Vance wrongly blames rural hospital closures on immigrants in the country illegally

Sam Whitehead

“We are bankrupting a lot of hospitals by forcing those hospitals to provide care to people who have no legal right to be in our country.”

Senator J.D. Vance (R-Ohio) during a rally on September 17.

During recent presidential campaign rally in WisconsinSenator J.D. Vance (R-Ohio) was asked how the Trump administration would protect rural health care access in the face of hospital closures such as two this year in Eau Claire and Chippewa Falls.

In response, he turned to immigration.

“You may not think that access to health care in rural areas is an immigration issue,” said Vance, former President Donald Trump’s running mate. “I guarantee this is an immigration issue because we are bankrupting a lot of hospitals by forcing those hospitals to provide care to people who have no legal right to be in our country.”

More than 150 rural hospitals. closed or eliminated inpatient services since 2010, reported researchers from the University of North Carolina at Chapel Hill. The loss of a hospital can have reverberations throughout the community. reduced access timely care and destroying the local economy.

Federal government made an effort to keep vast objects afloat, but this it was not an easy problem decide.

What Is Attack on rural hospitals?

Experts say Vance’s statement implies that immigrants in the country illegally are a drain on the resources of these hospitals, which often operate on thin margins, taking time and energy away from other patients without paying their bills.

We’ve reached out to the Vance and Trump campaigns for more information. They didn’t answer.

Hospital finance experts and industry representatives generally disagreed with Vance’s assertion, noting that many other factors were involved in the closure.

“When we talk to members of our rural hospitals, we hear something very different,” said Shannon Wu, director of payment policy for the American Hospital Association, a trade group representing more than 5,000 hospitals nationwide.

Brock Slabach, chief operating officer of the National Rural Health Association, said hospitals in border states are facing challenges treating immigrants who are in the country illegally. “But in my discussions, I never mentioned that anyone directly linked this to the hospital closing,” he said.

The specific situations that lead to a rural hospital closing its doors are unique to each facility, but many face the same stressors, the researchers said.

Rural hospitals tend to have low patient volumes, which creates a number of problems. They are often located in smaller communities, and some residents may choose to travel to hospitals in larger cities where they can receive more complex care, which researchers call “hospital rounds“

Such low patient volumes could lead to financial losses for small rural hospitals, said Harold Miller, president and CEO Center for Health Care Quality and Payment Reformnational policy center for health care payment and delivery systems.

Hospitals have fixed costs, such as running emergency rooms, and they need to have a large enough patient volume to cover them, he said.

“If a patient comes into the emergency room and doesn’t have insurance or can’t pay, it doesn’t really add much to the hospital’s costs because the doctor is already there,” he said, using an acronym for emergency department.

Rural hospitals treat a large proportion of patients They are covered by Medicare and Medicaid compared to city hospitals, according to the American Medical Association. Public insurance programs for older and low-income Americans typically pay providers less than private insurers.

However, Miller said, Medicare is “one of the best payers” for small rural hospitals. This is partly due to the fact that rooms with special “critical access hospital” receive more from Medicare and, in some states, from Medicaid.

Hospital industry officials and some experts say Medicare Advantage plans growing popularity has also hurt rural hospital profits, as private insurance companies offering such plans tend to less reliable payers than traditional Medicare.

First, the negotiated rates paid by Advantage plans may be lower, which is especially noticeable for these mission-critical access sites. Advantage plans also impose additional layers of costly and time-consuming administrative burden to ensure payment.

“They’ll deny the claim or say the patient didn’t really need the service after getting prior authorization, and so the hospitals don’t get paid for the service by someone who has insurance,” Miller said.

The insurance industry trade group AHIP refuted the claim that Medicare Advantage plans hurt rural hospitals, citing a federal government-backed study that said the plans actually improve the financial stability of rural hospitals.

But the study did not compare actual payments between Medicare Advantage and traditional Medicare plans and only looked at 14 states.

People without legal immigration status generally cannot get Medicaid or Medicare coverage. But Medicaid law provision does allow some immigrants in the country illegally to temporarily obtain coverage, said Hayden Dublois, director of data and analytics at the think tank. State Accounting Fundntability.

