Carole R. Myers and Madison Kahl

Carole R. Myers, PhD, RN is an Associate Professor at the University of Tennessee.

Madison Kahl is a recent University of Tennessee graduate whose honors thesis looked at Medicaid expansion.

Opinion: American Health Care Act will harm the state's rural communities.

Consider the state of Tennessee as a canary in the coal mine — and the canary is critically ill. Tennessee leads the country in the rate of closures of rural hospitals and could be a harbinger for other states.

The danger to rural hospitals and the communities is tied to radical changes in how Medicaid would be financed under the American Health Care Act, declines in federal funding for Medicaid, and elimination of the Affordable Care Act (ACA) Medicaid expansion.

The current situation in Tennessee, precipitated in part by not expanding Medicaid, will be exacerbated if the ACHA replaces the ACA. The AHCA changes Medicaid from an entitlement program to a block grant program. This change will be devastating to Tennessee. Benefits in entitlement programs are guaranteed to eligible individuals.

Entitlement funding is based on need and is open-ended.

In contrast spending is capped for block grants. The proposed AHCA funding for Medicaid block grants is capped at levels significantly below current funding.

The projected result is a 50 percent reduction in federal funding over 10 years which equates to an $880 billion loss and approximately 14 million people losing coverage per the Congressional Budget Office. Many rural hospitals cannot sustain such a blow.

Tennessee rural hospitals and communities are already struggling.

The portrait of rural Tennesseans and communities reveals deep-rooted disparities. Seventy-eight of Tennessee’s 95 counties (82 percent) are rural. A report from a task force convened to look at issues impacting rural communities noted that 17 rural counties rank in the bottom 10 percent of counties across the country in unemployment, poverty rates, and per capita market income.

An additional 35 Tennessee counties rank in the bottom 25 percent. Approximately 36 percent of Tennesseans live in a rural county. Rural residents tend to be older, more are uninsured, and they have higher rates of chronic diseases.

They also have higher death rates, lower life expectancies, and higher rates of infant mortality according to the Rural Health Reform Policy Research Center.

Tennessee leads the country in the rate of hospital closures. Nine rural hospitals have closed since the ACA was enacted. Only Texas has had more closures (11) and it is larger state.

An analysis of financial data derived from the Tennessee Joint Annual Reports on Hospitals by the Tennessee Justice Center revealed that 28 of the remaining 61 rural Tennessee hospitals are at risk for closures or severe cuts based a three-year average of losses.

Hospital closures hit a community hard, creating a cascade of far-reaching consequences. When a rural hospital closes an anchor institution is lost. Rural communities depend heavily on their nearby hospitals, more so than their urban neighbors.

The Tennessee Hospital Directory shows that 35 rural counties (83 percent) have only one hospital within their borders; 80 percent of rural, at-risk hospitals in Tennessee are the only one in the county.

Hospitals serve as economic powerhouses. Particularly in rural counties, hospitals are the top employers in the region, providing substantial income to local economies, up to two-times over.

Economists estimate that for every hospital employee, part-time or full-time, another job is supported in the community. The loss of a hospital is not just bad for health outcomes — it can precipitate the collapse of the local economy. Without adequate funding rural health and health care disparities will become more severe and the closure of rural hospitals may herald the death of a community.

Contact Senators Lamar Alexander who heads the committee that will hear the AHCA bill, and Bob Corker. Tell then to say no to the AHCA, preserve the ACA, and adequately fund our rural hospitals.

Carole R. Myers, PhD, RN is an associate professor at the University of Tennessee with a joint appointment in the College of Nursing and the Department of Public Health. She has recently been appointed as senior fellow for the George Washington University Center for Health Policy and Media Engagement.

Madison Kahl is a recent University of Tennessee graduate whose honors thesis looked at Medicaid expansion as a tool for rural economic development.