Sam Whitehead
“We’re bankrupting a lot of hospitals by forcing these hospitals to provide care for people who don’t have the legal right to be in our country.”
Sen. JD Vance (R-Ohio) throughout a Sept. 17 rally
During a recent presidential campaign rally in Wisconsin, Sen. JD Vance (R-Ohio) was requested how a Trump administration would defend rural well being care entry within the face of hospital closures, equivalent to two this year in Eau Claire and Chippewa Falls.
In response, he turned to immigration.
“Now, you might not think that rural health care access is an immigration issue,” mentioned Vance, former President Donald Trump’s working mate. “I guarantee it is an immigration issue, because we’re bankrupting a lot of hospitals by forcing these hospitals to provide care for people who don’t have the legal right to be in our country.”
More than 150 rural hospitals have closed or eliminated inpatient companies since 2010, researchers on the University of North Carolina-Chapel Hill reported. Losing a hospital can resonate all through a group — reducing access to well timed care and disrupting the local economy.
The federal authorities has made efforts to maintain the far-flung services afloat, but it surely’s not been an easy problem to resolve.
What Is Plaguing Rural Hospitals?
Experts mentioned Vance’s assertion implies that immigrants who’re within the nation illegally pressure the assets of those hospitals, which frequently function on skinny margins, by taking time and vitality away from different sufferers with out paying their payments.
We contacted each Vance and Trump marketing campaign workers members for added data. They didn’t reply.
Experts on hospital financing and business representatives usually disagreed with Vance’s assertion, noting that many different elements determine in closures.
“When we speak with our rural hospital members, that is not what we hear,” mentioned Shannon Wu, director of cost coverage on the American Hospital Association, a commerce group of greater than 5,000 hospitals across the nation.
Brock Slabach, chief working officer of the National Rural Health Association, mentioned border state hospitals face challenges treating immigrants who’re within the nation illegally. “But I’ve never, in my discussions, had anyone link it directly to a hospital closure,” he mentioned.
The particular conditions that lead a rural hospital to shut its doorways are distinctive to every facility, researchers mentioned, however many face a number of the identical stressors.
Rural hospitals are likely to have low affected person volumes, which presents its personal set of issues. They’re ceaselessly situated in small communities, and a few residents might select to journey to hospitals in greater cities the place they’ll get extra advanced care, what researchers name “hospital bypass.”
That small variety of sufferers could cause monetary losses at small rural hospitals, mentioned Harold Miller, president and CEO of the Center for Healthcare Quality and Payment Reform, a nationwide well being care cost and supply methods coverage middle.
Hospitals have fastened prices, equivalent to for working emergency departments, and have to have a excessive sufficient affected person quantity to cowl them, he mentioned.
“If a patient comes into the ED and doesn’t have insurance or can’t pay, it doesn’t really increase the cost to the hospital very much at all because the physician is already there,” he mentioned, utilizing an abbreviation for emergency division.
Rural hospitals treat a higher share of patients coated by Medicare and Medicaid in contrast with city hospitals, based on the American Medical Association. The public insurance coverage packages for older and low-income Americans usually pay suppliers lower than non-public insurers do.
Nevertheless, Medicare is “one of the better payers” for small rural hospitals, Miller mentioned. That’s partly as a result of services with a particular “critical access hospital” designation receives a commission extra by Medicare — and, in some states, Medicaid.
Hospital business officers and a few specialists say Medicare Advantage plans’ rising popularity has additionally damage rural hospitals’ backside traces as a result of the non-public insurance coverage corporations that supply the plans are usually less reliable payers than conventional Medicare.
For starters, the negotiated charges paid by Advantage plans might be decrease, which is very noticeable for these essential entry services. Advantage plans additionally introduce additional ranges of pricy, staff-intensive administrative burdens to make sure cost.
“They’ll deny the claim or say the patient really didn’t need that service through prior authorization, and so the hospitals don’t get paid for the service from someone who has insurance,” Miller mentioned.
The insurance coverage business commerce group AHIP pushed again on the assertion that Medicare Advantage plans hurt rural hospitals, citing a federally supported examine saying the plans really improve rural hospital monetary stability.
But the examine didn’t examine precise funds between Medicare Advantage and conventional Medicare plans and checked out solely 14 states.
People missing authorized immigration standing usually can’t acquire Medicaid or Medicare protection. But a provision within Medicaid law does enable some immigrants within the nation illegally to briefly acquire protection, mentioned Hayden Dublois, knowledge and analytics director for the assume tank Foundation for Government Accountability.
Medicaid, which pays less than Medicare and personal insurance coverage, “is not exactly a financial boon for hospitals,” and this may very well be a few of what Vance is referring to, Dublois mentioned.
