The battle for financing for healthcare in Washington is reflected in places such as the hills and hollows of the Blue Range of North Carolina.
The federal government is closed, focused on counteracting democrats to reduce healthcare programs. Where the Republicans see the opportunity to reduce the size of the government, their opponents argue that the abbreviations will reduce access to Medicaid – and push out to influence the viability of rural hospitals, which are already financially stretched.
This is the key part of the larger national debates associated with the growing costs of healthcare.
Why did we write this
The Washington debate about the medicine is reflected in rural communities, such as the Yelskaya Pine, North Carolina, where hospitals are trying to cover expenses.
Here, in the mountain city of Yelsky Pine, North Carolina, in the local regional hospital, Blue Ridge has Medicaid beneficiaries as a large share of their patients. He ended up in a list of five possible hospitals in the state, which could be closed from his financial losses over the past three years.
Since 1955, the hospital has been providing emergency assistance, until 2017 for the birth center, one of the poorest parts of Appalachi, a violently independent politically conservative zone, which voted by almost 80% for Donald Trump in 2024 (nearest other hospitals, one in Marion and one in Esheville, there are at least half an hour and time passage, respectively).
To raise funds to even open the hospital, the volunteers went from door to door, collecting a penny.
“I am shocked that they are considering [closing the hospital]- says John Richardson, a national artist from the surroundings in neighboring Bernsville, North Carolina. He says that such a step will reduce health care options for himself and others, in the region, where navigation on long, winding mountain roads, especially in the rain or snow, is more than a little cunning.
Rural hospitals and installation costs
48% of rural hospitals worked throughout the country on financial losses In 2023, according to the American Hospital Association.
“In general, 338 hospitals either tested for three consecutive years in a row of negative general profits, serve the highest share of patients with Medicaid, or both,” Senator -Democrat ED Massachusetts wrote in a June letterWarning the republican colleagues about how a reduction in Medicaid will affect rural people and hospitals.
Republican one big beautiful bill signed by President Donald Trump on July 4, contained several Big changes for MedicaidThe program of healthcare of the federal state for Americans with low income. The bill established new conditions for the right to participate, including the requirements for work and more frequent verification of acceptability. It also limited the ability of the States to use taxes with suppliers to finance their Medicaid programs.
The government arrived on September 30 as a deadline for financing, while two -party support necessary for passing, the Democrats refused to support the bill, if it does not facilitate the reduction of healthcare, which includes the reduction of Obamacare subsidies, as well as changes in Medicaid.
Closing the government follows from this impasse.
While many health care experts are concerned about the problems facing rural hospitals, conservatives protect the goal of Medicaid reform and restricting its value to federal taxpayers.
“Strengthening the integrity of Medicaid by eliminating waste, fraud and abuse, its resources can be reoriented to ensure better care for those to whom the program was developed: pregnant women, children with disabilities, older with low income and other vulnerable families with low income”, White House Information Bulletin He said when the changes were accepted.
The Paragon Health Institute, a conservative analytical center, claims that the increase in health care expenses during the Biden administration was determined by a “policy that registered at any price in both [Obamacare] Exchange and expansion of Medicaid. “
Bipartisan efforts for rural communities
A large bill of Republicans also created a fund of $ 50 billion to support rural hospitals from the risk group, but some experts say that the fund is too small to adequately solve problems.
The Yelskaya pine illustrates the type of small cities affected by the stream. With a population of about 2,000 people, he just saw his first cargo train in almost a year last week, since a year ago it is restored after floods caused by a hurricane Helen. When a resident of Trisha Nivven again opened her cafe damaged by floods, Blue Ridge Java's, hundreds of local residents appeared to celebrate.
Given the sensitive policy related to the closure of the government, the Niven does not dare to speak. Her one comment: “We need a hospital.”
This hospital is already in jeopardy. The agreement between the state and hospital corporation of America, which retains an open regional corporate hospital system, should end in 2029. HCA made some investments and created effectiveness. But the staff also filed a lawsuit for its low level of personnel and maintenance problems.
When the childbirth center was closed here in Yelka, this was partly because expensive help was not adequately covered, given that 40% of women who gave birth were relied on Medicaid to cover payments.
Mergers and monopolies
Before allowing the merger of two hospitals in Ashville to create a consortium that includes Blue Ridge, the legislative body is entrusted. But before the HCA in 2019 was acquired by the Mission Hospital group, the system convinced the legislative body to remove these restrictions.
“This has created, in fact, a monopoly created by the government,” says SPRUCE Pine Victoria Hicks, who participated in public efforts to maintain the hospital viability. “Thus, this is a bird's nest on Earth,” she says, referring to a hospital system that worked well before HCA was bought. Now she adds, “we have seen what is happening when you allow a commercial company to work in such conditions.”
Many of the contractions of Medicaid will not enter into force until after the election of 2026.
Protecting his position in closing, President Trump and other Republicans emphasized claims against unauthorized immigration and financial healthcare taxpayers, in particular Medicaid.
They say that one large beautiful bill of Trump has imposed new restrictions that democrats are now trying to abandon federal financing of emergency processing in order to reduce access to unauthorized immigrants. Only about 1% of financing medical care in hospitals is engaged in caring for such immigrants, mainly for Giving birth costsIN According to KFFIndependent information group of medical policy. And neither the former federal law, nor the current democratic proposals give unauthorized immigrants direct access to Medicaid.
But the Republicans say that the Biden administration provided parole for a huge number of immigrants, which allowed them to have the right to medical care financed by taxpayers and straining the system.
Here, in Yelsky pine, the idea that the difficult position of the hospital can be directly related to national policy seem to be incompatible for some, given the long -term value of the object for many who make these Appalachian sorting their home.
“I know when I was a child, almost 70 years ago, I remember how I entered and sat in the waiting room and waited for my parents who visited anyone,” says Lifelong resident Joanne Laskin. “It has always been very important for this area.”
