Save the 283 (rural hospitals)


A dozen Texas hospitals have closed their doors recently. Not simply gone on “drive by,” the condition where the ER is so busy hospitals tell ambulances to drive somewhere else. No, these Texas hospitals – often in rural areas where care is hardest to find – have ceased operations. Occasionally this happens in market contractions, when hospitals merge operations, but mostly what we are seeing is hospitals running out of money.

Why are hospitals in Texas running out of money? Mostly because Texas didn’t expand Medicaid. Refusing to expand Medicaid left a lot of poor people without access to insurance coverage, which is resulting in lack of access to health care. Did you know Texas has a lot of poor people, and do you know why?

Brief answers to these questions are below. But first: a group of people are walking from North Carolina to Washington, DC, to try and save rural hospitals. The “march on Washington” was organized by a Republican mayor whose small town lost a hospital. This Republican leader is a pragmatist who isn’t letting ideology stand in the way of saving lives. So he’s working with others to draw attention to this crisis, and find solutions. Several Texans are joining the walk – read more about them here.

More than half of all Texans make less than 400% of the federal poverty level (FPL). The FPL is actually set very low, so even 400% isn’t much, particularly for families. Expanding Medicaid to eligible, hard working citizens would have provided coverage to people, and therefore would have helped them pay the hospitals, therefore keeping hospitals in business.

Texas didn’t expand Medicaid, poor citizens can’t afford to pay for hospital stays, reimbursement dollars to hospitals are drying up because people were intended to have coverage, and hospitals go out of business while trying to treat people hurt on the job, deliver babies, and generally care for the people in their communities.

While we could talk a lot about “disproportionate care” reimbursements for hospitals care for large indigent populations, the simple paragraph above captures the gist of this issue. And it captures the tragedy – we could do something, but we aren’t.


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