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Rural hospitals depend on Medicare payments far more than rural hospitals, reports Steve Jordon at the Omaha World-Herald, and that gap will widen as rural populations age. As a result, Jordon writes, “rural hospital administrators and others worry that the Patient Protection and Affordable Care Act, signed into law in March, will cut revenue and curtail medical services at rural hospitals.” 

Jordon talked to hospital administrators at midsized hospitals in Nebraska are especially worried that reductions in Medicare payments will not be made up by requirements that most Americans buy health insurance. One Nebraska hospital writes off about $4 million a year in unpaid care out of $120 million in revenue. The new law is supposed to reduce those kind of write-offs by qualifying more people for Medicaid and the private insurance mandate.

“In theory that’s a good thing,” one administrator said. “However, the government anticipates paying for this whole program through efficiencies in government and reductions in Medicare reimbursement. How do you do that?” (The hospital above is in Columbus, Nebraska.)

Rebecca Lifkin, director of the University of North Carolina’s Rural Health Research and Policy Analysis Center, said rural hospitals were listened to during the health care debate. “The politics worked,” Slifkin said. “It’s why I believe a lot of very rural-friendly provisions made it in the final bill. There was a huge focus on rural hospitals. Everybody involved was quite concerned that they come out whole on this.”

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