{"id":30913,"date":"2018-11-01T05:00:34","date_gmt":"2018-11-01T10:00:34","guid":{"rendered":"http:\/\/stateimpact.npr.org\/oklahoma\/?p=30913"},"modified":"2018-11-01T11:38:22","modified_gmt":"2018-11-01T16:38:22","slug":"oklahomas-rural-hospitals-see-a-lifeline-in-medicaid-expansion","status":"publish","type":"post","link":"https:\/\/stateimpact.npr.org\/oklahoma\/2018\/11\/01\/oklahomas-rural-hospitals-see-a-lifeline-in-medicaid-expansion\/","title":{"rendered":"Oklahoma\u2019s rural hospitals see a lifeline in Medicaid expansion"},"content":{"rendered":"<div id=\"attachment_30914\"  class=\"wp-caption module image aligncenter\" style=\"max-width: 1920px;\"><img decoding=\"async\" loading=\"lazy\" class=\"size-large wp-image-30914\" src=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/10\/Emergency-Hospital-1920x1280.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/10\/Emergency-Hospital-1920x1280.jpg 1920w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/10\/Emergency-Hospital-672x448.jpg 672w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/10\/Emergency-Hospital-768x512.jpg 768w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/10\/Emergency-Hospital-150x100.jpg 150w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/10\/Emergency-Hospital-300x200.jpg 300w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/10\/Emergency-Hospital-620x413.jpg 620w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/10\/Emergency-Hospital-1620x1080.jpg 1620w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/10\/Emergency-Hospital.jpg 2000w\" sizes=\"(max-width: 1920px) 100vw, 1920px\" \/><\/p>\n<p class=\"wp-media-credit\">Jackie Fortier \/ StateImpact<\/p>\n<p class=\"wp-caption-text\">The Oklahoma Hospital Association estimates that half of rural to mid-sized hospitals in Oklahoma are in danger of shuttering.<\/p>\n<\/div><p><span style=\"font-weight: 400;\">On Election Day, voters in three traditionally Republican-led states will decide whether or not to expand Medicaid, the government health insurance program for the poor and people with disabilities.<\/span><\/p><p><iframe loading=\"lazy\" src=\"https:\/\/w.soundcloud.com\/player\/?url=https%3A\/\/api.soundcloud.com\/tracks\/522904287&color=%23ff5500&auto_play=false&hide_related=true&show_comments=false&show_user=true&show_reposts=false&show_teaser=false&visual=false\" width=\"100%\" height=\"150\" frameborder=\"no\" scrolling=\"no\"><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe><\/p><p><span style=\"font-weight: 400;\">Before the Affordable Care Act, Medicaid was reserved mainly for pregnant women, poor children, low-income seniors and people with disabilities. With the ACA came the requirement for states to expand access to Medicaid to childless adults whose incomes are less than 138 percent of the federal poverty level, which is<\/span><a href=\"https:\/\/www.healthcare.gov\/glossary\/federal-poverty-level-fpl\/\"><span style=\"font-weight: 400;\"> $12,140 for individuals<\/span><\/a><span style=\"font-weight: 400;\">. <\/span><\/p><p><span style=\"font-weight: 400;\">A U.S. <\/span><a href=\"https:\/\/www.kff.org\/health-reform\/issue-brief\/a-guide-to-the-supreme-courts-decision\/\"><span style=\"font-weight: 400;\">Supreme Court ruling <\/span><\/a><span style=\"font-weight: 400;\">in 2012 made the expansion optional for states. After that decision, Oklahoma Gov. Mary Fallin declined federal funds that would have footed the bill for Medicaid expansion. <\/span><\/p><p><span style=\"font-weight: 400;\">Fast-forward five years and <\/span><a href=\"https:\/\/www.npr.org\/sections\/health-shots\/2018\/10\/23\/659576261\/republican-gun-store-owner-and-legislator-campaigns-for-medicaid-expansion-in-id\"><span style=\"font-weight: 400;\">Idaho<\/span><\/a><span style=\"font-weight: 400;\">, <\/span><a href=\"https:\/\/www.pbs.org\/newshour\/show\/will-conservative-nebraska-vote-to-expand-medicaid\"><span style=\"font-weight: 400;\">Nebraska<\/span><\/a><span style=\"font-weight: 400;\">, and <\/span><a