Dollars and sense: Medicaid expansion in NC is long overdue

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If saving lives isn't enough for you, how about saving rural hospitals?

The data are overwhelming. In states that have expanded, the move has been a boon, both for the health of patients, the strength of local economies bolstered by thousands of new health care jobs, and increased stability, in particular, for rural hospitals that have been buffeted by changes rocking the health care system.

“There’s more data that’s showing a link to employment, overall better economic conditions,” said Hemi Tewarson, director of the health division at the National Governors Association. “There have been studies done that show rural hospitals have done better in expansion states compared to non-expansion states, primarily because they have another stream of reimbursement that has kept them more stable.”

As long as the bulk of our health care system remains in the private sector, we must enact programs that make rural hospitals and clinics "economically viable." If we don't, rural folks will end up having to travel 75 miles or more to be treated. That's simply too far for "well-care" visits, so most of those trips will be for serious (if not life-threatening) injuries or illnesses. It's those regular visits that can extend lives and improve the quality of those lives:

Because her patients have been doing better too, Steeley’s been getting grants to bring more people into her clinics in the past year. Her experience mirrors the findings of researchers from Boston and Iowa who looked at rural community health clinics in expansion states and found: “Changes in quality and volume were consistently observed in rural [community health centers] in expansion states, which had relative improvements in asthma treatment, body mass index screening and follow-up, and hypertension control.”

Those researchers concluded that “expansion may be particularly important to rural [community health center] patients, who have access to fewer primary care providers, and may serve as a mechanism for reducing disparities that persist between urban and rural regions.”

That "disparities" issue is extremely important, because the gap between urban and rural health has steadily grown since 1969:

Life expectancy was inversely related to levels of rurality. In 2005-2009, those in large metropolitan areas had a life expectancy of 79.1 years, compared with 76.9 years in small urban towns and 76.7 years in rural areas. When stratified by gender, race, and income, life expectancy ranged from 67.7 years among poor black men in nonmetropolitan areas to 89.6 among poor Asian/Pacific Islander women in metropolitan areas.

Rural-urban disparities widened over time. In 1969-1971, life expectancy was 0.4 years longer in metropolitan than in nonmetropolitan areas (70.9 vs 70.5 years). By 2005-2009, the life expectancy difference had increased to 2.0 years (78.8 vs 76.8 years). The rural poor and rural blacks currently experience survival probabilities that urban rich and urban whites enjoyed 4 decades earlier. Causes of death contributing most to the increasing rural-urban disparity and lower life expectancy in rural areas include heart disease, unintentional injuries, COPD, lung cancer, stroke, suicide, and diabetes.

Most of those life-threatening conditions can be treated, to one degree or another, especially if they are discovered early enough. But that's not going to happen if all the (remaining) rural health centers close down.

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The Supreme Court really dropped the ball

when it ruled Medicaid expansion should be "voluntary" with no penalty for states who refuse. So now, if you make enough money, you get more money, but if you don't make enough money, you don't get jack. The word "unfair" doesn't even cover it...