Wednesday Roundup: Rural Health Cuts


proposal to trim the federal budget would cut $320 billion in Medicare and Medicaid spending in the coming decade. It targets rural hospitals. 

The plan would cut $6 billion over ten years to rural hospitals, eliminating what the White House calls “higher than necessary reimbursement.” The proposal would eliminate Critical Access Hospital designation for hospitals that are close to urban hospitals, which will reduce funding to these institutions and “better align payment to rural providers with the cost of care.”

The National Rural Health Association notes that 41% of CAH operate at a loss and that without Medicare reimbursements over half of CAHs would be money losers. “Such devastating cuts will cause rural hospital doors to close, resulting in loss of access to health care and needed rural jobs,” the RHA blog notes.

Here is more from the association’s blog

Higher than necessary reimbursement? Currently, 41 percent of small rural hospitals, known as critical access hospitals (CAHs), operate at a financial loss. If the President’s proposal to cut billions in Medicare reimbursements hits these facilities, over half of CAHs would lose money.  Such devastating cuts will cause rural hospital doors to close, resulting in loss of access to health care and needed rural jobs.

CAHs account for only 5 percent of Medicare hospital inpatient expenditures, yet they provide critical care and jobs – it’s a sound investment not a “higher than necessary reimbursement.”

Congress created the special designation of a CAH in 1997 to prevent a flood of rural hospitals closures in the 1980s and 1990s. The CAH program is a safety net program that is working.  Despite so many struggling financially, many rural hospitals doors are able to stay open solely because of the CAH program. These hospitals provide vital care for the millions of our nation’s most vulnerable citizens – rural seniors who are on average, poorer and sicker than urban or suburban seniors.

Rural communities depend on rural hospitals for jobs, economic growth and revenue production.  Rural hospitals are often the largest or second largest employer in rural America. The average CAH supports more than 100 jobs and provides $5 million in wages, salaries and benefits to the local community.

• Every Alaskan will receive a check this year for $1,174 out of the state’s Permanent Fund. The Fund is replenished each year by oil royalties. The Fund has a balance of over $40 billion. 

• Gold is a weird investment. People spend a lot of money to dig it up, and then they bury it again.

Now Bloomberg reports that gold vaults are overflowing and banks are having to dig away to make more space for more gold. 

• The New York Times published a story this week on rural on-line forums in rural places. You can read it here.

The article deals mainly with Topix, a generic forum site and aggregator published by some big city newspapers. It turns out that a featureless, out-of-town online forum attracts kooks. Who’d a thunk? 

Al Cross over at the Rural Blog, which works with rural newspapers, had enough. He wrote

Topix has found “an unexpected niche in communities of a few hundred or few thousand people — particularly in what Chris Tolles, Topix’s chief executive, calls ‘the feud states.’ One of the most heavily trafficked forums, he noted, is Pikeville, Ky., once the staging ground for the Hatfield and McCoy rivalry.”

That’s about enough, Mr. Tolles. You and your newspaper paymasters (Gannett Co., the McClatchy Co. and Tribune Co.) are hereby invited to take your foul product out of rural America. And perhaps newspapers in towns where Topix draws many readers should ask themselves if that’s partly because they don’t turn over enough rocks and/or run vigorous editorial pages that inspire responsible debate.

Al is right. The Times misses the point that a decently run forum is a good thing for a town. (And, BTW, it doesn’t have to be electronic.) The Mountain Eagle, in Whitesburg, Kentucky, has been running comments mailed, phoned and emailed in from readers for decades in a section titled Speak Your Piece. It’s one of the best read sections of the paper. The newspaper cuts out the too-nasty stuff without limiting expression. Speak Your Piece is great. It has real news and reflects opinions in the town. And kids around love seeing their comments in the paper.

• Montana ranchers living downstream from coal strip mines are asking state regulators to prevent pollution from the operations that they say are threatening their livelihoods, the Summit County Citizens Voice reports

“Montana’s water belongs to everyone – we all depend on it,” said rancher Doug McRae, who lives near Colstrip.  “State regulators are asleep at the switch and need to wake up. Without clean water, I simply can’t run my business.”

(Thanks to Ken Ward Jr. at Coal Tattoo for finding this story.) 

Politico finds that nobody has more to lose in the budget debate in Congress than agriculture. Direct subsidization of crops is gone. What else might be cut?