href=\"https:\/\/www.deseretnews.com\/article\/900038281\/full-medicaid-expansion-now-in-utah-voters-hands-after-years-of-lawmaker-balking.html\"><span style=\"font-weight: 400;\">Utah<\/span><\/a><span style=\"font-weight: 400;\"> have changed their tune and could join the 33 states and Washington, D.C., that have expanded Medicaid. Idaho Gov. Butch Otter, a Republican, <\/span><a href=\"https:\/\/www.idahostatesman.com\/news\/politics-government\/state-politics\/article220832075.html\"><span style=\"font-weight: 400;\">endorsed the expansion<\/span><\/a><span style=\"font-weight: 400;\"> initiative Tuesday. In <\/span><a href=\"http:\/\/www.mtpr.org\/post\/ballot-initiative-would-re-authorize-montana-medicaid-expansion\"><span style=\"font-weight: 400;\">Montana<\/span><\/a><span style=\"font-weight: 400;\">, voters are set to decide whether to approve a tobacco tax to continue that state&#8217;s Medicaid expansion or let it roll back next year.<\/span><\/p><p><a href=\"https:\/\/www.npr.org\/sections\/health-shots\/2018\/10\/31\/659452120\/voters-in-4-states-set-to-decide-on-medicaid-expansion?utm_campaign=storyshare&utm_source=twitter.com&utm_medium=social\"><span style=\"font-weight: 400;\">NPR reports<\/span><\/a><span style=\"font-weight: 400;\"> that <\/span><span style=\"font-weight: 400;\">the campaign to get Medicaid expansion onto the ballot in Utah and the three other states have been led by <\/span><a href=\"https:\/\/www.thefairnessproject.org\/\"><span style=\"font-weight: 400;\">The Fairness Project<\/span><\/a><span style=\"font-weight: 400;\">, a nonprofit advocacy group that pushed for ballot measures on issues where they feel lawmakers are out of sync with citizens. The group is funded by the SEIU United Healthcare Workers West, a California health care workers union.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">\u2018A perfect storm\u2019 for hospitals<\/span><\/h3><p><span style=\"font-weight: 400;\">As more GOP-led states with vast rural areas consider Medicaid expansion, supporters in Oklahoma are watching. They say it\u2019s the best solution to make sure rural hospitals survive. <\/span><\/p><p><span style=\"font-weight: 400;\">\u201cBecause other states have found ways to accept these federal funds, they are moving forward, their hospitals are in better shape because of it,\u201d said Patti Davis, director of the <\/span><a href=\"https:\/\/www.okoha.com\/Default.aspx\"><span style=\"font-weight: 400;\">Oklahoma Hospital Association<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p><p><span style=\"font-weight: 400;\">Oklahoma\u2019s rural hospitals are in trouble: <\/span><a href=\"http:\/\/www.shepscenter.unc.edu\/programs-projects\/rural-health\/rural-hospital-closures\/\"><span style=\"font-weight: 400;\">Four have closed <\/span><\/a><span style=\"font-weight: 400;\">in the past eight years,<\/span><span style=\"font-weight: 400;\"> and the hospital association estimates that half of rural to mid-sized hospitals in the state are in danger of shuttering. <a href=\"https:\/\/oklahomaengaged.com\/medicaid-expansion-may-drive-key-rural-votes-in-oklahoma-governors-race\/\">Pauls Valley Regional Medical Center<\/a> grabbed headlines for its recent <\/span><a href=\"http:\/\/www.kten.com\/story\/39279810\/pauls-valley-hospital-closes-money-problems-blamed\"><span style=\"font-weight: 400;\">closure.<\/span><\/a><\/p><p><span style=\"font-weight: 400;\">It\u2019s a perfect storm for Oklahoma hospitals, Davis said.<\/span><\/p><p><span style=\"font-weight: 400;\">\u201cYou\u2019ve got Medicare cuts, then you\u2019ve got a decision not to expand Medicaid, then you\u2019ve got state budget cuts,\u201d she said. <\/span><\/p><p><span style=\"font-weight: 400;\">Oklahoma has the second-highest uninsured rate in the nation \u2014 a major financial strain on hospitals. <\/span><a href=\"https:\/\/ccf.georgetown.edu\/author\/joan-alker\/\"><span style=\"font-weight: 400;\">Joan Alker<\/span><\/a><span style=\"font-weight: 400;\">, a researcher at Georgetown University who <\/span><a href=\"https:\/\/ccf.georgetown.edu\/2018\/09\/25\/health-insurance-coverage-in-small-towns-and-rural-america-the-role-of-medicaid-expansion\/\"><span style=\"font-weight: 400;\">studies health policy<\/span><\/a><span style=\"font-weight: 400;\">, said the number of people without health insurance is even higher in rural areas.