MANSFIELD, La. — When Desoto Regional Health System took out $36 million in loans final 12 months to renovate a rural hospital that opened in 1952, officers have been banking on its predominant funding supply remaining secure: Medicaid, the joint federal-state well being program for low-income folks and the disabled.
But these {dollars} at the moment are in jeopardy, as President Donald Trump and the GOP-controlled Congress transfer to shrink the practically $900 billion well being program that covers greater than 1 in 5 Americans.
Desoto CEO Todd Eppler stated Medicaid cuts might make it tougher for his hospital to repay the loans and for sufferers to entry care.
“I just hope that the people who are making these decisions have thought deeply about it and have some context of the real-world implications,” he stated, “because it’s going to affect us as a hospital and going to affect our patients.”
One of the decision-makers is Eppler’s consultant in Congress: House Speaker Mike Johnson, who lives about 35 miles north of right here. He stated he is aware of the Republican chief and his workers perceive hospitals’ plight: The mom of Johnson’s chief of staff is CEO of a rural hospital in the district.
“I’ve never met a congressman yet that wanted a rural hospital in their district to close, and certainly Mike is no exception to that rule,” Eppler stated.
Last 12 months practically 290,000 folks in Johnson’s district have been enrolled in Medicaid, about 38% of the whole inhabitants, in line with information compiled by KFF, the well being info nonprofit that features KFF Health News.
About 118,000 of them are in this system due to the Affordable Care Act, which allowed states together with Louisiana to increase Medicaid to cowl low-income adults, a lot of whom have been working in low-paying jobs that don’t present medical insurance.
Louisiana ranks second in Medicaid enrollment, at practically 32% — a mirrored image of the state’s excessive poverty charge. As Republicans weigh cuts, their actions might have dramatic penalties for his or her constituents right here. Of the eight GOP-held House districts with probably the most Medicaid enrollees because of the growth, 4 are in Louisiana. Johnson’s largely rural district ranks sixth in growth enrollees.
Among them is Chloe Stovall, 23, who works within the produce aisle on the SuperValu grocery retailer in Vivian, Louisiana. She stated her take-home wage working full time is $200 every week. She doesn’t personal a automobile and walks a mile to work.
The retailer supplies well being protection, however she stated she received’t qualify till she’s labored there for a full 12 months — and even then, it’s going to value greater than Medicaid, which is free.
“I’m just barely surviving,” she stated.
In February, Johnson pushed a funds decision by the House that requires slicing a minimum of $880 billion over a decade from a pool of funding that features Medicaid, to assist fund an extension of Trump’s tax cuts and his border priorities. Republicans in Congress at the moment are contemplating the place to make cuts, and Medicaid is more likely to take an enormous hit.
Defending the plan, Johnson stated that Medicaid is “not for 29-year-old males sitting on their couches playing video games.”
Stovall stated nearly everybody she is aware of on Medicaid works a minimum of one job. “I don’t even own a TV,” she stated.
Contacted for remark, Johnson’s workplace pointed to his remarks at a convention in Washington final month. “We’re going to be very careful not to cut a benefit for anyone who is eligible to receive it and relies upon it,” Johnson stated.
KFF Health News spoke with two dozen Medicaid enrollees in Johnson’s district. Most stated they have been unaware their congressman is main the Republican cost to upend this system. Those knowledgeable of the Republican plan stated it scares them.
Some GOP members of Congress wish to eradicate the ACA’s Medicaid growth funding, which led to twenty million working-age adults gaining protection and helped slash the nation’s uninsured charge to its lowest stage in historical past. Forty states and the District of Columbia have agreed to the change, which promised further federal funding in change for increasing eligibility.
In this closely Republican district, the place Johnson received with 86% of the vote in November, 22% of residents stay in poverty.
Like Trump, Johnson says he desires cuts to Medicaid however hasn’t elaborated aside from saying this system shouldn’t cowl “able-bodied” adults with out imposing a piece requirement.
“Everybody is committed” to preserving Medicaid advantages “for those who desperately need it and deserve it and qualify for it,” Johnson stated at a information convention in February. “What we’re talking about is rooting out the fraud, waste, and abuse.”
Medicaid recipients in Johnson’s district, instructed about GOP plans to chop this system, stated their lives are laborious sufficient in a state the place the minimal wage is $7.25 an hour. Without Medicaid, they stated, they couldn’t afford well being protection.
In Vivian, close to the borders with Arkansas and Texas, near half of the two,900 residents stay in poverty. The main-street outlets are largely shuttered, apart from a thrift retailer and a mom-and-pop restaurant that focuses on fried pork chops.
“Most everybody you know is on Medicaid here,” stated Doris Luccous, 24.
