Many rural healthcare providers are struggling to survive, particularly in states that have declined to expand Medicaid eligibility under the Affordable Care Act. But providers in states that did expand Medicaid have their own struggles as well.
Currently, about one in eight rural hospitals is in imminent danger of closing its doors. Most are in states that did not expand Medicaid eligibility, according to California HealthLine.
Rural providers in the Golden State--among the most welcoming of states to the ACA--have been struggling with an onrush of newly insured patients.
“With the onset of coverage, you have all this relief to pent-up demand, people seeking more regular care and preventive (care), which often for the uninsured is not a priority,” C. Dean Germano, chief executive officer of the non-profit Shasta Community Health Center in Redding, told the publication. “They tend to come in because they have acute issues or they have long-term chronic issues that have become complicated.”
As a result, Shasta has had to spend money to hire two new physicians, created a family practice residency program and a fellowship program for crucial primary care professionals such as nurse practitioners and physician assistants. It also was so overwhelmed with new patients that for a time it closed its doors to new enrollees in Med-Cal, California's Medicaid program.
Medi-Cal and the California Department of Health Care Services has one of the lowest provider payment rates in the U.S., making it a challenge for Shasta to accept the new patient load and remain fiscally afloat. It has also had difficulty finding physicians and residents, primarily because many opt to go into higher-paying specialties.
Nevertheless, the challenges being faced by Shasta are likely preferable to those in non-Medicaid expansion states, which have faced complete closure of rural facilities due to unconscionable financial pressures, or makeshift measures in states such as Georgia to try and preserve the rural healthcare system and ensure it continues to function.
- read the California HealthLine article