\u201cWe\u2019re bankrupting a lot of hospitals by forcing these hospitals\u00a0to provide care for people who don\u2019t have the legal right to be in our country.\u201d<\/p>\n
Sen. JD Vance (R-Ohio) during a Sept. 17 rally<\/p>\n
During a recent presidential campaign rally in Wisconsin<\/a>, Sen. JD Vance (R-Ohio) was asked how a Trump administration would protect rural health care access in the face of hospital closures, such as two this year<\/a> in Eau Claire and Chippewa Falls.<\/p>\n In response, he turned to immigration.<\/p>\n \u201cNow, you might not think that rural health care access is an immigration issue,\u201d said Vance, former President Donald Trump\u2019s running mate. \u201cI guarantee it is an immigration issue, because we\u2019re bankrupting a lot of hospitals by forcing these hospitals to provide care for people who don\u2019t have the legal right to be in our country.\u201d<\/p>\n More than 150 rural hospitals have closed or eliminated<\/a> inpatient services since 2010, researchers at the University of North Carolina-Chapel Hill reported. Losing a hospital can resonate throughout a community \u2014 reducing access<\/a> to timely care and disrupting the local economy<\/a>.<\/p>\n The federal government has made efforts<\/a> to keep the far-flung facilities afloat, but it\u2019s not been an easy problem<\/a> to solve.<\/p>\n What Is<\/em> Plaguing Rural Hospitals?<\/strong><\/p>\n Experts said Vance\u2019s statement implies that immigrants who are in the country illegally strain the resources of these hospitals, which often operate on thin margins, by taking time and energy away from other patients without paying their bills.<\/p>\n We contacted both Vance and Trump campaign staff members for additional information. They did not respond.<\/p>\n Experts on hospital financing and industry representatives generally disagreed with Vance\u2019s assertion, noting that many other factors figure in closures.<\/p>\n \u201cWhen we speak with our rural hospital members, that is not what we hear,\u201d said Shannon Wu, director of payment policy at the American Hospital Association, a trade group of more than 5,000 hospitals around the country.<\/p>\n Brock Slabach, chief operating officer of the National Rural Health Association, said border state hospitals\u00a0face challenges treating immigrants who are in the country illegally. \u201cBut I\u2019ve never, in my discussions, had anyone link it directly to a hospital closure,\u201d he said.<\/p>\n The specific situations that lead a rural hospital to close its doors are unique to each facility, researchers said, but many face some of the same stressors.<\/p>\n Rural hospitals tend to have low patient volumes, which presents its own set of problems. They\u2019re frequently located in small communities, and some residents may choose to travel to hospitals in bigger cities where they can get more complex care, what researchers call \u201chospital bypass<\/a>.\u201d<\/p>\n That small number of patients can cause financial losses at small rural hospitals, said Harold Miller, president and CEO of the Center for Healthcare Quality and Payment Reform<\/a>, a national health care payment and delivery systems policy center.<\/p>\n Hospitals have fixed costs, such as for running emergency departments, and need to have a high enough patient volume to cover them, he said.<\/p>\n \u201cIf a patient comes into the ED and doesn\u2019t have insurance or can\u2019t pay, it doesn\u2019t really increase the cost to the hospital very much at all because the physician is already there,\u201d he said, using an abbreviation for emergency department.<\/p>\n Rural hospitals treat a higher share of patients<\/a> covered by Medicare and Medicaid compared with urban hospitals, according to the American Medical Association. The public insurance programs for older and low-income Americans generally pay providers less than private insurers do.<\/p>\n Nevertheless, Medicare is \u201cone of the better payers\u201d for small rural hospitals, Miller said. That\u2019s partly because facilities with a special \u201ccritical access hospital<\/a>\u201d designation get paid more by Medicare \u2014 and, in some states, Medicaid.<\/p>\n Hospital industry officials and some experts say Medicare Advantage plans\u2019 rising popularity<\/a> has also hurt rural hospitals\u2019 bottom lines because the private insurance companies that offer the plans tend to be less reliable payers<\/a> than traditional Medicare.<\/p>\n For starters, the negotiated rates paid by Advantage plans can be lower, which is especially noticeable for those critical access facilities. Advantage plans also introduce extra levels of expensive, staff-intensive administrative burdens to ensure payment.<\/p>\n \u201cThey\u2019ll deny the claim or say the patient really didn\u2019t need that service through prior authorization, and so the hospitals don\u2019t get paid for the service from someone who has insurance,\u201d Miller said.<\/p>\n The insurance industry trade group AHIP pushed back on the assertion that Medicare Advantage plans harm rural hospitals, citing a federally supported study saying the plans actually increase rural hospital financial stability.<\/p>\n But the study did not compare actual payments between Medicare Advantage and traditional Medicare plans and looked at only 14 states.