WASHINGTON — As President Donald Trump signed his tax breaks and spending cuts bill into law, Alabama researchers warned that changes to Medicaid could decimate the health care system in the state’s Black Belt.
The Black Belt in Alabama represents 13% of the state’s population and yet its health care challenges have significant impacts across the state, according to a recent report from the University of Alabama Education Policy Center.
Researchers in the report, published in June, highlight how the barriers to receiving health care in the Black Belt have persisted over the years with COVID-19, the closure of rural hospitals, and limited broadband access. They note that Trump’s budget bill will cut around $1 trillion from Medicaid and the Affordable Care Act, which they say will have outsize consequences for the state’s most vulnerable populations.
Black Belt counties are especially reliant on Medicaid, with 21 of the state’s most Medicaid-dependent counties located in the Black Belt. The average county in the area has 27% of its population covered by Medicaid, according to the report.
In Alabama, 10 rural hospitals have closed since 2010, with seven of those serving Black Belt communities.
The report highlights how Black Belt residents have fewer providers available to them compared to other counties in Alabama. Black Belt counties have 4,130 people per primary care physician. While in other counties in the state, there are 2,570 people per provider.
One health care provision in the newly passed mega bill that is of “significant concern” to the researchers is the freeze on provider taxes for states that have not expanded Medicaid.
“Given rising healthcare costs and inflation, a fixed provider tax will likely leave hospitals ‘in the hole’ within the next year, limiting their ability to provide care,” the report reads. “This is particularly worrisome for Alabama, which relies heavily on provider taxes to support its Medicaid system.”
The provider tax rate currently sits at 6% which is the highest it is allowed to be under the law. The report notes that the freeze might not immediately hurt hospitals, but “the inability to increase this funding source in the future is a major concern.”
Alabama hospital leaders offered similar concerns to Alabama Daily News last month.
Alabama has not expanded Medicaid under the Affordable Care Act. The mega bill also strips away incentives to expand Medicaid in the future.
In his support for the mega bill, U.S. Sen. Tommy Tuberville, R-Ala., previously said he didn’t have any issues with freezing the provider tax at current levels for non-expansion states. He said non-expansion states are expected to fare better under the bill than those that did expand under the Affordable Care Act.
“For us that didn’t expand Medicaid, it’s good,” Tuberville told ADN. “There’s not really any pressure on us unless they change the percentages.”
U.S. Sen. Katie Britt, R-Ala., said last week Alabama was in a “strong spot” when it comes to keeping the state’s rural hospitals open. She referred to Senate Republicans adding a provision in the bill, a rural hospital fund, for $50 billion to be distributed evenly to states to help offset any challenges they may face from other parts of the bill.
“We are clearly making structural reforms to Medicaid to make sure that the program lasts, and I think that the way that we have fought, particularly in the Senate…what Sen. Tuberville and I tried to do was make sure that Alabama was in the strongest place possible,” Britt told ADN.
Researchers note Black Belt counties face particularly high rates of diabetes, heart disease and infant mortality.
To address these challenges, the report recommends investing in initiatives to increase health education, create neighborhood programs that connect residents to resources and increase the number of providers in underserved areas in the state.