<\/span><\/p><p><span style=\"font-weight: 400;\">\u201cWe found that 38 percent \u2014 that\u2019s almost four in 10 \u2014 uninsured, low-income adults would benefit from the Medicaid expansion in Oklahoma as compared to 32 percent of similar adults in metro areas,\u201d Alker said. \u201cWe continue to see over time growing gaps in coverage levels between Medicaid expanders and the non-expanders.\u201d<\/span><\/p><p><span style=\"font-weight: 400;\">Rural places tend to be <\/span><a href=\"https:\/\/search-proquest-com.ezproxy.lib.ou.edu\/docview\/2002228473?accountid=12964&rfr_id=info%3Axri%2Fsid%3Aprimo\"><span style=\"font-weight: 400;\">poorer and have higher rates of unemployment and disability<\/span><\/a><span style=\"font-weight: 400;\"> \u2014 all factors linked to Medicaid eligibility. <\/span><\/p><p><span style=\"font-weight: 400;\">\u201cYou know when there&#8217;s that many uninsured folks, it exposes them to medical debt and bankruptcy and exposes the hospitals and clinics that see them to a lot of bad debt,\u201d Alker said. <\/span><\/p><p><span style=\"font-weight: 400;\">Hospitals are legally required to provide emergency care. In areas where most people don\u2019t have health insurance, that leads to more uncompensated care \u2014 <\/span><span style=\"font-weight: 400;\">services provided by hospitals or health care providers that don&#8217;t get reimbursed. That eats into the hospital\u2019s bottom line.<\/span><\/p>\n<div id=\"attachment_29686\"  class=\"wp-caption module image aligncenter\" style=\"max-width: 620px;\"><img decoding=\"async\" loading=\"lazy\" class=\"size-full wp-image-29686\" src=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/04\/20180328-nurse-practitioner080_WEB.jpg\" alt=\"\" width=\"620\" height=\"413\" srcset=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/04\/20180328-nurse-practitioner080_WEB.jpg 620w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/04\/20180328-nurse-practitioner080_WEB-500x333.jpg 500w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/04\/20180328-nurse-practitioner080_WEB-150x100.jpg 150w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/04\/20180328-nurse-practitioner080_WEB-300x200.jpg 300w\" sizes=\"(max-width: 620px) 100vw, 620px\" \/><\/p>\n<p class=\"wp-media-credit\">Jackie Fortier \/ StateImpact Oklahoma<\/p>\n<p class=\"wp-caption-text\">Oklahoma has the second-highest uninsured rate in the nation \u2014 a major financial strain on rural hospitals. This billboard advertises a hospital in Cordell, Oklahoma.<\/p>\n<\/div>\n<h3><span style=\"font-weight: 400;\">Some bipartisan support<\/span><\/h3><p><span style=\"font-weight: 400;\">The effect of Medicaid expansion on hospital survival is dramatic. <\/span><\/p><p><span style=\"font-weight: 400;\">University of Colorado professor <\/span><a href=\"http:\/\/www.ucdenver.edu\/academics\/colleges\/PublicHealth\/Academics\/departments\/HealthSystems\/About\/Faculty\/Pages\/LindroothR.aspx\"><span style=\"font-weight: 400;\">Richard Lindrooth<\/span><\/a><span style=\"font-weight: 400;\"> found that the probability that a hospital would close was reduced by more than <\/span><a href=\"https:\/\/www.healthaffairs.org\/doi\/full\/10.1377\/hlthaff.2017.0976\"><span style=\"font-weight: 400;\">81 percent<\/span><\/a><span style=\"font-weight: 400;\"> if a state expanded Medicaid. <\/span><\/p><p><span style=\"font-weight: 400;\">\u201cWe performed a more rigorous analysis and controlled for things like local market conditions such as unemployment rate, median income and also hospital characteristics to see if the increased probability of closure in states that did not expand Medicaid remain \u2014 and it did,\u201d he said.