Rural hospitals, once the medical hubs of the Midwest, are struggling: Patient volumes are falling, the uninsured are rising and finding skilled medical staff is like searching for a needle in a haystack. Now, some are celebrating the expansion of Medicaid. Remedy Their financial woes are blamed on expansion, but a closer look at the data reveals that expansion is nothing more than a billion-dollar waste with no long-term solution in sight.

States that accepted Medicaid expansion under the Affordable Care Act are facing a harsh reality: A quarter of their hospitals On the brink of closureAlmost. 50 rural hospitals in these states Since the expansion began, more and more stores have closed. 2020 Guidehouse Survey It found that three of the top five states with the highest percentage of critical community hospitals at risk are states that have expanded Medicaid. A staggering 76% of rural patients in these regions are choosing to seek care farther away from their communities in search of better medical care.

A closer look reveals that rural hospitals in expansion states are worse off: When adults switch from private insurance to Medicaid, hospitals' reimbursement rates drop by nearly 40%, putting them in financial difficulty. Far from being a panacea, expansion only exacerbates all of the challenges facing rural health care providers.

To be clear, reduced hospital utilization is the primary cause of the closures. It's not a lack of Medicaid expansion.Fraud, mismanagement, low reimbursements, natural disasters, and staffing shortages are far more common causes. Even when Medicaid expansion is cited as a reason for closure.which is often intertwined with allegations of wrongdoing..

The idea that expanding Medicaid will save Alabama's hospitals is complete folly. It will only increase state spending and dependency on federal aid. Taxpayers will foot the bill regardless of funding source, but state budgets will bear the brunt.

Alabama already allocates a large portion of its budget to Medicaid. Approximately 20%covering the surroundings 1.2 million subscribersThe expansion would add an estimated 200,000 people and come at a massive cost of $208 million. History shows that expansion states have consistently exceeded enrollment expectations and incurred costs far beyond initial estimates. If Alabama follows suit, it risks becoming even more dependent on Medicaid, at a cost to taxpayers.

Some have argued that refusing to expand would mean giving up federal funding. But with our nation drowning in more than $34 trillion in debt and a recent credit rating downgrade, generous federal aid is not sustainable. States will bear the brunt of the inevitable cuts, which would be a disaster for many.

The Yellow Hammer State is at a critical crossroads: maintain our independence and self-reliance, or succumb to the alluring promise of generous Federal aid. Don't be fooled by the illusion of “free” money from Washington, DC. History has shown that such promises come with conditions and consequences. There is always a price to pay, and that price is often much higher than we expect.

State Senator Arnold Mooney of Alabama 43rd District since 2014.

Brooklyn Roberts is senior director of the Health and Human Services Task Force at the American Legislative Exchange Council, the nation's largest bipartisan organization of state legislators.