MONTGOMERY, Ala. — The recent suspension of services at Thomasville Regional Medical Center in Clarke County has sparked a renewed outcry from health care advocates for state leaders to expand Medicaid.
The closure “until further notice” of TRMC, located in southwest Alabama, is just the latest in a string of rural hospital closures or service suspensions across the state.
In a lengthy statement, Thomasville Mayor Sheldon Day said the hospital’s closure came down to finances, with staff, including ER doctors, not receiving payments on time.
The 23-bed hospital’s financial struggles carried one unique element: TRMC was ineligible for federal pandemic relief funds due to opening in 2020. But it also suffered from having to eat the costs of patients without health care, as do many rural Alabama hospitals.
The solution, advocates say, is for state leadership to join the 40 states that have expanded their Medicaid programs to cover those making up to 138% of the federal poverty line, an expansion that comes with significant federal funding under the 2010 Affordable Care Act.
Jane Adams, Alabama government relations director for the American Cancer Society Action Network, said that the closure of TRMC would be “devastating” for the community, particularly for patients for which the next closest hospital is now Grove Hill Memorial Hospital 13 miles away, which could also lose inpatient services soon, or J. Paul Jones Hospital 34 miles away.
“We know the answer to this problem; why is the governor and why are lawmakers refusing to do what they know the solution to be?” Adams told ADN Tuesday.
“These hospitals cannot survive if they don’t have money. They need a payer source, and currently, they’re being overrun with patients that don’t have health insurance, and we could solve that problem.”
While acknowledging the unique situation with TRMC in that it was ineligible for federal pandemic relief funding, Adams put the blame on the hospital’s closure squarely on the state’s choice to expand Medicaid, something she warned would only worsen.
“Pretty soon we cannot prevent what we’ve been warning (about); if we do not (expand Medicaid) now, like literally in the next year, we will likely have four or five hospitals close,” she said.
“We’re already in crisis, and all you have to do is ask Alabamians who live in rural communities who don’t have access to doctors, who don’t have access to pediatricians, who don’t have access to maternity services. They know it’s a crisis.”
That urgency for state leaders to expand Medicaid was shared by Danne Howard, deputy director of the Alabama Hospital Association.
“This is something that we just cannot turn a blind eye to any longer; I don’t think anybody wants their legacy to be that we saw the collapse of rural hospitals that eventually placed such a strain on the urban hospitals that they all started to falter,” Howard told ADN Tuesday.
“Everything we’ve been saying is going to happen is beginning to happen, and we need to stand up and pay attention just like we would if any other industry that was in this state was beginning to collapse.”
Earlier this year, the health care advocates presented a plan for Medicaid expansion to state lawmakers, a proposal that would provide health care coverage to 260,000 uninsured Alabamians at zero cost for the state for up to ten years.
Whereas a number of Democratic state lawmakers have long supported Medicaid expansion, a significant number of Republican state lawmakers expressed an openness to the idea when briefed on the proposal in the spring.
However, there has yet to be a consensus among lawmakers to support legislation to expand Medicaid, and Gov. Kay Ivey, who holds the authority to expand Medicaid without the Legislature, has continued to remain skeptical of the idea, citing concerns about cost.
Howard warned, however, that unless state leaders enact some form of change to counter the number of uninsured Alabamians, hospitals will continue to close.
“If you look at just the overall reimbursement structure and the volume of the uninsured, that is just an untenable situation from a financial perspective,” she said.
More than half of Alabama’s 52 rural hospitals are currently at risk of closing, 19 of which are at an immediate risk of closure, per a report from the Center for Healthcare Quality and Payment Reform.