The Atlanta Journal-Constitution
Rural hospitals brace for damage from health law repeal
Access to service, loss of local jobs at issue for some.
CONNELLSVILLE, PA. — Judy Keller has always relied on Highlands Hospital for medical care, just as her parents did before her. When she walks through the halls, she recognizes faces from the community and even from her days as a schoolteacher.
The 64-bed hospital, she said, is a mainstay of this rural southwest Pennsylvania town.
“This hospital all my life has been here,” said Keller, who is retired. “(It) helps a lot of people who don’t have adequate health care coverage — and I don’t know what they would do without it.”
Aside from providing health care to a largely poor population, it provides hundreds of jobs in a town that locals say never recovered after industries such as coal mining and glass manufacturing disappeared.
But after the presidential election, Highlands — like many other rural hospitals — is likely to face new financial challenges that will intensify long-standing struggles, experts say. The Affordable Care Act, which President Donald Trump wants repealed, threw a number of lifesavers to these vital but financially troubled hospitals. The health care law’s full repeal, without a comparable and viable replacement, could signal their death.
Highlands provides one window into how some of these shifts could reverberate in small towns across the country. Sixty-four percent of the voters in Fayette County — one of the state’s poorest — supported Trump. Pennsylvania, which has the third largest rural population in the nation, played a pivotal role in his upset victory.
The health care law expanded Medicaid to tens of thousands of previously uninsured patients, providing new revenue streams for rural hospitals, which often serve a poorer, sicker patient population. The law also created a program that allowed some of these facilities to buy prescription drugs at a discount, though Highlands qualified for that program independently of the Affordable Care Act.
“All these rural hospitals are operating on thin margins. The removal of any income source or coverage, or expansion of bad debt, is going to create significant financial hardship,” said Alan Morgan, CEO of the National Rural Health Association.
Rural hospitals have long operated on the edge. In the past six years, more than 70 such hospitals have closed, citing financial duress. Almost 700 more have been deemed at risk of following the same path.
Meanwhile, the need for reliable health care remains pressing. Conditions such as heart and lung disease are widespread in rural areas. Addiction to the prescription painkillers is acute. Nationally, the Medicaid expansion offered a bit of stability for some rural hospitals at risk of closing. Researchers say it disproportionately benefited such hospitals — particularly here and other states with large rural populations, such as Illinois, Kentucky and Michigan.
In Pennsylvania, 625,000 people enrolled in the expanded Medicaid program. Close to 300,000 came from rural areas, said Andy Carter, president of the Hospital and Health System Association of Pennsylvania. As of October, about 42,700 of Fayette’s residents had Medicaid, according to state data, an increase of about 8 percent from June 2015. (Pennsylvania’s Medicaid expansion took effect in January of that year.) That’s close to one-third of the county’s population.
Despite that, John S. Andursky, Highlands Hospital’s chief financial officer, said he barely noticed the increase — the threat of closing is a “daily concern,” he said.
“It seems like you’re taking two steps forward, three steps back,” Andursky said. “It’s not like I can look to five years out — because I have to worry about tomorrow. I can’t worry about next year.”
Such pessimism can be heard throughout this town of about 7,600 residents. While the law was described as historic, many here do not perceive that it helped them. Like many other states, Pennsylvania rebranded their expanded offering of federal insurance program for the poor, fearing that “Medicaid,” which is also often referred to as “Medical Assistance,” would be off-putting; now it is called “Healthy PA.”
Bryan McMullin, who works in Connellsville’s river-rafting business, got coverage last year but said good health care remains hard to find.
“In this area, nothing’s changed in 40 years, no matter who is president,” he said.
Daniel Martin, a Highlands patient who also works in the rafting trade, said he uses his new coverage for his monthly blood medication. A Trump voter, he hadn’t realized that coverage now could be in jeopardy.
And small towns like this tend to be far sicker than other places. In Fayette, more than 10 percent of the population is estimated to have diabetes. Out of 67 counties in the state, Fayette ranks 66th for health outcomes and more than a third of its residents are obese. It’s tied with northern Potter County for the second-highest teenage birth rate in the state.
From 2014 to 2015, about 31 people overdose on drugs for every 100,000, according to an analysis by the federal Drug Enforcement Agency.
Also, the hospital is Connellsville’s second-largest single employer, after the school district. It contributes an estimated $15 million to the local economy, Andursky said. That’s in a town where unemployment is already at 7.6 percent — up from last year and higher than the state and national averages.
There are other hospitals in the region.
Uniontown, about 15 miles away, is also in Fayette County. It has 175 beds _ more than double those at Highlands — but no behavioral health services to treat problems like addiction. Frick, another small rural hospital about 12 miles away, technically serves neighboring Westmoreland County. For more serious conditions, and trauma care, university hospitals are about an hour away — in Pittsburgh on one end, and Morgantown, W.Va, on the other.
But rain and snow mean that traveling even short distances can be a hardship. “It is still challenging to have to travel even 20 miles to get your care,” said Lisa Davis, director of Pennsylvania’s Office of Rural Health. “It could take you all day to get to a one-hour appointment.”