One of the unintended consequences of reducing the size of Medicare and Medicaid arises out of the low margins and general fragility of rural health systems. Rural systems often deal with communities that are older, less likely to be insured, higher rates of disability, aging buildings, outdated payment and data systems, the lack of economic growth in the communities the system serves, and the ease with which the private owners of these systems write them off.
In other words, these rural health care systems lack resilience. Every fluctuation in the health care needs of their communities is a real disturbance of their equilibrium. Take the opioid crisis for example. What would be a tragic but manageable spike in overdoses in a metropolitan area can dramatically undermine short-term access to emergency room services in rural areas.
If the systems close, access is severely and permanently compromised. Travel times can dramatically increase for patients, professionals leave the geographic area and worsen existing access to specialty services, and people forgo or delay getting health services to manage the burdens of access and their marginal economic status.
All the major current policy threats (withdrawing from Medicaid Expansion, Per Capita capping Medicaid, Block Granting Medicaid, and the various proposals for reducing the growth of Medicare) will dramatically increase the likelihood of rural health system failure.
It won’t be enough to prevent these immediate threats to rural healthcare systems. New models of access and service delivery in areas of sparse population and more limited resources need to be developed, and they need to be developed now. It is hard to see how this can happen (given the lack of general resources in rural areas) without government support.
See this KFF Article for more information and resources.