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Blatt
“A small community is only as healthy as its hospital.”
That sign hangs near the entrance of Fairfax Community Hospital, a 15-bed facility in the town of Fairfax in Osage County, one of many rural Oklahoma hospitals that has spent several years on life support. In a recent Washington Post profile of the hospital, which has changed ownership and been in and out of bankruptcy repeatedly in recent years, one of the few remaining employee asked, “If we aren’t open, where do these people go?” “They’ll go to the cemetery,” another said. “If we’re not here, these people don’t have time. They’ll die along with the hospital.”
The closest hospital to Fairfax Community is 30 miles away on a two-lane road. Even with limited operations, the hospital in Fairfax provides emergency blood transfusions, intubations, overdose reversals, and several helicopter flights each month to larger hospitals. All of this saves lives.
Rural hospitals in Oklahoma are in crisis. Since 2011, at least five have closed - in Sayre, Frederick, Latimer, Paul’s Valley, and Eufaula. Hospitals in Drumright, Prague, Seiling, Stigler, Vinita and Atoka, as well as Fairfax, have filed for bankruptcy. Over half of rural hospitals in Oklahoma lost money from 2011 to 2017, according to a Gatehouse Media report, and the average profitability margin has shrunk to 0.8 percent.
“A hospital closure is a frightening thing for a small town,” noted Patti Davis, head of the Oklahoma Hospital Association, in the Gatehouse article. “ It places lives in jeopardy and has a domino effect on the community. Health care professionals leave, pharmacies can’t stay open, nursing homes have to close.” The exodus of good-paying health care jobs adds to the downward economic spiral afflicting many rural areas.
Numerous factors contribute to the financial strains on rural hospitals in Oklahoma, but an important and frustrating one is our state’s continued refusal to expand Medicaid coverage to low-income adults. This drives up the number of uninsured patients – in Oklahoma, nearly four in ten low-income rural residents are uninsured - and leaves hospitals serving those who are sicker and more expensive to treat. Only 14 states have still failed to expand Medicaid, yet these states account for 77 of the 106 hospital closures this decade (73 percent), Gatehouse determined. These hold-out states, like Oklahoma, are home to a much higher percentage of money-losing facilities and lower collective profit margins.
Expanding Medicaid can make a real difference. A recent study in the journal Health Affairs found that “Medicaid expansion was associated with improved hospital financial performance and substantially lower likelihoods of closure, especially in rural markets and counties with large numbers of uninsured adults before Medicaid expansion.”
The benefits of expanding Medicaid are proving to be widespread. In Kentucky and Arkansas, two states that have similar demographics and challenges to Oklahoma but that have expanded coverage, researchers have found a 30 percent drop in the share of people skipping medications due to cost, a 64 percent drop in the share relying on the emergency room for their health care, and a 40 percent increase in the share of people reporting excellent health.
A new management group recently took over Fairfax Community Hospital in a last-ditch effort to keep it open and the hospital is now back on its feet. Oklahoma voters may have a last-ditch chance to save rural hospitals and rural communities if State Question 802, which would finally expand Medicaid in Oklahoma, makes it to the ballot in 2020.
Blatt is Executive Director of Oklahoma Policy Institute.