Significant reductions in Medicaid financing might leave rural areas nationwide confronting extensive hospital shut-downs and decreased health care accessibility, asserts Michael Shepherd, a health policy analyst at the University of Michigan.
Shepherd, who serves as an assistant professor of health management and policy at the U-M School of Public Health, explores the politics and regulations surrounding health inequities in rural regions, including the closure of rural hospitals, the opioid crisis, and Medicaid legislation. His studies concentrate on what he refers to as the “rural health spiral,” a phenomenon where declining health outcomes in rural areas generate a cycle that seldom sees resolution, leading to diminished faith in government interventions over time.
He recently co-penned an op-ed assessing how suggested budget reductions would unfairly impact rural communities. Here, Shepherd reflects on the implications of these recommended changes.
How crucial is Medicaid for rural populations?
Medicaid is crucially important for rural individuals, not only for those who gain direct benefits but also for the viability of rural healthcare facilities that cater to all residents. Twenty-three percent of rural residents are covered by Medicaid, compared to 19% nationwide. Nearly half of rural children are enrolled in Medicaid, which also funds over half of rural births.
Rural medical facilities, mental health providers, and outpatient clinics rely heavily on Medicaid payments. Reductions in Medicaid funding jeopardize institutions that cater to the wider rural populace, including those with employer-sponsored or private insurance.
What occurs when rural hospitals lose Medicaid support?
Consider McNairy County, Tennessee. In 2016, they shut down their regional hospital, primarily due to the state’s refusal to expand Medicaid. After its closure, locals had to travel 45 minutes to an hour for medical attention. If you’re on Tennessee Medicaid, you cannot cross the state line into Mississippi for covered services—you must rely on in-state options that are even more distant.
Studies indicate that when a rural hospital closes, patients travel, on average, 20 miles further for regular care and 40 miles additional for specialized treatment. Each extra mile escalates your health care risks for urgent situations like strokes or heart attacks. Research also reveals that rural hospital closures lead to notable rises in mortality and that maternal and obstetric health outcomes deteriorate following closures.
How do Medicaid cuts influence those not enrolled in Medicaid?
Hospitals in rural regions are frequently the largest employers. The medical sector can provide up to 10% of employment in a rural community. In most rural areas, there aren’t significant employers outside of public schools or hospitals.
If a hospital shuts down, it results in increased unemployment, decreased incomes, and individuals potentially leaving the area to seek employment elsewhere. It’s not merely that Medicaid recipients may face benefit losses—everyone could lose health care access, and a substantial number will lose jobs.
Even community mental health service providers are heavily reliant on Medicaid. Withdrawing Medicaid benefits would mean individuals cannot access their mental health counselors, as those facilities depend on federal funding and Medicaid clients to remain operational.
What does research reveal about states that expanded Medicaid versus those that didn’t?
States that opted to expand Medicaid experienced a substantial decline in rural hospital closures, while non-expansion states continued to witness increases. My findings indicate that about 80% of rural hospitals that have shut down since the Affordable Care Act were situated in Republican states that did not expand Medicaid.
According to the Center for Healthcare Quality and Payment Reform, over 300 rural hospitals are currently facing “immediate risk” of closure—and this is without accounting for the proposed cuts. Rural hospitals function on minimal budgets and continue operating largely due to Medicaid reimbursements. These reductions could severely heighten closure rates.
Why do politicians back cuts that may harm their own constituents?
This touches on what is referred to as “accountability” in political science—whether voters can link policy results to the politicians accountable for them. Numerous studies indicate that voters frequently find it challenging to assign accountability correctly, particularly when policies yield complex, delayed results.
In my research, I discovered that even when state Republicans opted against expanding Medicaid—which ultimately resulted in unfavorable outcomes for rural hospitals—voters held Democrats and the Affordable Care Act responsible for their circumstances. This establishes what I term the “rural health spiral,” where worsening conditions lead to decreased trust among rural populations in governmental solutions, increasing support for politicians unlikely to use government to address issues.
My findings reveal a pattern where Republicans can politically gain from decisions that worsen the situations for their constituents, while Democrats face backlash for enacting policies that genuinely benefit similar communities. It stems from our federal system, where national policies may have significantly different repercussions based on state-level actions, yet voters frequently attribute credit or blame to the president’s party regardless.
What would you urge individuals to comprehend about the broader implications of these cuts?
Those not enrolled in Medicaid should be concerned. If you reside in a rural area, you’re likely to lose health care access yourself should these reductions occur, irrespective of whether or not you receive Medicaid.
What stands out is that Medicaid enjoys popularity across party lines. Survey results indicate that 61% of Republicans, 71% of Independents, and 83% of Democrats view Medicaid as crucial to their communities. These cuts do not align with what people desire.