My Turn: Urge lawmakers to stand by the ACA

For the Monitor
Published: 4/26/2019 12:15:21 AM

The Affordable Care Act allowed New Hampshire to expand Medicaid to offer health care coverage to more than 50,000 Granite Staters. We cannot forget that the Affordable Care Act is critical to providing health coverage in our rural communities, which have lower rates of employer-sponsored coverage than cities.

Today, one in four Americans get health coverage through Medicaid in rural communities. According to the Kaiser Family Foundation, rates of Medicaid coverage are generally higher in rural areas. In 41 of the 43 states with both rural and other areas, rural areas have a higher Medicaid coverage rate than non-rural areas. More than 12% of New Hampshire adults living in rural areas are uninsured today, compared to 8% living in non-rural areas, according to Protect our Care.

Under the Affordable Care Act, the uninsured rate has fallen by 4% in rural New Hampshire. Between 2013 and 2015, New Hampshire hospitals’ uncompensated care costs decreased by $111 million, or roughly 52%. But because of the gap in coverage, rural hospitals see a larger percentage of uncovered patients, meaning that they carry a higher percentage of the burden.

But the Affordable Care Act has been under siege by the Trump administration for the past three years, and now a case working its way to the Supreme Court threatens to end it all together. If that happens, the impact on New Hampshire’s rural hospitals would be devastating. Medicaid expansion would end on a federal level, and the 17% of Granite Staters living in rural areas that have health coverage through Medicaid could lose their coverage. The cost burden would shift to rural hospitals throughout the state, many of which are struggling now to offer exceptional care in a very challenging market.

In New Hampshire, where lawmakers expanded Medicaid, no rural hospitals have closed since 2010. But without the Affordable Care Act, that would change, leading to an acute crisis in rural health care. Along with hospitals, community health centers that offer care in underserved rural communities would be affected. Medicaid expansion decreased the percentage of uninsured patients seen by community health centers by more than 10%, with a 13% increase in patients with health coverage through Medicaid.

Bad policy can have sweeping consequences, and Granite Staters need to see what Washington’s war on health care can mean to our state: tens of thousands losing health care, costs soaring at hospitals and community health centers, the cost of health care rising as a result, and medical facilities closing in rural communities.

Don’t let this happen. Speak up and speak out. Tell elected N.H. leaders to stand by the Affordable Care Act and to support our rural communities, and keep New Hampshire healthy and growing.

(Jayme H. Simões lives in Concord.)

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