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Commentary: Not Expanding Medicaid Is Hurting Missouri Rural Hospitals


To date, Missouri has failed to expand its Medicaid program as part of the Affordable Care Act, aka "Obamacare." As a result, federal dollars that would normally flow to underserved areas are being transferred to states that have expanded their programs. This loss of funding has major implications for health care in our state especially for those in areas of poverty and who are underserved. One particularly susceptible area is rural Missouri.

Sac-Osage Hospital in Osceola is a telling example.

Osceola is a town of 916 people in the Ozarks. It is 92 percent Caucasian, 1.6 percent African-American with the remainder Asian and Native American. Median household income is $19,791 and the poverty level 38.4 percent.  By comparison, the national poverty rate in 2013 was 14.5 percent.

In 1969, this community opened its own hospital, the Sac-Osage Hospital with the slogan, "Your Health Care -- Close to Home." Its website boasted: 24-hour emergency care; 24-hour ambulance service; in patient care including acute care, skilled nursing and hospice; patient and family support services and social services.

This impoverished community treasured its hospital. In 2009, its citizens voted to impose a property tax on themselves to support this financially struggling institution. In 2012, the hospital boasted 385 admissions and 2,009 emergency department visits. It had a staff of over 100. By 2014 occupancy was down to 1-3 patients a day and the staff down to 60. After 45 years, it was no longer financially viable. It closed on Sept. 15.

Arrangements have been made for Osceola patients to have ambulance and inpatient services provided by Citizens Memorial Hospital in Bolivar, Mo., 37 miles away. So much for "Your Health Care--Close to Home."

Besides losing care close to home, the community lost an important civic institution. Its socially valuable programs for Osceola residents included lectures on healthy lifestyles and nutrition. It was also the town's largest employer. Those who are now unemployed will not have the wages they had spent on other goods and services at other businesses in town. That will lead to a decline in municipal, state and federal tax revenues and loss of public services. The mortgage still must be paid off, and those payments could be spent on other local commodities, e.g., public education, which will now suffer. The community may very well die.

The hospital collapsed because of inadequate funding. That problem could be resolved largely or entirely by Missouri expanding its Medicaid program. And we should expect to see the problem recur in other rural communities with similar financial problems.

We need to educate and inform the citizens of our state, act as advocates for those who are in poverty, or are uninsured or underinsured. In 2015 the federal government will pay 100 percent of the costs of expanding Missouri's Medicaid program. It will pay 95 percent of the costs from 2016-18, and 90 percent thereafter in perpetuity. We should urge our legislators to expand Medicaid because it is the moral, socially just, and economically right thing to do. Failure to expand has no reasonable justification.

Terry D. Weiss, M.D., is an associate clinical professor of medicine at Saint Louis University School of Medicine.