Cuts, closures face top hospitals in states that didn't expand Medicaid

Some of the top U.S. hospitals in states that failed to expand Medicaid are closing their doors or laying off employees, leaving remaining hospitals with less staff and patients with fewer treatment options, forcing them to travele farther for care.

Hospitals across the country dismissed approximately 5,000 employees since June, Bloomberg reported. Among them are Vanderbilt University Medical Center in Tennessee, Indiana University Health and other hospitals in states that haven't expanded the joint state-federal Medicaid health program under the Affordable Care Act.

The Cleveland Clinic in Ohio offered early retirement to 3,000 employees, and is planning to cut operating-room expenses and pay less to vendors, as part of a $330 million budget reduction in 2014, the Daily Caller reported. A portion of the budget cuts are directly associated with the Affordable Care Act, according to the article. Meanwhile, Bloomberg reported that at least five public hospitals have closed in the past year, three of them in Georgia due to reduced federal subsidies and lack of Medicaid expansion, with the possibility of more closures to come.

Joanne Peters, a spokeswoman for the U.S. Health and Human Services Department, said hospital closures and funding problems fall on the shoulders of the state legislatures that failed to expand Medicaid, which would reduce the amount of uncompensated care hospitals typically handle. As part of Medicaid expansion, the federal government would pay 100 percent of the cost for the first three years, and 90 percent in subsequent years. But Republican Gov. Nathan Deal said even though the federal government would cover the initial costs of the expansion, states couldn't handle the financial burden down the road, Bloomberg reported.

Meanwhile, some hospitals must make tough choices about cutting back cancer treatment, infant care and emergency programs to combat the budget issues, according to the article. Closures mean patients are waiting longer for treatment, which could prove deadly depending on their condition, Ashish Jha, M.D., who teaches health policy at the Harvard School of Public Health in Boston, told Bloomberg.

"In an urban city if a hospital closes, there's probably another one within 10 minutes," he said. "In a rural community, that's not true. So the consequences of shutting down are much bigger."

Of the 5,700 hospitals in the U.S., only about 35 percent are in rural communities, and there are 640 counties nationwide lacking quick access to an acute care hospital, FierceHealthcare previously reported, representing nearly a quarter of all residential areas in the country.

To learn more:
- here's the Bloomberg article
- read the Daily Caller article