Country Medicine (2)

In late April, Kansas News Service reported on our ailing rural health care with focus on the hospital in Arkansas City ‒ not quite what “rural” means in the state’s wide western stretch, but rural enough. Farm country depends on this hospital 45 miles south of Wichita.
The hospital’s CEO, Jeff Bowman, said SCK Health lost $3 million last year and continues to lose about $250,000 a month. To save the hospital, Bowman and other hospital officials propose to close part of it. The idea is to shutter the inpatient unit and become a “rural emergency hospital”, an upscale clinic that provides only emergency and outpatient services.
Left alone to confront the problem, rural communities must find ways to manipulate the system. With a “rural emergency” designation, the Arkansas City hospital could qualify for more than $3 million in federal subsidies, and a five percent increase in Medicare payments.
To save part of a hospital, patients in southern Kansas sick enough to be admitted in Arkansas City must find a bed in, say, Wichita. Imagine the dilemma out west, where there are few cities even the size of Arkansas City (pop. 11,7000) or Wellington (7,600) and medical care, emergency or otherwise, is distant. In the land of few doctors and fewer clinics, serious help can be 50 or 100 miles away.
Arkansas City is not alone. The Center for Healthcare Quality and Payment Reform, a non-profit think tank, reports that Kansas per-capita leads America in the number of struggling rural hospitals. More than 80 of the state’s 104 rural hospitals are losing money. Half of them or more are at risk of closing. Five have closed since 2010.
The trouble stems chiefly from population decline. The 2020 census told a story of rural loss, especially in the west, where some populations dropped from ten to 16 percent in counties that had already lost thousands in previous decades. In central and southeast Kansas, similar declines.
As populations drop, hospitals and clinics wither, and doctors and nurses and the personnel who support them go away.
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The opening page of the Kansas Hospital Association website features the flash of a “KanCare Expansion Ticker.” It’s a running total of federal funds Kansas has forfeited since January 2014, the state’s first opportunity to expand its Medicaid (KanCare) program. The Ticker cycles rapidly, dollar-by-dollar ‒ $100 every four seconds, $1,500 every minute.
Last week, the mounting total approached $6.4 billion.
Topeka and Washington jointly finance KanCare, which provides health coverage for about 400,000 Kansans ‒ children, pregnant women, individuals with disabilities and the elderly. All are poor.
Adults with children are eligible, but only if they make less than starving wages ($9,500 for a family of four). Adults childless aren’t eligible for coverage, no matter their income. About 150,000 Kansans ‒ rural and urban ‒ are left without coverage, and health care.
Kansas is one of 10 states that still refuse to expand Medicare, which would cost about $1.3 billion annually. The federal government would cover 90 percent of that, with the state’s share at between $34 and $42 million per year.
Without expansion, many hospitals and clinics will go deeper in debt or close.
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Rural health care is the great afterthought in American politics, something for farm country to worry about. In Kansas, it is a Republican afterthought.
One poll after the next says 70 to 80 percent of Kansans, rural and urban, favor KanCare expansion. The Kansas Hospital Association, administrators, physicians, business leaders and government officials have repeatedly advocated expansion.
The Kansas House in 2019 passed a measure to expand Medicaid but Senate Republican leaders refused to allow the Senate to debate it. Since then, nothing.
Rural Kansas provides the Republican majorities of both chambers.
Five metropolitan counties elect 76 of the 125 members of the House, but it’s a deadlock, 38 Republicans and 38 Democrats. The other 100 counties elect two Democrats and 47 Republicans ‒ a rural majority that provides domination for House Republicans, 85-40.
The pattern holds for the 40-member Senate. Democrats are from metropolitan counties. The Republicans’ 29-11 majority includes ten rural Republicans who tilt the senate’s power balance. These Republicans might use their collective power for something their constituents need and want. So far they acquiesce, bowing to urban bosses who take their marching orders from distant cause lobbies and think tanks.
A lot of Kansans, rural and urban, need affordable health care. Opportunity has been knocking for nine years. Why wait for it to knock again?