President Trump's big budget bill has passed the House and is headed to his desk.
Health experts have been warning about the potential devastating impacts the bill's cuts to Medicaid would have on health care. They believe hospitals in rural areas could close.
Tim Wolters, director of reimbursement at Citizens Memorial Hospital in Bolivar, knows rural health care well, and the spending bill and its impact on people who need that care concern him greatly.
"There are so many different pieces to the bill in terms of the cut in eligibility for a number of patients and then just funding cuts that are kind of on top of that, so, but yeah, definitely those who lose eligibility will — you know, we're still going to be taking care of them in the hospitals across the state," he said, "but we're not going to be seeing them in our primary care clinics, for example. They'll end up coming back to the emergency room when something does happen. So if they lose their Medicaid coverage, they're just going to kind of fall out of the system, so to speak, and then they're only going to access care when they vitally need it. And that's just not the best way to take care of these citizens."
Wolters said they're still trying to piece together the impacts of the bill to Citizens Memorial Hospital and its patients. But he has some idea what the cuts to Medicaid will mean.
"We're estimating just for Bolivar, just for us, it's probably going to be somewhere at least in the range of about $3 million per year in terms of lost reimbursement," he said. "And that just means we're going to have to find a way to, you know, make up for that. We're roughly at break-even. So over the last three years, in the aggregate, for example, our bottom line was less than 1% of our revenues so we're essentially at break even. And so if we have to cut back on some of our services, that just means less access for all patients, not just Medicaid. It's going to affect everybody."
He said hospitals across the state are going to have to figure out how to make up for the cuts in funding. For CMH, it might mean cutting back on services at clinics in parts of their service area – about a dozen locations, according to Wolters. That will make it harder for patients to access care.
He said Missouri has seen about a dozen hospitals in rural areas close in the past decade.
"And hospitals in general are roughly — the average rural hospital's running at break-even just like we are, and so, it's going to be, you know, potentially devastating to rural hospitals that — those who don't have the ability to make up for some of these cuts, I just feel very, unfortunately, very confident we'll see hospitals close in the coming years if something's not done to offset what Congress has done here. Now, I will say, there's this new $50 billion for a rural health transformation program that Senator (Josh) Hawley and a few other senators were able to get into the final bill, and that funding is appreciated, but it doesn't make up for the Medicaid cuts. That funding is available for the next five years. But, frankly, a lot of the cuts don't even start until after that. It's — we're talking five or six years down the road when the Medicaid cuts are fully in place. So there's sort of some temporary relief, but long term, the prospects just really aren't that good when you're looking down the road at what this bill does."
Wolters was recently in Washington D.C. to talk with Missouri politicians about his concerns. He visited both senators' offices.
"Senator Hawley, like I said, he's been very concerned about the Medicaid cuts. I mean, he did vote for the bill, but that was with this $50 billion rural fund in there," he said. "And I think they're so focused on the tax cut side of the bill, that they, probably some of the Medicaid cuts, unfortunately, got lost in the debate. Kind of weighing the good versus the bad, I guess they felt like they were going to support the bill regardless of the impact on Medicaid and health care in the state. And so, like I said, that's the unfortunate part of this is that, as with every piece of legislation, you know, politicians may see good and bad in there, and they have to kind of weigh what they think is more important to the voters. And, unfortunately, I feel like health care kind of got the short end of the stick on this bill."
Wolters said, even though rural health care systems will be particularly hard hit by the spending bill, all health care providers will be impacted in the long run.
"I think it's going to have an impact on everyone that, as we all need health care, I think we're going to see, unfortunately, a health care system that's going to be struggling a little bit down the road as this bill takes effect."
*Story was updated shortly after publication due to the passage of the bill by the House.
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