As political power players in Washington continue to bicker and wrangle over the country's debt ceiling crisis, rural healthcare providers are up in arms over $16 billion in proposed cuts to rural hospitals and frontier America.
Included in a list of proposed reductions is $14 billion over 10 years to "reform rural hospitals" and $2 billion over 10 years to "repeal Frontier State Adjustments." Whether those cuts are part of current debt ceiling negotiations is "the several-billion-dollar question," Maggie Elehwany, vice president of government affairs and policy at the National Rural Health Association (NRHA), said in an interview.
She says the documents, which have been attributed by some to Congressman Eric Cantor (R., VA), the minority whip, were leaked and that no other details about the cuts are known.
"We are operating on a lot of unknowns out there. But," Elehwany said, "We really need to go loud on it, so to speak."
Even though information about the cuts was revealed a couple of weeks ago, NRHA is still concerned that these deep cuts may still be part of current debt ceiling negotiations, especially since a Congressional Budget Office [CBO] report issued in March suggests that eliminating the Critical Access Hospital, Sole Community Hospital, and Medicare Dependent Hospital programs would "reduce federal outlays by $23 billion over the 2012–2016 period."
"We're sure hoping that that [CBO report] didn't lead to the fodder for these discussions in rural healthcare," Elehwany said, adding that they can guess that the cuts might come from cost-based reimbursement. "It would all be a guessing game. But we have folks that are trying to do the math on all possible scenarios."
In response to the proposed $16 billion in cuts, rural health stakeholders nationwide are speaking out, arguing that rural hospitals already face too many financial challenges to survive such a deep slash in spending.
"The Arizona Health Care Cost Containment System (AHCCCS) chronically underpays Arizona hospitals, which receive less than 70 percent of the cost of caring for AHCCCS patients," the Arizona Hospital and Healthcare Association writes in a letter to Arizona Senate Republican Jon Kyl.
"Reducing Medicare rates for rural providers, when coupled with recent AHCCCS cuts, will force rural facilities to eliminate many services and jobs. In extreme circumstances, some hospitals will be in danger of closing. A closed hospital could mean as much as a 20 percent loss of revenue to the local rural economy."
NRHA is urging rural stakeholders to contact their representatives in Washington to urge them not to support debt ceiling measures that would "decimate" rural healthcare. In response to the proposed cuts, the NRHA has placed an urgent message on its homepage, urging site visitors to "help prevent $16 billion in proposed cuts to rural hospitals and frontier America." It includes links to contact information for Senators and Representatives. The NRHA site also features state-by-state data on the number of each type of rural facility in that state, as well as senators, their contact information, and the e-mail addresses of key contacts in their offices.
Elehwany said rural healthcare has advocates in the Senate Rural Health Caucus, such as Senators Tom Harkin (D-IA) and Pat Roberts (R-KS). Roberts, incidentally, has co-sponsored a bill that would give all Americans "the right to a waiver to become exempt from portions of President Obama's new health care reform law."
Elehwany urges stakeholders to continue to educate their representatives, and not just until the August 2 debt ceiling deadline because she suspects that similar negotiations will continue, perhaps until 2013.
"For the next several years you just really need to invite your member of congress to your critical access hospital, to your sole community hospital. Let them know what you do, let them know why Congress created the reimbursement," Elehwany said. "Those hospitals are their own best advocates."
Alexandra Wilson Pecci is an editor for HealthLeaders.