<\/p>\n People lacking legal immigration status generally cannot obtain Medicaid or Medicare coverage. But a provision within Medicaid law<\/a> does allow some immigrants in the country illegally to temporarily obtain coverage, said Hayden Dublois, data and analytics director for the think tank Foundation for Government Accou<\/a>nt<\/a>ability<\/a>.<\/p>\n Medicaid, which pays less<\/a> than Medicare and private insurance, \u201cis not exactly a financial boon for hospitals,\u201d and this could be some of what Vance is referring to, Dublois said.<\/p>\n In data from a few states, Dublois found a rise in people enrolling in Medicaid without being able to verify their immigration status. But his research hasn\u2019t looked specifically at how this population might affect rural hospitals\u2019 financial viability.<\/p>\n Some states have acted in recent years to expand health coverage to people in the country illegally \u2014 offering insurance to more than 1 million low-income immigrants<\/a>.<\/p>\n One of those states, California, has had nine hospitals close or end in-patient services since 2005.<\/p>\n People may be able to pay out-of-pocket for care, researchers said, or may have access to private insurance through an employer.<\/p>\n Covering the costs for the uninsured is only one financial stressor rural hospitals face, said George Pink, deputy director of the North Carolina Rural Health Research Program.<\/p>\n \u201cIs that going to be enough to drive a hospital into bankruptcy? Probably not,\u201d he said.<\/p>\n A financial decline can take years, Pink said. As losses mount, hospitals can be forced to sell property or other assets, draw down any financial reserves, and max out their credit.<\/p>\n \u201cThis is not an overnight phenomenon,\u201d he said.<\/p>\n Our Ruling<\/strong><\/p>\n Vance said providing care for immigrants without legal status was \u201cbankrupting\u201d rural hospitals and forcing them to close.<\/p>\n Although that population is more likely to be uninsured<\/a>, living in the country illegally does not mean people lack the ability to pay for health care \u2014 especially if they live in states that offer them insurance coverage.<\/p>\n Research shows many factors contribute to rural hospital closures \u2014 not solely financial losses from providing care for those without insurance, whether those people are migrants in the country illegally or U.S. citizens.<\/p>\n We rate Vance\u2019s statement False.\u00a0<\/p>\n PBS NewsHour, \u201cWATCH LIVE: Vance Addresses Campaign Rally in Eau Claire, WI<\/a>,\u201d Sept. 17, 2024.<\/p>\n HSHS Hospital Sisters Health System, \u201cHSHS Sacred Heart Hospital and HSHS St. Joseph\u2019s Hospital Closure Information<\/a>,\u201d accessed Sept. 26, 2024.<\/p>\n Cecil G. Sheps Center for Health Services Research, the University of North Carolina-Chapel Hill, \u201cRural Hospital Closures<\/a>,\u201d accessed Sept. 27, 2024.<\/p>\n GAO, \u201cRural Hospital Closures: Affected Residents Had Reduced Access to Health Care Services<\/a>,\u201d Dec. 22, 2020.<\/p>\n The Journal of Rural Health, \u201cThe Impact of Rural General Hospital Closures on Communities \u2014 A Systematic Review of the Literature<\/a>,\u201d Nov. 20, 2023.<\/p>\n Rural Health Information Hub, \u201cRural Emergency Hospitals (REHs)<\/a>,\u201d accessed Sept. 30, 2024.<\/p>\n KFF Health News, \u201cFederal Program To Save Rural Hospitals Feels \u2018Growing Pains<\/a>,\u2019\u201d Jan. 16, 2024.<\/p>\n Microsoft Teams interview, Shannon Wu, director of payment policy at the American Hospital Association, Oct. 1, 2024.<\/p>\n Zoom interview, Brock Slabach, chief operating officer, National Rural Health Association, Oct. 1, 2024.<\/p>\n Cecil G. Sheps Center for Health Services Research, the University of North Carolina-Chapel Hill, \u201cPatterns of Hospital Bypass and Inpatient Care-Seeking by Rural Residents<\/a>,\u201d accessed Oct. 1, 2024.<\/p>\n Zoom interview, Harold Miller, president and CEO, Center for Healthcare Quality and Payment Reform, Sept. 26, 2024.<\/p>\n American Medical Association, \u201cIssue Brief: Payment & Delivery in Rural Hospitals<\/a>,\u201d accessed Oct. 15, 2024.<\/p>\n Rural Health Information Hub, \u201cCritical Access Hospitals (CAHs)<\/a>,\u201d accessed Sept. 30, 2024.<\/p>\n KFF, \u201cMedicare Advantage Enrollment, Plan Availability and Premiums in Rural Areas<\/a>,\u201d Sept. 7, 2023.<\/p>\n KFF Health News, \u201cTiny, Rural Hospitals Feel the Pinch as Medicare Advantage Plans Grow<\/a>,\u201d Oct. 23, 2023.<\/p>\n Email interview, James Swann, director of communications and public affairs, AHIP, Oct. 21, 2024.<\/p>\n Medicaid.gov, \u201cImplementation Guide: Citizenship and Non-Citizen Eligibility<\/a>,\u201d accessed Oct. 10, 2024.<\/p>\n Zoom and email interview, Hayden Dublois, data and analytics director, the Foundation for Government Accountability, Oct. 1, 2024.<\/p>\n The Commonwealth Fund, \u201cHow Differences in Medicaid, Medicare, and Commercial Health Insurance Payment Rates Impact Access, Health Equity, and Cost<\/a>,\u201d Aug. 17, 2022.<\/p>\n KFF Health News, \u201cStates Expand Health Coverage for Immigrants as GOP Hits Biden Over Border Crossings<\/a>,\u201d Dec. 28, 2023.<\/p>\n Phone interview, George Pink, deputy director, North Carolina Rural Health Research Program, Sept. 30, 2024.<\/p>\n KFF, \u201cState Health Coverage for Immigrants and Implications for Health Coverage and Care<\/a>,\u201d May 1, 2024.<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nOur sources:<\/h4>\n
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