Tale of two hospitals shows impact of Medicaid expansion

By Paul Taylor
    Consider this a tale of two hospitals.
    Four years ago, our health system was forced to shut down Ozark Community Hospital in Springfield. Two hundred employees lost their jobs, and a corner of the city lost its access to both primary and emergency care. We’ve since closed three other clinics in Missouri.


    One hundred miles to the south, our hospital in Gravette, Arkansas is thriving, with 350 employees on payroll at a facility that includes primary and specialty care clinics.
    The difference? Arkansas expanded Medicaid in 2014. Missouri’s elected leaders have consistently resisted such a move—a failure Missouri voters will now have a chance to rectify with the August 4 vote on a citizens’ initiative ballot measure called Amendment 2.
    It’s really that simple. While OCH Health System was adding providers and employees in Arkansas, we were losing providers and shrinking staff across the border.
    Small, rural hospitals are in crisis; since 2005, the number to close nationwide is approaching 200.
    In Missouri, 15 hospitals have closed since 2014—10 in rural locations. Hundreds more remain at risk, barely hanging on even before the global pandemic. The common thread: most to close are in the 13 states that haven’t expand Medicaid.
    Rural hospitals are the economic lifeblood of the communities they serve. When the hospital closes, the town dies. Or in Gravette’s case, offers a chance at rebirth.
    The economic benefits of Medicaid expansion in Arkansas are apparent. Officials here have used more than $400 million expansion savings during the last three years to cut state income taxes and reduce payments previously allocated to the uninsured.
    Thanks to a 900 percent return on investment through a much higher federal matching rate, Missouri can expect the same effect on its state budget. By 2026, the projected savings will exceed $1.3 billion annually, according to Washington University researchers.
    Among the existing Medicaid recipients who would qualify for the higher federal reimbursements: expectant mothers, people with disabilities, and women diagnosed through breast and cervical cancer screening programs.
    The economic impact of Missouri Medicaid expansion beyond the state budget savings would be even more sizable.
    A new Missouri Foundation for Health report concludes that a Yes on 2 vote next month will generate 16,000 new jobs annually over the first five years of expansion, with a $2.5 billion annual economic output.
    Four out of five of those new jobs would be in occupations outside the health industry. And 90 percent of those sorely needed positions would be located outside of St. Louis and Kansas City.
    Is it any wonder that the groups lining up to support Medicaid expansion include the likes of the Missouri Chamber of Commerce and Industry, which calls the voter petition-driven ballot initiative a “pro-jobs measure that will help fuel economic growth throughout the state?”
    As a safety-net provider, our health system focuses on providing access to care for those who cannot obtain it elsewhere. Unlike most other such providers, we are a for-profit, paying real estate, sales and income taxes but ineligible for taxpayer funds, grants and donations. Our operating margins are narrow—and Medicaid expansion makes all the difference.
    Closing Ozarks Community Hospital in Springfield was incredibly painful. We held on as long as we could, but without increased coverage for uninsured patients, we were placing our entire organization at risk. We had no choice but to reduce services in Missouri.
    I grew up in Joplin and lived in Missouri for almost 60 years. I’ve watched our Missouri-licensed physicians become licensed in Arkansas, and staff members drive hours to work across the state line. Simply put, Missouri is losing money, jobs, medical facilities and talent to Arkansas.
    The past few months have shown that access to care is more important than ever. It’s time to protect frontline healthcare jobs, help keep endangered rural hospitals open and ensure that all Missourians have access to emergency care.
    A similar message was heard loud and clear to our west; on June 30, Oklahoma voters approved their own Medicaid expansion ballot measure, meaning Missouri tax dollars now help subsidize Medicaid expansion in 37 other states.
    On August 4, vote yes on Amendment 2.
    EDITOR’S NOTE: Paul Taylor is CEO of the OCH Health System, which in addition to the Gravette hospital owns and operates 15 medical clinics in Missouri, Oklahoma and Arkansas.

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