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A motion blurred photograph of a patient on stretcher or gurney being pushed at speed through a hospital corridor by doctors & nurses to an emergency room.
When the Affordable Care Act was written, it was without any kind of premonition that the Supreme Court would do something so cravenly political as to take the teeth out of the Medicaid expansion, making it optional. The law reconfigured Medicaid funding, taking away some of the subsidies for community hospitals that provide care for the uninsured under the assumption that providing expanded coverage to more of these people would lessen the hospitals' burden of uncompensated care. Because congressional Republicans won't do anything to fix the law, states that aren't taking the Medicaid expansion money are now seeing the repercussions.
At least five public hospitals closed this year and many more are scaling back services, mostly in states where Medicaid wasn’t expanded. Patients in areas with shuttered hospitals must travel as far as 40 miles (64 kilometers) to get care, causing delays that can result in lethal consequences, said Bruce Siegel, chief executive officer of America’s Essential Hospitals, a Washington-based advocacy group for facilities that treat large numbers of uninsured or low-income patients.

“Everyone in a community will be affected,” Siegel said. “We could see the end of life-saving services, and patients would bear the brunt.”

Hospitals have dismissed at least 5,000 employees across the country since June, mostly in states that haven’t expanded the joint state-federal Medicaid health program for the poor as anticipated under the U.S. health overhaul known as Obamacare. Hospitals like the Cleveland Clinic in Ohio, Vanderbilt University Medical Center in Tennessee and Indiana University Health are among providers seeking cost savings in areas such as cancer treatment, mental health and infant care.

This is life and death at its most basic, as usual hitting red state populations the hardest. Because it's rural areas that will the most affected, where people will have to travel much greater distances to get care in a medical emergency. That heart attack or stroke victim who has to be transported 40 miles, after having to wait for an ambulance to reach them from who knows where, is a lot more likely to die or be permanently disabled than someone minutes away from care.

Republican governors and legislatures have made that choice, not just for the uninsured people in their states, but for everyone. You could have the best insurance available, but if you don't have a hospital to go to within minutes of an emergency, it's not going to make a damned bit of difference.

Originally posted to Joan McCarter on Mon Nov 25, 2013 at 11:25 AM PST.

Also republished by Daily Kos.

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