The head of the National Rural Health Association said the organization will oppose the Senate’s healthcare bill because the legislation will hurt rural America.
“In its current form, this bill is anti-rural,” said Alan Morgan, NRHA chief executive officer.
The bill, named the Better Care Reconciliation Act, contains several provisions that would hit especially hard in rural areas, Morgan said.
Among these are deep cuts in Medicaid spending and an end to Medicaid expansion. About 45 percent of rural children use Medicaid, compared with 38 percent in metropolitan areas, according to a Georgetown University study.
The bill would reduce funding for treatment of opioid addiction, another issue for rural America. The rate of opioid overdose deaths is 45 percent higher in nonmetropolitan counties, according to NHRA. The Senate bill provides $2 billion to fight opioid addiction in 2018, while the House version of the bill, called the America Health Care Act, provides $45 billion over 10 years.
“They actually found a way to make the House bill worse,” Morgan said. “You really had to work to do that.”
The Senate version does nothing to improve insurance market places for rural areas and could make them worse by cutting tax credits for insurance purchases, wrote Erin Zumbrun, an NHRA policy manager, in a blog post.
Premium costs were already a problem in rural areas because of lack of competition, Zumbrun wrote.
“The Better Care Reconciliation Act will further exacerbate this problem by substantially reducing the tax credits available to assist individuals in purchasing insurance,” Zumbrun wrote. That will “likely [lead] to many more individuals [being] unable to afford health insurance or purchasing coverage with high deductibles and low coverage that in essence is the same as being without coverage.”
Rural hospitals will continue to be at risk of closure under the new bill, Zumbrun said. “Expansion of insurance coverage is irrelevant if there is no one to provide care,” she wrote.
The [act] does not reverse the plethora of cuts to the Medicare program that have resulted in negative Medicare margins. Because rural Americans tend to older, sicker, and poorer than their counterparts, this has resulted in 7 percent gains in median profit margins for urban providers while rural providers have experienced a median loss of 6 percent.
One analysis shows that 673 rural hospitals are vulnerable to closure. Since 2010, 79 rural hospitals have closed, according to a University of North Carolina at Chapel Hill health research center.
Morgan also noted one part of the bill that probably won’t attract much attention but ought to. The bill zeroes out the Public Health and Prevention Fund, which has been used to fight the zika virus, a mosquito-borne disease that can cause severe birth defects.
“There is a real concern that zika is going to reemerge this summer in rural communities along the southern border,” he said. “From a rural public health standpoint it’s a real problem.”
On Wednesday, Democratic senators held a hearing in advance of the bill’s release. Witnesses from rural organizations testified about the potential impact of Medicaid cuts for the disabled and the impact of removing mental health coverage requirements. Their comments were based on the House version of the bill and assumptions about what would be the Senate version.
“This bill is going to hit rural America like a wrecking ball,” said Democratic Senator Ron Wyden of Oregon, who attended the Wednesday hearing.
Republican Senator Mitch McConnell, majority leader, said the bill was necessary because the Affordable Care Act has failed. “Obamacare isn’t working,” he said when releasing the bill. “By nearly any measure it has failed and no amount of eleventh hour reality-denying or buck-passing by Democrats is going to change the fact that more people are going to get hurt unless we do something.”