Close to half of the residents of Vivian, Louisiana, close to the borders with Arkansas and Texas, stay in poverty. Most employers there pay the minimal wage, which hasn’t modified since 2009, and lots of staff depend on Medicaid.(Phil Galewitz/KFF Health News)
Luccous stated she makes $250 every week after taxes as a housekeeper at a nursing residence whereas elevating her 2-year-old daughter in her childhood residence. While procuring along with her father — who doesn’t work, due to a incapacity — she stated she counts on Medicaid for her bipolar medicines and to pay for remedy appointments.
“I don’t know where I would be without it,” she stated.
Neither Luccous nor Stovall stated they voted within the final election, and neither knew that Johnson is their consultant in Congress.
Vivian has few massive employers, and most employers pay the minimal wage, which hasn’t modified since 2009. “We are just stuck,” Stovall stated.
Still, she stated, “it’s a community where everybody knows everybody, and people are always willing to lend a hand because so many are in difficult financial circumstances.”
Willie White is CEO of David Raines Community Health Centers, which operates six outpatient clinics in northwestern Louisiana that serve primarily Medicaid enrollees. He stated that Louisiana already ranks among the many worst states for folks’s well being and that Medicaid cuts would solely worsen the state of affairs.
“You cannot expect health outcomes to improve if people can’t afford to access care,” White stated.
Willie White is CEO of David Raines Community Health Centers, which has six outpatient clinics in northwestern Louisiana, most of them in Speaker Mike Johnson’s district. The state’s determination to increase Medicaid has meant that extra of the facilities’ sufferers have entry to specialty care. White is anxious that main Medicaid cuts might hurt sufferers and the facilities’ monetary well being.(Phil Galewitz/KFF Health News)
While the clinics present major and dental care on a sliding price scale for uninsured sufferers, signing them up for Medicaid offers them higher entry to specialists and brings the well being facilities income to cowl the price of delivering care.
Many of the facilities’ sufferers gained protection by Medicaid growth. Afterward, charges of screenings for colon and cervical most cancers went from 10% to 50%, White stated.
But if Congress cuts Medicaid, the well being facilities can be pressured to chop companies, he stated.
“Mike Johnson has been here and knows us, and he and his office have been responsive about our issues,” White stated. “The message in prior years was, ‘We need additional funding,’ but now it is asking for no cuts.”
Community well being facilities, which in 2023 offered care nationally to greater than 32 million largely low-income folks, have seen funding will increase from Republicans and Democrats for many years.
“Everyone is supportive, but the question remains what that support will look like under the current administration,” White stated. “If there are to be reductions, they need to be done with a scalpel.”
Expecting cuts, the well being facilities have already restricted journey and put a maintain on filling vacant positions, White stated.
Sitting in a David Raines clinic in Bossier City, Benjamin Andrade, 57, stated having Medicaid has been a lifesaver since he wanted coronary heart surgical procedure in 2020. Andrade is a chef and stated he helps his spouse and two youngsters on $14 an hour.
He had not heard about any potential cuts to this system. Without Medicaid, he stated, “it would be very hard for me to pay for all the medicines I take.”
Dominique Youngblood, 31, who was on the clinic for a dental checkup, stated she’s had Medicaid most of her life. “Medicaid helps me so I don’t have to pay out-of-pocket going to the doctors,” she stated.
Dominique Youngblood waits for a dental checkup on the David Raines Community Health Center in Bossier City, Louisiana. She says she’s had Medicaid most of her life and fears what would occur if she misplaced protection for herself and her two youngsters.(Phil Galewitz/KFF Health News)
Youngblood, who has two youngsters, makes $12 an hour at a day care heart. Asked about GOP efforts to cut back this system, she stated, “It’s not fair, because it helps a lot of people who cannot afford medications and emergency room trips, and those are costs you can’t control.”
Back in Mansfield, Eppler’s hospital is greater than only a well being facility — it’s the place many individuals on the town come for lunch. The cafeteria was packed on a current Friday as staff served boiled shrimp, fried okra, and baked fish.
Eppler stated he’s conscious Republicans in Congress are focusing on a system of taxes that some states, together with Louisiana, levy on hospitals and different well being suppliers to attract down extra federal Medicaid funding. That cash helps finance what are often called supplemental funds to suppliers. Some conservatives belittle the additional funding as “money laundering.”
But that cash accounts for about 15% of the DeSoto well being system’s funds, stated Eppler, a retired Air Force lieutenant colonel who has been CEO for a dozen years. “We are using that money to invest in the next 50 years of Desoto Parish, to build a hospital that they can have that will be sustainable,” he stated.
The supplemental funds, for instance, assist pay to offer psychological well being companies at three outpatient clinics. “If that $4 million went away, we would have to limit services — it’s just that simple,” he stated.
Eppler, a retired Air Force lieutenant colonel, has been CEO of DeSoto Regional Health System for a dozen years.(Phil Galewitz/KFF Health News)
Phil Galewitz:
[email protected],
@philgalewitz
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