Democrats say they know why rural hospitals are not being very vocal in opposing Republican efforts to repeal Obamacare: Fear of a scathing tweet from President Trump.
But the biggest rural health group in Washington says that’s not so. Hospitals aren’t afraid of Trump, but they do have problems with Republicans and Democrats.
A collection of Democrats were asked during a Friday call with reporters if they were frustrated by a lack of vocal support from rural hospitals to keep the Affordable Care Act.
House Minority Leader Nancy Pelosi said she wasn’t and pointed to fear of Trump as the main culprit.
“This is hard to go up against the president and his party in Congress,” she said.
Other Democrats chimed in that rural hospital managers are probably worried about retribution from Trump on social media.
“Do they want to take on the president?” asked Rep. Cheri Bustos, D-Ill.
Bustos added that going against the president could be hard when he does “these middle-of-the-night tweets, whether it’s Oreo cookies or Nordstrom’s or the country of Mexico.”
Bustos said rural hospitals will be in trouble if the law is repealed, partly because of an increase in uncompensated care.
Another lawmaker said it makes sense for rural hospital staff to not take a major stance.
“The personnel makeup of hospital administrators and people in corporate America in general is to be reserved and not to be out with torches and pitch forks on the front lines of fights like this,” said Rep. Matt Cartwright, D-Pa.
But the National Rural Healthcare Association, a top rural hospital advocacy group in Washington, said its members have been very vocal.
“We had over 500 of our membership in town last week who went up to Capitol Hill and talk about their concerns for rural America,” Maggie Elehwany, the group’s vice president of government affairs told the Washington Examiner.
Rural hospitals are “angered at Democrats and Republicans right now. I think a lot of rural America was really left behind.”
Since 2010, when Obamcare was signed into law, 80 rural hospitals have closed, according to the North Carolina Rural Health Research Program.
Another 673 hospitals are on the brink of closure, according to a 2016 study from the Chartis Center for Rural Health.
Elehwany said the Obamacare’s goals were laudable and the group strongly supports expansion of insurance, especially in rural America. However, to help pay for the law, Obamacare included a provision that reduced federal payments to hospitals for patients who cannot pay their bills or have bad debt, which are costs that cannot be recovered.
The idea was that hospitals would have less charity care due to the expansion of coverage through the Medicaid expansion and the law’s subsidies.
“It didn’t work out that way,” Elehwany said.
She highlighted the 2012 Supreme Court decision that states could opt out of expanding Medicaid, which 19 states decided to do. That meant fewer people had access to Medicaid than anticipated.
But that wasn’t the only obstacle to getting less charity care.
Another issue was people who were on the exchange and got high-deductible plans and then couldn’t afford to pay for their healthcare, she added.
Other hits to rural hospitals included cuts to Medicare reimbursements as part of sequestration.
While rural hospitals have qualms with the implementation of the law, they are also upset with Republicans for not being able to fix the problems.
The hospital group has been pushing legislation that “reinstates the ability to write off bad debt but unfortunately it hasn’t gone anywhere so far,” Elehwany said.
However, some members of Congress have backed legislation such as the Save Rural Hospital Act introduced last Congress by Rep. Sam Graves, R-Mo.
The legislation removed cuts to charity care and made other fixes to boost payments to rural hospitals, but it didn’t go anywhere in Congress.
Elehwany said rural hospitals want to work with both parties on healthcare.
“We just need both sides to pay attention to this crisis,” she said.
