Rural Reads: Redneck reality, Obama's budget and critical access hospitals

Apr 12, 2013

Every Friday, KBIA's Health & Wealth Desk talks about the week's most interesting articles and reports on rural health, wealth and society issues. 

'Redneck reality' and rural portrayal in cable television

Entertainment newspaper The A.V. Club muses on A&E's popular reality show Duck Dynasty, saying the show is the 21st century incarnation of old rural-themed sitcoms that once dominated network television. Think Petticoat JunctionThe Beverly Hillbillies, and Hee-Haw. It's an interesting read, but we were especially interested with the author's take on ways the television shows have to negotiate the rural-urban political disparities. 

While the rural-themed programming of days gone by tended to depict the small Southern town as a bucolic haven for good-hearted folk, redneck reality is more apt to acknowledge the social and economic ills of the subcultures it depicts. These shows are sanitized for the protection of viewers with blue-state sensibilities; when they occur at all, political discussions tend to center on generalized platitudes about freedom and family, rather than specifics that might turn off half the potential audience.

 

H/T: The Rural Blog

Did headlines about death rates at rural hospitals tell the wrong story?
The Daily Yonder is killing it with their opinion pieces this week. 

Case in point: A new report made headlines last week, saying death rates are rising at rural, geographically isolated hospitals. But an opinion writer for the Yonder says news reports are not telling the real story of these so-called critical access hospitals:

The patients in the small rural hospital with heart attack, heart failure or pneumonia have become a select population. A large proportion has decided that they are through paying all the human costs of the miracles of modern medicine. They have made the decision to stay in familiar surroundings near home and family. 

The researchers found that 13.3% of the patients at critical access hospitals with one of the three conditions died, compared to 11.4 % of the medical center patients. Given all the terrible tools that modern medical centers have to work with, I’m amazed they only manage a small difference in patient survival over the most basic, little country hospitals in America. 

Credit Leader Nancy Pelosi / Flickr

All the president's budget

In his recently unveiled proposed budget, President Barack Obama has proposed delaying the federal funding cuts to payments for hospitals that provide uncompensated care. These cuts have been one of the biggest, most urgent arguments behind the push to expand Medicaid to more uninsured, low-income Missourians.

For supporters of the expansion in the state, the DSH payment cuts have been a major point of argument. Back in 2012, MO HealthNet (the official name for Missouri's Medicaid program) oversight committee chair Dr. Corinne Walentik told the St. Louis Post-Dispatch that as much as 40 to 50 percent of all rural Missouri hospitals could close of DSH payments get cut and Medicaid doesn't get expanded. 

Obama's budget proposes to delay the cuts by a year, until 2015. State Sen. John Lamping (R-Ladue) said this move takes out the urgency in the argument to expand Medicaid.

"That argument is now a year further out," Sen. Lamping said. "We don't have to be concerned with that reality in 2014."

But, citing other cuts to hospital payments, supporters for the expansion says the cuts' delay doesn't mean Medicaid shouldn't get expanded by next year.

"This may be one of those additional things that allow people to say that we don’t need to [expand Medicaid] this year," Missouri Hospital Association spokesperson Dave Dillon said. "[But] we do. We will continue to need to do this because of the massive amounts of cuts that are coming."

Those cuts include reductions in the amount the federal government pays hospitals for providing care to Medicare recipients. Both the Affordable Care Act and the recent federal budget sequestration include Medicare cuts.

"The ACA literally makes billions of dollars of additional cuts in Medicare to hospitals," Dillon said.

Before Obama unveiled his budget, Sen. Lamping sponsored a resolution that asked the Missouri General Assembly to lobby the government to stop DSH payments. 

"All we were suggesting is that while we're going through this process of decide whether to expand or not to expand, we'll continue to receive DSH dollars," Lamping said. 

With about five weeks left in the legislative session, Missouri legislators are still debating whether to expand Medicaid. Gov. Jay Nixon and state Democrats want to expand the program to cover up to more 300,000 Missourians by 2020, but GOP legislators worry about the long-term cost. Supporters want to increase Medicaid eligibility to Missourians who earn 138 percent of the federal poverty level. As it stands right now, an able-bodied Missourian without children is not eligible for Medicaid, no matter how low his or her income. 

Through what’s called the disproportionate share hospital, also known as DSH, payments, the federal government gives money to hospitals that provide a disproportionate amount of free care to patients who are uninsured and can’t afford services. The Affordable Care Act, though, includes significant cuts to DSH payments. That's because a major component of the health care law, as it was signed into effect in 2010, included the requirement for states to expand Medicaid, the safety-net program that provides health insurance for low-income U.S. citizens. But in 2012, the Supreme Court decided expanding Medicaid should be optional for states. 

The DSH cuts were scheduled to begin next year, but President Obama’s new proposed budget wants to delay the cuts until 2015. As The Washington Post's health policy blogger Sarah Kliff wrote, the move is a recognition to the Republican governors and state general assemblies who have vowed to not expand Medicaid in their state. 

Through what’s called the disproportionate share hospital, also known as DSH, payments, the federal government gives money to hospitals that provide a disproportionate amount of free care to patients who are uninsured and can’t afford services. The Affordable Care Act, though, includes significant cuts to DSH payments. That's because a major component of the health care law, as it was signed into effect in 2010, included the requirement for states to expand Medicaid, the safety-net program that provides health insurance for low-income U.S. citizens. But in 2012, the Supreme Court decided expanding Medicaid should be optional for states. 

The Washington Post's health policy blogger Sarah Kliff wrote, the move to delay DSH cuts is a recognition to the Republican governors and state general assemblies who have vowed to not expand Medicaid in their state.