Medicaid who pays less than Medicare and private insurance are “not exactly a financial boon for hospitals,” and that may be part of what Vance is talking about, Dublois said.

Dublois found an increase in the number of people signing up for Medicaid without being able to verify their immigration status, according to data from several states. But his study did not specifically look at how this population might affect the financial viability of rural hospitals.

Some states have taken illegal steps in recent years to expand health insurance to the nation’s population, offering coverage of more than 1 million low income immigrants.

In one of these states, California, nine hospitals have closed or discontinued inpatient services since 2005.

People may be able to pay for care out of pocket or have access to private insurance through an employer, the researchers said.

Covering the costs of the uninsured is just one of the financial stresses facing rural hospitals, said George Pink, associate director of the North Carolina Rural Health Research Program.

“Will this be enough to drive the hospital into bankruptcy? Probably not,” he said.

The financial downturn could take years, Pink said. As losses mount, hospitals may be forced to sell real estate or other assets, depleting any financial reserves and maxing out their credit.

“This is not an overnight phenomenon,” he said.

Our solution

Vance said providing care to immigrants without legal status has “bankrupted” rural hospitals and forced them to close.

Although this population most likely not insuredLiving in the country illegally does not mean people cannot pay for health care, especially if they live in states that offer them coverage.

Research shows that many factors contribute to rural hospital closures—not just the financial cost of providing care to those without insurance, whether those people are undocumented immigrants in the country or U.S. citizens.

We rate Vance’s statement as false.

Our sources:

PBS NewsHour, “WATCH LIVE: Vance speaks at campaign rally in Eau Claire, Wisconsin“, September 17, 2024

HSHS Hospital Nursing System, “Information regarding the closure of HSHS Sacred Heart Hospital and HSHS St. Joseph’s Hospital“, accessed September 26, 2024.

Cecil G. Scheps Center for Health Services Research, University of North Carolina at Chapel Hill, “Closing of rural hospitals“, accessed September 27, 2024.

GAO, “Closure of rural hospitals: affected residents have limited access to medical services“, December 22, 2020

Journal of Rural Health”,Impact of rural general hospital closures on communities – a systematic literature review“, November 20, 2023

Rural Health Information Center, “Rural Emergency Hospitals (REH)“, accessed September 30, 2024.

KFF health news”,Federal program to save rural hospitals is experiencing ‘growing pains’“, January 16, 2024

Microsoft Teams Interview with Shannon Wu, Director of Payment Policy, American Hospital Association, October 1, 2024.

Zoom interview with Brock Slabach, Chief Operating Officer, National Rural Health Association, October 1, 2024.

Cecil G. Scheps Center for Health Services Research, University of North Carolina at Chapel Hill, “Patterns of hospital bypass and inpatient care seeking among rural residents“, accessed October 1, 2024.

Zoom Interview with Harold Miller, President and CEO, Center for Healthcare Quality and Payment Reform, September 26, 2024.

American Medical Association, “Issue Brief: Payment and Delivery in Rural Hospitals“, accessed October 15, 2024.

Rural Health Information Center, “Critical Access Hospitals (CAH)“, accessed September 30, 2024.

KFF, “Medicare Advantage Enrollment, Plan Affordability, and Premiums in Rural Areas“, September 7, 2023

KFF health news”,Tiny rural hospitals struggle as Medicare Advantage plans grow“, October 23, 2023

Email interview with James Swann, AHIP Director of Communications and Public Affairs, October 21, 2024.

Medicaid.gov, “Implementation Guide: Eligibility for Citizenship and Non-Citizens“, accessed October 10, 2024.

Zoom and email interview with Hayden Dublois, Director of Data and Analytics, Government Accountability Foundation, October 1, 2024.

Commonwealth Fund”,How Differences in Medicaid, Medicare, and Commercial Health Insurance Rates Affect Access, Health Equity, and Cost“, August 17, 2022

KFF health news”,States expand health coverage for immigrants as GOP criticizes Biden over border crossings“, December 28, 2023

Telephone interview with George Pink, Associate Director, North Carolina Rural Health Research Program, September 30, 2024.

KFF, “Public Health Insurance for Immigrants and Implications for Health Insurance and Care“, May 1, 2024