In knowledge from a couple of states, Dublois discovered an increase in individuals enrolling in Medicaid with out having the ability to confirm their immigration standing. But his analysis hasn’t appeared particularly at how this inhabitants may have an effect on rural hospitals’ monetary viability.
Some states have acted lately to develop well being protection to individuals within the nation illegally — providing insurance coverage to greater than 1 million low-income immigrants.
One of these states, California, has had 9 hospitals shut or finish in-patient companies since 2005.
People might be able to pay out-of-pocket for care, researchers mentioned, or might have entry to personal insurance coverage by way of an employer.
Covering the prices for the uninsured is just one monetary stressor rural hospitals face, mentioned George Pink, deputy director of the North Carolina Rural Health Research Program.
“Is that going to be enough to drive a hospital into bankruptcy? Probably not,” he mentioned.
A monetary decline can take years, Pink mentioned. As losses mount, hospitals might be pressured to promote property or different property, draw down any monetary reserves, and max out their credit score.
“This is not an overnight phenomenon,” he mentioned.
Our Ruling
Vance mentioned offering take care of immigrants with out authorized standing was “bankrupting” rural hospitals and forcing them to shut.
Although that inhabitants is more likely to be uninsured, dwelling within the nation illegally doesn’t imply individuals lack the power to pay for well being care — particularly in the event that they reside in states that supply them insurance coverage protection.
Research exhibits many elements contribute to rural hospital closures — not solely monetary losses from offering take care of these with out insurance coverage, whether or not these persons are migrants within the nation illegally or U.S. residents.
We price Vance’s assertion False.
Our sources:
PBS NewsHour, “WATCH LIVE: Vance Addresses Campaign Rally in Eau Claire, WI,” Sept. 17, 2024.
HSHS Hospital Sisters Health System, “HSHS Sacred Heart Hospital and HSHS St. Joseph’s Hospital Closure Information,” accessed Sept. 26, 2024.
Cecil G. Sheps Center for Health Services Research, the University of North Carolina-Chapel Hill, “Rural Hospital Closures,” accessed Sept. 27, 2024.
GAO, “Rural Hospital Closures: Affected Residents Had Reduced Access to Health Care Services,” Dec. 22, 2020.
The Journal of Rural Health, “The Impact of Rural General Hospital Closures on Communities — A Systematic Review of the Literature,” Nov. 20, 2023.
Rural Health Information Hub, “Rural Emergency Hospitals (REHs),” accessed Sept. 30, 2024.
KFF Health News, “Federal Program To Save Rural Hospitals Feels ‘Growing Pains,’” Jan. 16, 2024.
Microsoft Teams interview, Shannon Wu, director of cost coverage on the American Hospital Association, Oct. 1, 2024.
Zoom interview, Brock Slabach, chief working officer, National Rural Health Association, Oct. 1, 2024.
Cecil G. Sheps Center for Health Services Research, the University of North Carolina-Chapel Hill, “Patterns of Hospital Bypass and Inpatient Care-Seeking by Rural Residents,” accessed Oct. 1, 2024.
Zoom interview, Harold Miller, president and CEO, Center for Healthcare Quality and Payment Reform, Sept. 26, 2024.
American Medical Association, “Issue Brief: Payment & Delivery in Rural Hospitals,” accessed Oct. 15, 2024.
Rural Health Information Hub, “Critical Access Hospitals (CAHs),” accessed Sept. 30, 2024.
KFF, “Medicare Advantage Enrollment, Plan Availability and Premiums in Rural Areas,” Sept. 7, 2023.
KFF Health News, “Tiny, Rural Hospitals Feel the Pinch as Medicare Advantage Plans Grow,” Oct. 23, 2023.
Email interview, James Swann, director of communications and public affairs, AHIP, Oct. 21, 2024.
Medicaid.gov, “Implementation Guide: Citizenship and Non-Citizen Eligibility,” accessed Oct. 10, 2024.
Zoom and e mail interview, Hayden Dublois, knowledge and analytics director, the Foundation for Government Accountability, Oct. 1, 2024.
The Commonwealth Fund, “How Differences in Medicaid, Medicare, and Commercial Health Insurance Payment Rates Impact Access, Health Equity, and Cost,” Aug. 17, 2022.
KFF Health News, “States Expand Health Coverage for Immigrants as GOP Hits Biden Over Border Crossings,” Dec. 28, 2023.
Phone interview, George Pink, deputy director, North Carolina Rural Health Research Program, Sept. 30, 2024.
KFF, “State Health Coverage for Immigrants and Implications for Health Coverage and Care,” May 1, 2024.