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Rural Health: The Hospital on "Life Support"

All year long on Alabama Public Radio, we’ve been looking at rural healthcare. Advocates of rural healthcare in Alabama say a critical element is how to pay for treatment. Today’s failed effort by Republican Senators to repeal the Affordable Care Act only serves to punctuate these concerns. Alabamians already face the fourth highest health insurance rates in the nation and rural hospitals here receive among the lowest reimbursements from Medicare. APR’s Pat Duggins has more on what this means for rural healthcare providers, and the people who need that help…

Class is letting out at Southern Academy in the town of Greensboro in rural Hale County. For teachers with experience, spotting students who have health insurance and those who don’t seems pretty easy…

“You have a kid who’s on medication, and they start to act out. And you go, ‘where’s your medicine?’ Sharon Segura teaches science. ‘We can’t get it…we can’t afford it…we don’t have a way to get it.”

And, it’s not just students and their parents who sweat about health coverage every month…

“What I hear from other adults in this building, is the insurance premiums.” That includes Segura. She retired from teaching two years ago, but then she started dealing with the Affordable Care Act… “I came back to work because my insurance premiums went up so much. The year I retired, my family coverage was $363 a month. Now it’s $1250.”

So, Segura’s back in the classroom. Her husband is supposed to be retired as well, but he’s working three jobs to help cover the bills. Talk in Congress about a new GOP proposal to do away with what’s known as Obamacare is leading to more uncertainty. But, it's not just people like the Seguras who are worried about paying for healthcare.

“We’re losing about a million dollars a year.” That’s George Alford. He lives in rural Wilcox County. And he’s not talking about his family budget. Alford is on the board of John Paul Jones Hospital in the town of Camden. “We couldn’t even have groceries delivered to do the meals without pulling some strings with some people to get enough money to pay off…for bread.”

Elizabeth Kennedy shows us around. She’s the Chief Executive Officer at John Paul Jones. Before you ask, the hospital isn’t named for the famous Naval War Hero. Dr. Jones was a prominent physician in Camden. This hospital is a cash strapped facility in a poor county. Very poor. In fact, in 2012, the U.S. Census Bureau listed Wilcox County as the most impoverished county in the nation. For rural hospitals in Alabama, there’s an area where they rank badly as well…

“If you’re talking about Medicare, yes," says Danne Howard. She’s Chief Policy Officer for the Alabama Hospital Association. Howard says eighty percent of the rural hospitals in Alabama are losing money…

“Healthcare is an odd bird, as far as what is billed, what it costs, and what is reimbursed."

Take Medicare for example.

That’s the federal insurance program for the elderly. Rural hospitals in Alabama complain they get paid the lowest reimbursement rates in the U.S. Danne Howard says that because those rates are based on what hospital workers are paid, and that’s where Alabama’s rural hospitals get into trouble… “They’ve even remained level, or they’ve even had to have some reductions and some staff layoffs. And so, we’re showing we’re not paying as much wages as other states, so, guess what happens? We lose money for the States that are paying higher.”

In Alabama, rural hospitals get sixty to seventy cents from Medicare for every dollar’s worth of treatment of service they provide the program. George Alford says, at John Paul Jones Hospital in Camden, it's even worse.

“We collected, I think thirty some odd percent of that…”

There are plans in Congress to try to adjust Medicare reimbursements to make them more fair. Alford says that wouldn’t help because of what his hospital is paid by private insurers and Medicaid for the poor. He says they pay even less.

“Ten percent on Medicaid. Then, Blue Cross Blue Shield and your other private insurers we collected about forty percent," he says.

Simply put, John Paul Jones is swimming in debt. Last month, the board announced it would close the hospital. But, George Alford says there was a “plan B” …a proposed one penny hike in the county sales tax with the money going to the hospital.

“It gives us a chance…a legitimate chance of continuing to serve," says Alford. "Rather than folding out tent and saying ‘well, it’s been nice.’”

But, not everyone’s happy about it…

“It’s a terrible policy solution. It’s no way to run a hospital,” says Jim Carnes. He’s the Policy Director for Alabama Arise, a citizen’s advocacy group out of Montgomery. “It’s a real shame to put the burden of keeping that hospital open on the backs of Wilcox Countians, who are facing some of the stiffest economic statistics in the state and the country.”

One irony is Alabama Governor Kay Ivey is from Wilcox County. Alabama is one of the states that rejected a plan to expand Medicaid with incentive dollars from Washington. Alabama Arise believes if Ivey changes her mind that could help hospitals in peril like John Paul Jones in Camden. Carnes plans to bring the idea back up in the 2018 legislative and he hopes  the Governor is listening…

“We haven’t heard the Governor say much about the fact that this is happening in her hometown. But, I hope that’s keeping her up at night," says Carnes. "Because she knows these people. They are her people.”

Back at Southern Academy in rural Greensboro, people like teacher Sharon Segura are watching and waiting to see what happens next in Congress on the Affordable Care Act. And she continues to watch how health coverage affects her students.

“Just remember one day there was a girl twisting her glasses, and I said ‘you’re going to break them,’ and she said “I’ll just go get a new pair.’ Well, they may not be possible.”

And as bad as her own insurance bills are, Segura knows co-workers who are worse off…

“I know other teachers here, who…and I thought mine’s terrible, and I complained and complained. And some of them said ‘Mine’s $2200 a month…mine’s $2600 a month.”

Supporters of John Paul Jones Hospital in Wilcox think they’ll get permission from State for the one penny sales tax hike they want. Alabama Arise’s goal to get Governor Kay Ivey to expand Medicaid coverage may be less successful. One of her first acts in office was to disband a task force that was looking at many of the rural health innovations we’ve talked about during this series.

Pat Duggins is news director for Alabama Public Radio.
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