Impact of Medicaid Expansion on Rural Hospitals

A hospital waiting room is a lonely place."Well, of course you worry, and you just hope everything is going to turn out," said Pat Little as she waited for news on her brother's condition.Little's brother was brought to White County Medical Center with heart problems. It was a 30 mile drive just to get there. It would have taken two hours to get him to Little Rock."In an emergency that would be too far to go, if it was a real, real emergency," said Little.The rural hospital is the first line of defense for people in six counties and a safety net for the uninsured, medicaid and medicare recipients."Those types of patients depend on hospitals, often times the emergency room to provide their primary care," explained WCMC CEO Ray Montgomery.Montgomery estimates 80 percent of ER patients in his hospital could be seen by a primary care doctor, if they had one. Instead, the hospital absorbs the cost for care, but even that has a limit."We don't even get paid cost for that Medicaid patient, so every patient that we see on the Medicaid side, we're still losing money, and then you have the charity care that we're getting almost no money at all," said Montgomery.This year, the White County emergency room had a record-breaking 50,000 patients. "Hospitals, historically, have been very resilient, but I've never seen the alignment of these pressures on hospitals, and I've been in the healthcare business for 40 years," said Montgomery.A rural hospital opens its doors to everyone, and if those doors are to remain open, Montgomery believes the state has to expand Medicaid. However, the state senator that represents the rural community is on the opposite side of the Medicaid debate. Senator Jonathan Dismang is considering what would happen if that extra 38 percent was not covered by Medicaid but instead given the opportunity to buy subsidized private insurance."The max that their premium could be is two percent of their annual income," explained Sen. Dismang (R) District 28.Private insurance pays more, so the senator says it's possible the hospital could make money instead of losing it as with Medicaid."There is actually some additional revenue for the hospital for the folks that in between the 100% and the 138% if they're on private health insurance," said Dismang.Looking at those same numbers in the long-term, Montgomery disagrees."If we're in that approach currently and for the future that probably makes sense, but it's going to change. I can guarantee you it's going to change," said Montgomery.Two very different opinions. One will likely win out in the Capitol. Which one is anyone's guess."I believe at the end of the day, they'll do the right thing. It's a difficult business decision, but what's important here is we're talking about lives," said Montgomery.

CONTINUING COVERAGEArk. Medicaid faces nearly $200M funding gap (Nov. 13)Ark. Medicaid faces 'significant' cuts in services (Nov. 13)Beebe: Medicaid expansion can spare nursing homes (Nov. 14)Ark. surgeon general addresses Medicaid expansion (Nov. 27)Beebe: Vote on Medicaid expansion during regular session (Jan. 3)Medicaid expansion hot topic leading up to general assembly (Jan. 7)Focus on Medicaid as Ark. session begins (Jan. 14)Beebe: Medicaid shortfall not as large as anticipated (Jan. 15)Ark. lawmakers seek more details on Medicaid (Jan. 17)Medicaid shortfall possibly $60 million less than expected (Jan. 17)Impact of Medicaid expansion on rural hospitals (Jan. 25)Ark. House GOP leader: Medicaid a work in progress (Jan. 28)Beebe: Don't delay Medicaid vote until next year (Feb. 11)Officials tout 'Medicaid contraction' (March 1)Ark. lawmakers approve contract on Medicaid (March 5)Ark. GOP leader floats special session on Medicaid (March 25)