Since 2010, dozens of rural hospitals have been forced to shut their doors due to the Affordable Care Act, the Washington Post reported.
Citing the National Rural Health Association, which represents 2,000 small hospitals around the nation, the Post reports that 48 rural hospitals have closed since 2010, most in Southern states, with 10 closing in Texas. Some 283 more hospitals are in danger of closing.
While there are other contributing factors than the Affordable Care Act, declining federal reimbursements for hospitals is the main reason for the slew of closings. Medicare payments to hospitals have also been reduced, as have payments to hospitals for the uninsured.
The decision to reduce payments was made based on the assumption that states would expand their Medicaid programs, but 23 states have not done so.
Another problem is the high deductibles charged by many of the new Obamacare insurance plans, often between $2,500 and $5,000, which people can't afford to pay, resulting in fewer visits to the hospital.
Rural hospitals must also deal with declining populations, and a higher percentage of elderly and uninsured patients. Doctors require higher pay to work in rural towns, hospitals must buy expensive yet necessary equipment that doesn't get used often, and hospitals are unable to provide the lucrative speciality services and treatments that big city hospitals provide, according to the Post.
If state and federal officials do nothing to fix the problem, rural health experts fear their hospitals could suffer a repeat of what happened after the Medicare payment system was changed in 1983.
That Medicare overhaul established fixed reimbursements for care rather than payments based on a hospital's reported cost. It resulted in 440 hospitals closing before the policy was amended in 1997 to make exceptions for small hospitals.
"And now, beginning in 2010, we've had another series of cuts that are all combining to create another expansion of closures just like we saw in the '90s," Brock Slabach, senior vice president of the Rural Health Association, told the Post. "We don't want to wake up with another disaster."
