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What An Obamacare Repeal Would Mean For Rural Hospitals


The House and Senate have taken the first steps to dismantle the Affordable Care Act. It's not clear whether lawmakers will have a replacement for the law before it's repealed. The Affordable Care Act has allowed millions of Americans to buy health insurance for the first time. But it has been controversial. We don't know the impact on hospitals. We're joined now by Maggie Elehwany. She's a lobbyist with the National Rural Health Association. They represent nearly 2,000 hospitals in rural America. Thanks for joining us.


SIMON: Recognizing that there's no one answer, how has the Affordable Care Act affected rural hospitals?

ELEHWANY: Well, let's talk about kind of the overview. So the goal of the ACA was to help the 37 million uninsured out there. And, yes, uninsurance rates have gone down dramatically or at historic lows. But I think a lot of things were unforeseen.

And the way some of the regulations were implemented are actually harming rural America and not fulfilling the ultimate goals of the ACA. And what I mean by that is half of those 37 million - the goal was to expand Medicaid and get those folks into a Medicaid program. We know that a lot of states have taken the Supreme Court up on its option of opting out of Medicaid. That has predominantly hurt rural America.

In fact, if you're a rural state, if you're a poor state, more likely than not, you have not expanded Medicaid. So we're seeing millions of folks left behind at that. Our concern is that since the ACA was passed, we've had an escalation of rural hospitals close. We've had 80 rural hospitals close since 2010. If this rate continues, in less than 10 years' time, we're going to have 25 percent of rural hospitals close within less than a decade.

SIMON: Do you have any concern about the Congress repealing the Affordable Care Act - what's called Obamacare - without a replacement?

ELEHWANY: We certainly do. I do not want to take away, by any means, the good that it has done in rural America. I said it's brought uninsured rates down by 8 percent. It's allowed families to keep their children on their plan until they're age 26. It's helped people buy insurance if they've had preexisting conditions.

We do not want to see rural Americans lose one lapse in the benefits that they have. We are not mad at Republicans or Democrats. We're mad at Republicans and Democrats. We want to make sure that they understand that the well intentions of the ACA have really fallen short and may actually be exacerbating the hospital-closure crisis.

SIMON: We've done a little reporting. I've done some stories in rural hospitals and health care over the years. It can be hard to get doctors to some locations, can't it?

ELEHWANY: Yes, absolutely.

SIMON: Because they spend a long time in medical school. And there just aren't necessarily the opportunities for economic success in a rural environment that they would have in a big city.

ELEHWANY: That's absolutely true. Recruitment and retention of physicians remains one of the top problems in rural-health-care delivery. And I talked about - to bring it back to the Affordable Care Act, there was some other positive provisions in the Affordable Care Act that, sadly, were never funded by Congress through the appropriations process that we think really could've helped recruitment and retention of physicians. There were some specific programs targeted to help workforce issues in rural America. We would love to see, when we address building upon the ACA, reforming it, those programs.

SIMON: What do you hope Congress does?

ELEHWANY: I'm not speaking in one political aisle or the other.

SIMON: Yeah.

ELEHWANY: But rural America spoke very loudly. On a 3-to-1 basis, they voted for Donald Trump. They were voting for a concept. I believe that they feel that they have been left behind. And if you think about it, it's not just health care, where they see their hospitals closing. And one hospital CEO described it as a three-pronged stool. It's the churches, the hospitals and the schools. If you lose one of those legs of that stool, the whole community collapses.

So these towns with their hospital closing are seeing elements of their community go away. Their physicians may leave 'cause they're hospital-based. The nurses leave. The pharmacists leave. These medical deserts are forming. You know, there's studies that show even housing values drop after a hospital closes. So what business wants to relocate to these communities?

There's just not the vitality, the job growth in rural communities. And I think there's a lot of frustration out there that these are hardworking folks who sometimes feel that, inside the beltway, the people in Washington D.C. have forgotten about them.

SIMON: Maggie Elehwany is vice president of government affairs and policy and chief lobbyist for the National Rural Health Association. You represent rural hospitals. Thanks very much for being with us.

ELEHWANY: Thank you so much. Transcript provided by NPR, Copyright NPR.