaid patients. Cuomo also expressed concern that amendments to the bill revealed on Monday would disproportionately affect people in New York City.
With the Collins - Faso Amendment, a war has been launched on New York.
— Andrew Cuomo (@NYGovCuomo) March 21, 2017
And it will devastate those who are older and sicker.
“There is no capacity to pay on the state side, so the cut is to the providers. Forty percent of New Yorkers are on Medicaid—seniors getting home health care, seniors in nursing homes, and hospitals; … they will have to absorb this cut,” Cuomo said. “Borderline hospitals will close. The state is not going to pay. It can’t pay.”
Meanwhile in Washington, a provision of the AHCA that would shift more than $2 billion in Medicaid costs from mostly Republican-controlled, upstate New York counties to the state government leaves out Democratic-controlled New York City. Politicos have dubbed it the "Buffalo Bribe."
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Rep. Louise Slaughter (D-N.Y.) called it "a political sleight of hand" that seeks to buy GOP votes.
But New York Rep. Chris Collins, a Republican, said the amendment “will stop Albany from forcing its unfunded mandate down the throats of taxpayers, and help counties lower the property tax burden on hardworking families.”
RELATED: Urban Institute: AHCA’s Medicaid cuts will strain states
Gary J. Fitzgerald, president of Iroquois Healthcare Association, a regional healthcare group that represents 54 hospitals and health systems in upstate New York, said in an op-ed for The (Auburn) Citizen that the bill would be devastating to the rural communities in that region and would “cripple” rural providers’ abilities to care for the most vulnerable patients.
He particularly noted that the bill eliminates funding for opioid and heroin abuse treatment, issues that plague the region and other rural areas like it.
“Hospitals and health systems in upstate New York are responsible for providing the initial medical and emergency services for these patients, as there are few rehabilitation and treatments centers in rural areas,” he wrote. “Further reductions to hospitals that provide critical care will only exacerbate the opioid and heroin epidemic that is prevalent in many rural neighborhoods.”
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Rural providers outside of New York are also closely watching the health reform debate unfold, according to an article from the Associated Press. In nonexpansion states, like Georgia, rural hospitals saw few benefits from changes under the Affordable Care Act, though many patients in the region would have benefited from expanded Medicaid.
However, leaders at rural hospitals like the 49-bed Evans Memorial Hospital in Claxton haven’t heard much from the AHCA that would assure them that it’s the best plan.
"I wouldn't want to be in a position where I needed to say, 'Here's what we need to do to fix it,'" Kyle Parks, M.D., a surgeon at Evans Memorial, told the AP. "Because I honestly don't know what that would be."
A number of rural hospitals are on the verge of closure—nearly 13% are vulnerable to closure—though they are often the only provider available to a significant segment of the population. About 1 in 5 Americans receives care regularly from rural providers.
In states that have a large number of rural facilities, they can also be economic drivers and large employers. In Tennessee, for instance, its 61 rural hospitals account for $1 billion of the state’s economy and 16,000 jobs, according to a new report from the Tennessee Hospital Association.