One-Size-Fits-All Health Care Does Not Fit Rural Hospitals

As the administrator of a small, rural hospital in Butler, Alabama, I am all too familiar with the challenges rural health care providers face. And I am increasingly concerned that the new government insurance systems being proposed by some national leaders — such as “Medicare for All,” Medicare buy-in, or public option systems — will make our challenges even greater.

For rural facilities, the stakes could not be higher. In less than 10 years, my home state of Alabama has seen the closure of six of its rural hospitals. Eighty-eight percent of the state’s rural hospitals are operating at a loss, and there are more rural hospital closures expected in the state. In fact, 50 percent of Alabama’s remaining rural hospitals are at risk of closing.

Throughout America, our rural hospitals are struggling. A recent report found that over one-fifth of the country’s rural hospitals are at high risk of closing, putting patients and local economies in danger. As presidential candidates and lawmakers in Congress debate the future of health care in our nation, it is critical that they focus on policies that will help rural patients and communities, not put our hospitals and care at even greater risk.

It’s clear that more must be done to increase access to affordable, quality health care to all Americans, but a one-size-fits-all government system such as Medicare for All is the wrong approach and would only exacerbate the financial struggles rural hospitals face today.

Under such a system, hospitals would see their payments cut to levels insufficient to cover the cost of providing care, with experts warning, “some hospitals, especially struggling rural centers, would close virtually overnight,” and as some hospitals attempt to offset these steep cuts, they could be forced to do away with important services like mental health. This would affect patients’ access to and quality of care as they endure longer wait times or travel longer distances to find the health care services they need.

Remember this fact when the folks promoting these government-run insurance systems claim that you could keep your preferred hospitals and physicians.

Access to health care in rural areas suffers due to difficulties in recruiting, keeping physicians at the local level and many practicing physicians nearing retirement. There is a concern that many of these physicians would rather retire than provide a lower quality of care due to diminishing income and heavy government regulation.

And lawmakers shouldn’t be fooled by more moderate-sounding proposals such as “Medicare buy-in” or a “public option,” as these plans feature the same debilitating cuts to hospitals and are stepping stones to a one-size-fits-all system run by Washington, with all the same negative consequences to patients and hospitals.

That point is underscored by studies on “public option” proposals. One study found that such systems could produce layoffs and “potentially force the closure of essential hospitals.” Another study explained that reimbursing hospitals at the proposed lower rates “would compound financial stresses they are already facing, potentially impacting access to care and provider quality.”

Today, more than 294 million Americans are covered through employer-provided plans and other private coverage, which work in tandem with public programs such as Medicare and Medicaid to cover over 90 percent of all Americans today. Polls indicate that the majority of Americans are satisfied with their current coverage and do not want to give up the choices and control they have today — a fact U.S. Rep. Terri Sewell (D-Ala.) wisely noted at a recent U.S. House hearing on one-size-fits-all government run health care: “I have a lot of folks in my district – 50 percent of the folks in my district have employer-based health care coverage, and they want to keep that.”

Instead of devising systems that will hurt patients, lawmakers and presidential hopefuls should focus on proven solutions to expand coverage and save our rural hospitals. In fact, by using tools available by law today, such as expanding Medicaid in the states that have failed to do so, millions more Americans would immediately be covered, including up to 300,000 Alabamians who would be eligible for Medicaid under expansion.

It’s about time our leaders in Washington took this common-sense, constructive approach and put patients and communities first. Our rural communities’ health depends on it.


J.W. Cowan is administrator for Choctaw General Hospital in Butler, Alabama.

Morning Consult welcomes op-ed submissions on policy, politics and business strategy in our coverage areas. Updated submission guidelines can be found here.

Morning Consult