Rural Americans Demand More from Medicare

I’ve been involved in politics since the 1970s, and I have consistently urged Democrats to advocate for rural Americans. Ignoring these populations has led to the demise of the Democratic Party in parts of the American South and West. In my home of Mississippi, we haven’t had a statewide elected Democrat since 2015.

Thankfully, some current and past Democratic leaders have prioritized the needs of rural Americans. Presidents Bill Clinton, Barrack Obama and Joe Biden convinced many rural voters to give them a chance, which helped them win the White House. With this in mind, and as we gear up for the 2024 elections, Democrats should start talking about the lack of access to healthcare in rural communities.

Fixing our rural wellness challenges are complex, but I believe there is one thing the Biden administration can do now, that would dramatically improve medical outcomes for Americans living outside cities. Specifically, requiring Medicare to reimburse hospitals fairly for certain procedures, to ensure those hospitals remain economically viable, in the face of a rash of rural hospital closures around the nation.

To try and lower the government’s healthcare spending, Medicare pays hospitals an identical reimbursement rate – for certain procedures – as independent physician offices, hospital outpatient departments, emergency departments, and ambulatory surgical centers. The thinking by Medicare, is that these lower reimbursement rates will spur hospitals to urge patients to get treated in outpatient facilities. But this is a mistake, because it is the patient who chooses to go to a hospital and not vice-versa.

Also, it is not realistic to think that patients are always going to go to one of these outpatient options if they are having a medical emergency. Perhaps they trust a certain doctor or nurse who works at a specific hospital.

A new study released just this week, also found clear evidence that patients who tend to use hospitals are from disenfranchised, low-income and minority communities. Often, people who lack access to basic medical care, don’t have a doctor or feel that an outpatient clinic is too costly. Sadly, many of these folks put off treatment until they need, or feel they must go to the hospital. I know this to be true, because as someone who served rural communities in the state legislature, and the Congress, I still get calls from my friends and neighbors with medical questions. People are nervous about healthcare and if they – or someone in their family – are experiencing a medical crisis, I typically advise them to go to the hospital.

But going to the hospital is becoming a greater challenge for folks in rural communities. A recent article from Mississippi Today, found that “data from mid-January shows that now, 38% [of Mississippi’s rural hospitals] are at risk of closing. Of the 28 rural hospitals at risk of closing, 19 are at risk of shuttering immediately…” The article also reports that nearly all of these rural hospitals are “not profitable.”

These rural hospitals are struggling to stay afloat because they need help getting higher reimbursement rates from Medicare, need access to more Medicare funds (which our Mississippi Governor stubbornly refuses to accept) and insurance companies also reimburse rural hospitals at too low a rate for them to be profitable. This triple whammy is creating a real crisis for rural communities, not just in Mississippi, but all across America.

From an article in Becker’s Hospital Review: “About 60 million people — nearly 1 in 5 Americans — live in rural areas and depend on their local hospitals for care. Nearly 80 of those hospitals have ended all services since 2011, according to the Cecil G. Sheps Center for Health Services Research.”

If the Biden administration wants to build on its record fighting for rural communities, then requiring Medicare to fairly reimburse hospitals for certain medical treatments, would be a step in the right direction. It would help ensure that those remaining hospitals in small towns across America, remain open. That would bolster Joe Biden’s case to remains in the White House, and, more importantly, that rural Americans get access to better healthcare.