Rural Health Advocates See the Looming Medicaid Cuts as Devastating

On Tuesday, July 8, a group of healthcare and community leaders held a press conference in the town of Brewster, which lies 200 miles east of Seattle and 130 miles west of Spokane, in east-central northern Washington. With a population of just under 2,000, Brewster is one of the many, many communities that are expected to be strongly impacted by the Medicaid cuts and other elements in the tax and immigration bill passed by Congress and signed into law by President Donald Trump on July 4.

As previously reported, the legislation cut nearly $1 trillion from Medicaid, and a variety of provisions are expected to make it harder for individuals to qualify for Medicaid coverage, as well as harder for many to maintain health insurance coverage through the ACA marketplaces. Indeed, a comprehensive analysis by experts at the consumer advocacy non-profit Families USA anticipated exceptional harm to both the Medicaid program and to those reliant on it and on the exchanges for health insurance coverage.

Per all that, healthcare professionals and community members gathered at Three Rivers Hospital, a critical access hospital in Brewster, on July 8 to “raise the alarm about the anticipated impact of deep federal budget cuts to Medicaid on rural hospitals,” according to a press release from Rural People’s Voice, a Brewster-based advocacy organization working to improve the lives of local residents. The press release noted that “The event came in response to Congressman Dan Newhouse’s recent vote in favor of a federal budget bill that healthcare leaders and experts say threatens core services at two of three hospitals Okanogan County. Local doctors, hospital staff, patients, and small-town residents described how the proposed changes would hit rural hospitals especially hard – jeopardizing care in areas where options are already limited. Rural hospitals and clinics rely heavily on Medicaid funding, and many could face service reductions or possible closure with the loss of Medicaid revenue. Speakers at the event called on Rep. Newhouse to be accountable for his vote, which supported permanent tax breaks for corporations and the wealthy, while slashing the very programs that help rural families access medical care.”

The press release quoted local leaders, among them J. Scott Graham, CEO of Three Rivers Hospital, who stated that “We are really unhappy about the change that took place last week with the legislation that essentially guts Medicaid for the care that we provide.”

“I’m tired of watching my patients decide between lifesaving treatment or housing, and I’m tired of sleepless nights hoping and praying our hospital finds enough revenue to stay open just a little bit longer,” Joshua Corsa, M.D., emergency room director at Three Rivers Hospital, said. And his sentiments were echoed by Amy Ellingson, M.D., clinical medical director at the hospital, who said that “Protecting Medicaid isn't a policy, it's a lifeline for rural communities like ours and it's essential to the health, strength, and the very future of Okanogan County.

Meanwhile, Rena Shawver, executive director at Okanogan County Community Action Council, said, “I sit right at the front counter and I see people coming into our office every day who are truly in need of these services to prevent them from becoming homeless – to bridge a gap in some of their earnings because we don't have a lot of job opportunities here. And I'm very fearful for what's going to happen if all of these cuts go through. Medicaid is essential for our community.”

Shortly afterwards, Healthcare Innovation Editor-in-Chief Mark Hagland spoke with Elana Mainer, executive director of Rural People’s Voice, about why she and her colleagues had organized the press conference, and what they were hoping to accomplish. Below are excerpts from their interview.

Tell us about Rural People’s Voice and your mission as an organization?

Rural People’s Voice brings together working-class people in North Central Washington to win policies, build leaders, and advance on-the-ground change rural people need and deserve. They organize hard-working families, young people, and seniors; multi-generational Washingtonians and immigrants; fifth-generation pear farmers and first-generation college students; small business owners, teachers, students, and laborers. They bring together people who are just trying to make a good life in rural Washington, and help us win a better future for all.

We are an organization made up of everyday working families, formed five years ago. We do deep organizing and leadership development, around childcare, housing, healthcare, fair taxes. 12 people on our staff, 501c4 organization. We do work to try to influence policy and legislation, and encourage leaders to win office.

How do you see the impact of the Medicaid cuts?

Two of the three hospitals in Okanogan County are listed as being at risk for closure because of these cuts. In fact, quite a few hospitals in our congressional district are on that list. My kids were born when I was on Medicaid. We’ve seen disinvestment from rural hospitals for decades now. And so few of us have the private insurance that so many have in urban areas. Medicaid is what our community relies on. Between 60 and 70 percent of children in this county are on Medicaid. And how much more can we lose? The Three Rivers Hospital terminated obstetrics in the past few years. If we lose services and specialists, that costs all of us in the long run. At the press conference, it wasn’t just hospital and healthcare folks talking about this: there are all sorts of stories about people committing fraud, but most of us here have been on Medicaid our whole lives, and it’s our lifeline, it’s our safety net; we work hard every day, and that kind of public benefit is essential for us out here. And our behavioral health clinic relies on Medicaid; our long-term care facilities rely on Medicaid, and they are all over-taxed and under-invested in, in rural communities.

Some of those advocating for Medicaid recipients, as well as some policy experts, have said that the assertions around the need for work requirements and around Medicaid fraud, are wildly overstated, and that the underlying element is really bias against the poor.

We’re all right to ask who benefits from that story of poor people being fraudulent or lazy; and it’s not us. Who is it who is running that story? We knocked on 10,000 doors last year, and you don’t need to knock on a lot of doors to find out that things are getting harder and harder out there for families. And when things get harder, we try to find stories to easily explain things. And it’s pretty easy and convenient for those at the top bringing in a lot of money, to divide people—pitting poor people against immigrants, everyone against LGBTQ people, etc.; and that can be very successful. And the more we believe the stories about poor people committing fraud or being lazy, the less we need to pay attention to the fact that everyone I know works very, very hard to provide for their family and to try to live a good life. We know that to be true, but it’s been a very successful strategy for those at the top to divide and conquer us.

Even in places like Washington state, the poorest folks pay 14 percent in taxes, while the wealthiest pay 4 percent in taxes. If the wealthiest paid their fair share, we could all send our kids to technical colleges. So those stories about laziness and fraudulence ignore the fact that most of us work very hard; but they keep us from coming together; they divide us and make it more difficult for us to work together for change. And our power will always be in people coming together, to tell our representative what we need. Those stories are dangerous and they’re designed to be dangerous.

What would you like the senior leaders in hospitals and health systems, to know?

I was born and raised in eastern Washington, and I was a social worker for many years, working for social service organizations. And part of what we did was to help people to get by. And it felt we were fighting for a tinier and tinier pot, as politicians kept moving to strip us of our food benefits, housing, even our ability to protect our jobs through labor organizing; and I came to this out of love for my community, and my inability to do what I want to accomplish. So I would say to hospital leaders, come to the right sites. Hospitals are huge institutions, and Medicaid is a huge institution. And we need them to stand with everyday working people. And these institutions aren’t enough for what everyday working-class families need. So I would say, come to the right fight. Come together with us. And most of us actually don’t believe these broken stories. The person who picks fruit in the orchard or the school secretary: when it’s clear that there’s enough to go around, come to the right fight—we’re ready for you.

Is there anything you’d like to add?

The other thing I would say to healthcare leaders is that they have the ear of the people who are legislating and making huge policy choices. And I don’t think our local representatives—a lot of them believe the same broken stories we’ve been talking about. Because the representatives care when hospitals close. I would hope that these hospital leaders would be very clear about what we’re up against, rather than just patching holes.

We’ve been communicating with these hospital leaders, and rural hospitals have been fighting for too long. We want to see rural healthcare leaders show up for us, all across the country, and serves a better vision, including serving rural hospitals.