From: lessgovt@gmail.com   
      
   Medicaid Expansion Won’t Stop Rural Hospital Closures   
   By Hayden Dublois, April 28, 2023, WSJ   
      
   I have analyzed every hospital closure since 2014 when ObamaCare went into   
   effect. Medicaid expansion has failed to halt rural hospital closures, and in   
   some cases it contributes to them. The reason is simple: Medicaid is so poorly   
   run that it often adds    
   financial burdens to hospitals. The 10 Republican-led states that haven’t   
   adopted this policy would be wise to hold their ground, given that Medicaid   
   expansion also has disastrous consequences for state budgets and fosters   
   historic levels of government    
   dependency.   
      
   Here are the facts. Since 2014, dozens of hospitals have closed in states that   
   haven’t expanded Medicaid. Yet their stated reasons almost always have   
   nothing to do with Medicaid expansion. Damage from natural disasters,   
   declining business and fraud,    
   among many other factors, have caused hospitals to close. Only four hospitals   
   in nonexpansion states directly attributed their closures to a lack of   
   Medicaid expansion. Two of them later were alleged to have engaged in   
   wide-scale fraud and financial    
   mismanagement, casting doubt on their earlier statements.   
      
   Even more telling is what happened in the nearly 40 states that did expand   
   Medicaid before the start of this year. Despite the assurances of liberal   
   activists, nearly 50 hospitals have closed in these states since expansion   
   passed, including more than a    
   dozen in rural areas. Missouri voted to expand Medicaid by ballot initiative   
   in Aug 2020, with implementation beginning a little more than a year later.   
   Yet two rural hospitals closed in Sept 2022, well after expansion took effect.   
      
   The situation will surely worsen. According to data from the Center for   
   Healthcare Quality and Payment Reform, 1 in 4 rural hospitals in expansion   
   states are still at risk of closure. A 2019 Navigant study found that the top   
   five states at risk of losing    
   community-essential rural hospitals are all expansion states.   
      
   This is exactly what Medicaid expansion was supposed to prevent, yet expansion   
   itself is driving this crisis in rural and urban hospitals alike. The   
   program’s reimbursement rates are about 60% of what private health insurance   
   pays, often leaving    
   hospitals with large losses on Medicaid patients. Nationwide, more than 18   
   million able-bodied adults and counting have enrolled in the program due to   
   expansion, and each new recipient potentially adds red ink to a hospital’s   
   balance sheet.   
      
   Rural hospitals typically struggle financially as it is, and Medicaid   
   expansion can push them into insolvency. But the problem isn’t limited to   
   rural hospitals. Pennsylvania expanded Medicaid in 2015 and Philadelphia’s   
   Hahnemann Hospital closed in    
   2019 because of what the Philadelphia Inquirer called a “heavy reliance on   
   Medicaid.”   
      
   Despite these closures, hospital advocacy groups have joined Democrats in   
   vigorously demanding expansion. The promise of federal money in the short   
   term—and the resulting bonuses and pay bumps for hospital executives—is   
   apparently more important than    
   future stability.   
      
   Democrats won’t stop until they convince all 50 states to expand Medicaid.   
   As one activist told the New York Times in March, “this argument about rural   
   hospital closures has been an incredibly compelling argument to voters.”   
   That same story, which    
   focused on Mississippi, was titled “A State’s Choice to Forgo Medicaid   
   Funds Is Killing Hospitals.” Mississippi and Alabama are likely the next two   
   states in Democrats’ sights.   
      
   The remaining Republican-led states shouldn’t fall for it. By not expanding   
   Medicaid, they are likely saving rural hospitals from even worse financial   
   pressure, while protecting taxpayers from enormous losses and saving   
   able-bodied adults from    
   government dependence. In these states, at least, the truth about Medicaid   
   expansion still prevails.   
      
   Mr. Dublois is data and analytics director at the Foundation for Government   
   Accountability.   
      
   https://www.wsj.com/articles/medicaid-expansion-wont-save-rural-   
   ospitals-obama-care-fraud-dependency-e9ad20c7   
      
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