Discussion
The study found out that rural inpatient hospitals in Medicaid non-expansion states were more likely to face closure. After ACA enactment in rural inpatient hospitals, there have been adverse effects facing the rural hospitals across the US states.. As a result, the country has faced the closure of various hospitals within the rural areas since 2010. As shown in figure 3, 113 hospitals in rural areas have closed between January 2010 and August 2019 (Cecil G. Sheps Center, 2020) . Reducing the number of covered lives in Medicaid means that the individuals who solely depend on it will no longer have the healthcare coverage. Out of 30 hospitals in the US States, there is at least one rural hospital closed since 2010. That indicates that very many hospitals have closed as an impact of ACA within the country. It was also found that the rural hospitals that mostly faced closure were those hospitals located in the south. Besides, up to date, there are nine states with at least five rural hospitals closed due to the ACA enactment in the country. Texas State leads with 20 rural hospitals closed, followed by Tennessee with 12 hospitals from the rural areas closed.
Sates that have non-expansion of Medicaid have a significant increase in hospitals ending their operation. These states have gone against Medicaid expansion programs, refusing to accept the federal money channeled through Medicaid expansion programs. Furthermore, more than 77% of these rural hospitals closed in the states opted out of the Medicaid program (BeneStream, 2016). The program has been beneficial to those hospitals within the states that embraced it. It avails more than $305 billion in federal funding (Norris, 2020). Moreover, ACA is associated with substantial changes in the hospital's payer mix. Through Medicaid programs, many people can access the required medical services since they have the ability to pay for them due to the existence of the program.
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These results suggest that Medicaid expansions have significantly improved the operation of the most rural hospital across the country and their financial performance. It has further eliminated or reduced healthcare coverage disparities between adults in rural areas and urban areas. That, therefore, means there is the greater importance of Medicaid programs in all hospitals across the country.
Study limitations
The study, however, has various limitations. For instance, despite the strengths of the study designs used in the reviewed studies, there has been limited availability of measures that could help control the concurrent events in the markets that may differentially affect hospitals within states that have embraced expansion and those that did not embrace expansion. For instance, ACA insurance market places that were put into consideration increased the healthcare coverage concurrently with the expansion of the Medicaid eligibility. These affected both the uncompensated cost of care. In case these changes differentially affected hospitals within both states that expanded Medicaid programs and those that did not, then most of these studies that were considered for review might have been biased. As a result, this study also uses a biased result to come up with a conclusion.
Additionally, there might have been measurement errors in the reviewed studies since Medicaid revenue and uncompensated healthcare data from Medicare's cost report may sometimes report errors and time differences in cost settlement. As a result, the healthcare cost and revenue considered in the articles used in this study might have been having errors. Consequently, our study may also face the same error problem.
Implications
The study result shows rural inpatient hospitals in Medicaid non-expansion states faced closure. In contrast, those rural hospitals within the states that embraced the program expansion improved their services and profit margin. For instance, one study found that rural hospitals located in the states that increased eligibility of Medicaid and enrollment faced lower hospital closures due to ACA enactment. Furthermore, a study also found that non-expansion states have suffered a high increase in hospital closure by clustering the closed hospitals within 14 states that have not expanded the Medicaid program (Ollove, 2019) . Such hospitals have opted against the Medicaid program.
Considering the great effects that the Medicaid program has brought to the hospitals within states that embraced it, in addition to the closure impact that ACA brought to the rural inpatient hospitals within these states, it clear that Medicaid has most hospitals together with the citizens enjoy benefits of Medicaid program within the US. It covers children, adults, seniors, and disabled individuals to access health care equally. Additionally, hospitals also benefit from the government's funds through this program to help them pay for the operation costs hence increasing their profit margin. As a result, there have been few instances of hospitals from the states embracing the Medicaid program ceasing their operations. Therefore, it is recommended that the US's federal government develop a policy that forces all the states to embrace the Medicaid programs to help improve services that rural hospitals offer to their patients and improve their profit margin from the funds channeled through the program.
Conclusion
The study suggests that ACA has had adverse effects on the rural inpatient hospitals in none expansion states. If the rural hospitals continue to operate in non-expansion states, then there are more chances that they will cease their operations. All hospitals within the US should, therefore, embrace the Medicaid program due to its greater effect.
References
BeneStream. (2016). 77% of Rural Hospital Closures Have Occurred in States That Have Not Expanded Medicaid . BeneStream. Retrieved 29 November 2020, from https://benestream.com/2016/03/11/77-percent-of-rural-hospital-closures-have-occurred-in-states-that-have-not-expanded-medicaid/ .
Cecil G. Sheps Center. (2020). 176 Rural Hospital Closures: January 2005 – Present (134 since 2010) - Sheps Center . Sheps Center. Retrieved 29 November 2020, from https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/.
Norris, L. (2020, October 06). Find Medicaid coverage in your state. Retrieved October 27, 2020, from https://www.healthinsurance.org/medicaid/
Ollove, M. (2019). Rural Hospitals in Greater Jeopardy in Non-Medicaid Expansion States . Pewtrusts.org. Retrieved 29 November 2020, from https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2019/01/22/rural-hospitals-in-greater-jeopardy-in-non-medicaid-expansion-states#:~:text=Roughly%20another%204%20million%20people,don't%20receive%20health%20care .
