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How Health Care Policy Is Shaping Services In Rural North Carolina

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Mission Health, a hospital system in Western North Carolina, announced this week that it would close its maternity ward at Angel Hospitalin Franklin, North Carolina. The hospital serves a mostly low-income, rural population. Mission Health said it cut the hospital’s labor and delivery services to remain solvent in the face of low reimbursement rates.

North Carolina’s rejection of federal funding to expand Medicaid may have contributed to Angel Hospital’s hardships, which are shared by rural hospitals around our state. Now Republicans have passed a healthcare bill in the House that would give states greater flexibility to manage their own healthcare systems but would limit Medicaid and other subsidies even more.

Host Frank Stasio talks with reporters and experts about how North Carolina’s rural populations are being helped or hindered by these political decisions. He is joined by Matt Bush, the news director of Blue Ridge Public Radio, Dr. Maureen Ben-Davies a pediatrician from McDowell Pediatrics, Jon Oberlander, professor and chair of social medicine and professor of health policy and management at the University of North Carolina-Chapel Hill, and Julie Rovner, the chief Washington correspondent for Kaiser Health News.


Matt Bush on economic issues behind the closure of Angel Hospital’s maternity ward

The city of Franklin is about 3,000 people. And this is, again, about an hour west of Asheville. So you’re getting into the far reaches of Western North Carolina … And it serves a very impoverished area. Mission [Health System, which operates Angel Hospital] says 77 percent of the people who come to that hospital either use Medicaid, Medicare, or don’t pay. And that’s higher than an average hospital. And that’s the truth in most rural hospitals, that the percentage of people who use Medicaid, Medicare, and no-pay is higher. So this is a pretty impoverished area. This is also an area where a lot of [people’s] yearly income is right above the federal poverty line. And this was a lot of people that the Affordable Care Act was designed to help – with the Medicaid expansion among other things – to help them get health insurance. So right now this is an area that’s very, very susceptible to changes in healthcare and potentially people losing their healthcare. 

Maureen Ben-Davies on what happens to those who qualify for neither Medicaid nor subsidies   

Then they are uninsured. I see them in clinic and it’s heartbreaking. It’s the parent who’s got an asthmatic child who comes in first thing in the morning after dealing with a child who’s having difficulty breathing all night. But [they’re] fearful of going to the ER and getting that hospital bill that’s going to drag them down for months. The look of guilt and love in their eyes can be very heartbreaking, heart-wrenching. Medications for asthma can be very expensive so if you are covered you pay your nice $10 copay, but when you go to fill your medication out at the CVS and they tell you it’s going to be $100 to fill that inhaler for your child to have well-controlled asthma, then that’s a difficult decision people have to make. Food or medicine?

Julie Rovner on the effects of Medicaid expansion

Well there was an interesting study that actually came out of researchers at the University of North Carolina that found that rural hospitals were much more affected by whether states did or didn’t expand Medicaid. That in states that did expand Medicaid, rural hospitals were much more likely to be profitable than states that didn’t. So even though Medicaid doesn’t pay that much, as we talked about, it is important to the finances of those rural hospitals. 

Jon Oberlander on impact should the Affordable Care Act replacement bill pass the Senate

It would be devastating to our state, and to every other state. The Republican bill would cut about $900 billion out of federal Medicaid spending over 10 years. That’s a 25 percent cut in Medicaid spending. It would have a devastating impact on hospitals in North Carolina, on physicians, and across the country, millions and millions of Americans would lose coverage as a result of it...
...On average the subsidies that people get to buy health insurance under the Affordable Care Act, they would fall by about 50 percent. And what the Republican plan does is a couple things. One is it changes … the Affordable Care Act gives money to people based on their income: Income-related tax credits to buy health insurance if they’re uninsured. Under the Republican plan, those tax credits would no longer vary by income. They would be fixed according to age. Some younger people, some healthier people will do well. But lots of other people including older people, including people who live in rural areas, would pay a lot more.

Jon Oberlander on putting the current debate in context

This is a debate that’s gone on in the United States for a century. Most other rich democracies settled this question long ago: Is healthcare a right. And that fundamental question is still being contested in this country. One way to view the Affordable Care Act is the United States took a giant step toward the principle that all Americans should have access to health insurance. And one way to view the American Health Care Act, the House Republican bill, is that it takes a giant step backwards from that principle. There is no going back to the status quo ante. And you can see that in the sort of gymnastics that House Republicans had to perform in order to get this bill through.

Jennifer Brookland is the American Homefront Project Veterans Reporting Fellow. She covers stories about the military and veterans as well as issues affecting the people and places of North Carolina.
Longtime NPR correspondent Frank Stasio was named permanent host of The State of Things in June 2006. A native of Buffalo, Frank has been in radio since the age of 19. He began his public radio career at WOI in Ames, Iowa, where he was a magazine show anchor and the station's News Director.
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