<\/span><\/p><p><span style=\"font-weight: 400;\">Rural residents are worried about their local hospitals \u2014 and they\u2019re paying attention. <\/span><\/p><p><span style=\"font-weight: 400;\">At a <\/span><a href=\"https:\/\/www.youtube.com\/watch?v=9oiBngU2N4g\"><span style=\"font-weight: 400;\">recent political forum<\/span><\/a><span style=\"font-weight: 400;\"> sponsored by <\/span><a href=\"https:\/\/togetherok.org\/\"><span style=\"font-weight: 400;\">Together Oklahoma <\/span><\/a><span style=\"font-weight: 400;\">and <\/span><a href=\"https:\/\/oklahomawatch.org\/\"><span style=\"font-weight: 400;\">Oklahoma Watch<\/span><\/a><span style=\"font-weight: 400;\"> in Lawton, all the candidates in attendance \u2014 Republican and Democrat \u2014 supported Medicaid expansion. <\/span><\/p><p><span style=\"font-weight: 400;\">About <\/span><a href=\"https:\/\/www.manatt.com\/getattachment\/82559c33-721d-4209-b1b1-8281e9ff616b\/attachment.aspx\"><span style=\"font-weight: 400;\">250,000 people would have access to health insurance <\/span><\/a><span style=\"font-weight: 400;\">if Medicaid were expanded in Oklahoma, but it comes with an estimated $100 million price tag, which critics say the state can\u2019t afford. The federal government would cover at least 90 percent of the cost. <\/span><\/p><p><span style=\"font-weight: 400;\">Davis with the Oklahoma Hospital Association says another option is better funding for Insure Oklahoma, a state and federal program that subsidizes the cost of health insurance for low-income workers, many of whom fall in a <\/span><a href=\"https:\/\/www.kff.org\/medicaid\/issue-brief\/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid\/\"><span style=\"font-weight: 400;\">coverage gap<\/span><\/a><span style=\"font-weight: 400;\">. <\/span><\/p><p><span style=\"font-weight: 400;\">\u201cIf we accepted federal funds and put them in Insure Oklahoma, they [low-income workers] would qualify for a subsidy to help purchase their premium and then it would be affordable to them,\u201d Davis said. <\/span><\/p><p><span style=\"font-weight: 400;\">Another change to Medicaid may be on the horizon. <\/span><span style=\"font-weight: 400;\">This fall, the Oklahoma Health Care Authority will apply for a federal waiver to <\/span><a href=\"http:\/\/journalrecord.com\/2018\/10\/16\/medicaid-work-rule-raising-concerns-over-lost-coverage\/\"><span style=\"font-weight: 400;\">impose work requirements<\/span><\/a><span style=\"font-weight: 400;\"> on some Medicaid recipients.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>On Election Day, voters in three traditionally Republican-led states will decide whether or not to expand Medicaid, the government health insurance program for the poor and people with disabilities.\ufeffBefore the Affordable Care Act, Medicaid was reserved mainly for pregnant women, poor children, low-income seniors and people with disabilities. With the ACA came the requirement for [&hellip;]<\/p>\n","protected":false},"author":199,"featured_media":30914,"comment_status":"open","ping_status":"closed","sticky":false,"template":"page-noFeature.php","format":"standard","meta":[],"categories":[23],"tags":[857,443,125,322],"acf":[],"_links":{"self":[{"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/posts\/30913"}],"collection":[{"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/users\/199"}],"replies":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/comments?post=30913"}],"version-history":[{"count":6,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/posts\/30913\/revisions"}],"predecessor-version":[{"id":30920,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/posts\/30913\/revisions\/30920"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/media\/30914"}],"wp:attachment":[{"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/media?parent=30913"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/categories?post=30913"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/tags?post=30913"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}