Medicaid expansion keeps rural hospitals open

Medicaid expansion keeps rural hospitals open

Medicaid expansion remains a big success for Louisiana. Since the state expanded eligibility to low-income, working-age adults in July 2016

Number of the Day

255,667 - Total number of ballots cast in early voting, statewide, as of today. (Source: Louisiana Secretary of State)


Medicaid expansion keeps rural hospitals open

Medicaid expansion remains a big success for Louisiana. Since the state expanded eligibility to low-income, working-age adults in July 2016, more than 487,000 people have signed up for coverage  and almost 250,000 of them have seen a doctor for preventative care or a new-patient visit. It’s a very different story in states that have refused to expand Medicaid. Health-care access in those states remains very limited for people making just slightly more than the federal poverty level, which is $20,700 for a family of three. This has led many hospitals in rural areas, which are, on average, poorer than urban areas, to close their doors, affecting both the health and the economy of their regions. Austin Frakt, writing in the New York Times’ Upshot blog, explains:


Beyond the potential health consequences for the people living nearby, hospital closings can exact an economic toll, and are associated with some states’ decisions not to expand Medicaid as part of the Affordable Care Act. Since 2010, nearly 90 rural hospitals have shut their doors. By one estimate, hundreds of other rural hospitals are at risk of doing so. In many communities, hospitals are among the largest employers. They also draw other businesses to an area, including those within health care and others that support it (like laundry and food services, or construction). A study in Health Services Research found that when a community loses its only hospital, per capita income falls by about 4 percent, and the unemployment increases by 1.6 percentage points.

Medicaid expansion has been a key bulwark against these closures.

In a Commonwealth Fund Issue Brief, researchers from Northwestern Kellogg School of Management found that hospitals in Medicaid expansion states saved $6.2 billion in uncompensated care, with the largest reductions in states with the highest proportion of low-income and uninsured patients. Consistent with these findings, the vast majority of recent hospital closings have been in states that have not expanded Medicaid. In every year since 2011, more hospitals have closed than opened. In 2016, for example, 21 hospitals closed, 15 of them in rural communities. This month, another rural  hospital in Kansas announced it was closing, and next week people in Kansas, and in some other states, will vote in elections that could decide whether Medicaid is expanded.

Those states would be wise to follow Louisiana’s example.

Without the individual mandate, we all pay more for health care

America’s healthcare system is notoriously inefficient: America pays more for health care than any other country in the Organization for Economic Co-operation and Development, while ranking poorly in overall health-care system performance. One of the main drags on our system is cost: even when people have health coverage, paying for care places a significant burden on families. In a national survey of people who had experienced severe illness, more than half of all respondents faced dire financial consequences on top of their serious health condition, even though 9 of 10 had insurance.


Now, a new study by the Kaiser Family Foundation’s Rabah Kamal, Cynthia Cox, Rachel Fehr, Marco Ramirez, Katherine Horstman, and Larry Levitt estimates that Congress’ decision to repeal the individual mandate – requiring that everyone have health insurance or pay a fine – has driven up premiums by 16 percent:


Among insurers that publicly specify the effect of these legislative and policy changes in their filings to state insurance commissioners, we found that 2019 premiums will be an average of 6% higher, as a direct result of individual mandate repeal and expansion of more loosely regulated plans, than would otherwise be the case. Adding the impact from the loss of cost-sharing reduction payments – which drove up silver premiums by an average of 10% according to the Congressional Budget Office – to the impact from individual mandate penalty repeal and expansion of more loosely regulated plans, this analysis suggests on-exchange benchmark silver premiums will be about 16% higher in 2019 than would otherwise be the case. A separate analysis finds that 2019 premiums on the whole are staying relatively flat or dropping in many parts of the country, in large part because insurers are currently overpriced. Nonetheless, this analysis finds that 2019 premiums would be dropping even more if the individual mandate penalty were still in full effect.


Immigrant workers put food on America’s tables

As the Trump administration prepares a military response for Central Americans fleeing persecution and hardship – many of them families with children following the legal pathway for an asylum claim – a series by The New Food Economy reminds readers that immigrant labor, much of it undocumented, is overwhelmingly responsible for bringing food to American tables:

Almost everything we put in our mouths was at some point raised, picked, carried, packed, cooked, or served by immigrant hands. Nearly 70 percent of farm laborers in the United States are foreign-born, while about 22 percent in food preparation and processing are. In the nation’s large, global cities the proportion of immigrants in restaurant work tend to be even higher—in New York City, roughly 70 percent of cooks and food preparation workers were born in another country. All this means that food production in the U.S. would cease without immigrants—as, increasingly, it does. An ongoing shortage of agricultural visas, and the Trump administration’s promises to deport more people and raid more farms and businesses has meant that food-related jobs across the country routinely go unfilled. This labor shortage has affected produce, seafood and fish processing, milk and wine, to name just a few; meanwhile, in cities like San Francisco, dishwashers are in short supply. The fact is that native-born Americans simply aren’t willing to do some of the very toughest jobs. It’s brutally hard work—one reason that mental health issues are epidemic among the nation’s farm workers, and the suicide rate is four times higher than in the general population. But when immigrants don’t show up, the work goes undone: harvested fish get wasted, and fruit rots on the vine.


Without a robust legal pathway to immigration, undocumented labor remains baked into the American food system. Meanwhile, proposed changes to the rules for permanent residency would penalize documented immigrant families for using public benefits to keep their families fed and healthy, and simply for being poor. Public comments on this rule are particularly important: you can register your opinion with the Department of Homeland Security through


Election Day registration would improve turnout and maintain election security

The major candidates to be Louisiana’s next Secretary of State met Monday for a debate that the Times-Picayune |’s Julia O’Donoghue described as “a mostly sleepy event.” But as The Advocate’s Mark Ballard reports, each of the candidates support requiring voters to present picture identification, and oppose registering voters on Election Day. That’s a shame, because Election Day Registration (EDR) has been shown to boost voter participation with no negative effect on election security. In 2007, Minnesota’s Secretary of State, Mark Ritchie, pointed out that “EDR is much more secure because you have the person right in front of you—not a postcard in the mail.  That is a no-brainer. We have 33 years of experience with this.” As the National Conference of State Legislatures reports, while evidence for the size of the effect is mixed, the preponderance of the data suggests that gains from same day registration are significant and non-partisan:


There is strong evidence that same day and Election Day registration increases voter turnout, but the extent of the impact is difficult to conclude. Immediately following the implementation of SDR, states usually see a boost in voter numbers. Same day registration states also tend to outperform other states in terms of turnout percentages. Many states that have implemented SDR have historically produced higher voter numbers, making changes hard to gauge. Multiple studies place the effect between an increase of 3 to 7 percent, with an average of a 5 percent increase. Finally, studies reveal no conclusive evidence of whether SDR shapes partisan outcomes or whether certain populations are more likely to benefit.


Democracy functions best with an engaged and active electorate – especially in “sleepy” but consequential races. Election day registration would be a step forward.

Early voting ends today.

Number of the Day:

255,667 – Total number of ballots cast in early voting, statewide, as of today. (Source: Louisiana Secretary of State)