ACA enrollment numbers

[Crockett]

There is also the issue of medical specialization. Do you want a doctor who does four knee replacements a year to operate on you or one that does four a week? My parents live in a small town and want to patronize the local hospital. If their life or mobility is at stake, I want them going to the Metroplex. By the way, I remember angst over closing of rural hospitals during the Reagan administration. I can't remember if we blamed the president then ....

 

[theiioftx]

Quick question that I don't have the answer for, is this a function of the ACA or is it a demographic shift? For decades the population has been migrating to the urban centers for jobs. Concurrently, mechanization has limited the need for rural jobs. Take farming for example since I grew up in Nebraska in a farming community. In the 70's and 80's farmers were still using equipment that could plant 6 or 8 rows at a time. Now the seeders plan 16, 18 or even 20 rows simultaneously. In the 80's you could make a decent living on 350 acres. Now if you farm less than 1000+ then you aren't able to even scrape by. You could apply the same analogy to ranching, logging, or other rural industries.

So, the problem of rural communities losing basic services has been a challenge for decades whether it be mail service, phone service or even internet service more recently. Why is healthcare any different? Hospitals with significant fixed costs and a diminishing customer base would be in trouble regardless of the ACA.

No doubt, many things contribute to it. However, ACA has shifted payer and case mix resulting in more cost with lower reimbursement. This has resulted in the need for more local taxes which are already difficult to get voter approval.

 

[theiioftx]

There is also the issue of medical specialization. Do you want a doctor who does four knee replacements a year to operate on you or one that does four a week? My parents live in a small town and want to patronize the local hospital. If their life or mobility is at stake, I want them going to the Metroplex. By the way, I remember angst over closing of rural hospitals during the Reagan administration. I can't remember if we blamed the president then ....

Rural hospitals are not designed for complicated surgeries or illnesses. If they are in a car wreck or some other issue, they can be stabilized and transferred to a qualified facility. And who cares about whether there are jobs lost, after all the dems can just cut them more handouts.

Any specific link or reference to closing of rural hospitals in the 80's or are you just blathering dem talking points?

 

[Crockett]

Any specific link or reference to closing of rural hospitals in the 80's or are you just blathering dem talking points?

I lived and worked in small communities from graduation in '81 until 1995. Losing rural hospitals was a big issue for community leadership, chambers of commerce and statewide organizations of small community leaders. Honestly, I read generally on a lot of websites but I can't remember reading anywhere about 80s hospital closing since the 1990s. The "blathering" is original.

 

[NJlonghorn]

Rural hospital closures has been a problem for decades. Here are a fewer links:

http://www.ncbi.nlm.nih.gov/pubmed/1736022
http://www.ncbi.nlm.nih.gov/pubmed/10118855
http://www.ncbi.nlm.nih.gov/pubmed/10183522

It does seem to be an even bigger problem now than it was in the 1980s, but that's just my gut feeling. I haven't seen an analysis, whether qualitative or quantitative.

 

[theiioftx]

Rural hospital closures has been a problem for decades. Here are a fewer links:

http://www.ncbi.nlm.nih.gov/pubmed/1736022
http://www.ncbi.nlm.nih.gov/pubmed/10118855
http://www.ncbi.nlm.nih.gov/pubmed/10183522

It does seem to be an even bigger problem now than it was in the 1980s, but that's just my gut feeling. I haven't seen an analysis, whether qualitative or quantitative.

So your articles specifically site poor reimbursement in the 80's as a cause. That is my point. ACA has devastated rural hospitals. However, having an average of 16 per year close versus 673 in the immediate future is a much larger impact. Finally, I wonder what happened in 1992? One answer, the threat of Hillarycare.

 

[BevoBeef]

Quick question that I don't have the answer for, is this a function of the ACA or is it a demographic shift? ...........................................................................................................
So, the problem of rural communities losing basic services has been a challenge for decades whether it be mail service, phone service or even internet service more recently. Why is healthcare any different? Hospitals with significant fixed costs and a diminishing customer base would be in trouble regardless of the ACA.

IMHO, rural hospitals seem to do OK as long as there is population stability in the rural towns nearby. I had two grandparents and a father that died in rural town hospitals. As long as the population is not decreasing in the rural area, then the market is not really changing. After looking at some follow-on links from the article referenced above, the problem is more in governmental control (which is only partly ACA related).

According to this, 3 of the 5 things to know about the rural hospital vulnerability are:
(1) The 673 rural hospitals vulnerable to shutting down are located across 42 states. This implies that the problem is more-or-less widespread.
(2) Sixty-three percent of the hospitals vulnerable to closure are located in states that have not expanded Medicaid. This implies that if you do not support medicaid in the new ACA environment, the patients will go seek healthcare elsewhere. The higher vulnerability rates for closure are in the southeast (southern) states, which are probably politically related to the leanings in those states.
(3) Sixty-eight percent of the hospitals vulnerable to closure are critical access hospitals (CAH). These CAH rural hospitals are classified such by the federal government and forced to operate under certain restrictions. This article touches on why CAH hospitals are seeing little growth. One reason -- "Support for critical-access hospitals has been in the Obama administration's crosshairs for several years. This past year, the president's budget proposed eliminating the extra 1% of payment over costs that go to the (CAH) hospitals."

 

[Seattle Husker]

IMHO, rural hospitals seem to do OK as long as there is population stability in the rural towns nearby. I had two grandparents and a father that died in rural town hospitals. As long as the population is not decreasing in the rural area, then the market is not really changing. After looking at some follow-on links from the article referenced above, the problem is more in governmental control (which is only partly ACA related).

According to this, 3 of the 5 things to know about the rural hospital vulnerability are:
(1) The 673 rural hospitals vulnerable to shutting down are located across 42 states. This implies that the problem is more-or-less widespread.
(2) Sixty-three percent of the hospitals vulnerable to closure are located in states that have not expanded Medicaid. This implies that if you do not support medicaid in the new ACA environment, the patients will go seek healthcare elsewhere. The higher vulnerability rates for closure are in the southeast (southern) states, which are probably politically related to the leanings in those states.
(3) Sixty-eight percent of the hospitals vulnerable to closure are critical access hospitals (CAH). These CAH rural hospitals are classified such by the federal government and forced to operate under certain restrictions. This article touches on why CAH hospitals are seeing little growth. One reason -- "Support for critical-access hospitals has been in the Obama administration's crosshairs for several years. This past year, the president's budget proposed eliminating the extra 1% of payment over costs that go to the (CAH) hospitals."

Thanks for the additional research, BevoBeef. In my experience in rural Nebraska where both my grandmothers still live, Medicaid is critical to the elderly care. For example, one grandmother (93) traveled 3hrs to Denver for a recent eye surgery than leverage her local hospital in Scottsbluff, NE, the biggest hospital in Western Nebraska. Why? The reason I received is that the local hospital can't retain specialists that could be readily accessed in Denver. This is a problem with rural hospitals too. Specialists don't want to work in these rural hospitals.