MONTGOMERY, Ala. (WSFA) - Ways to strengthen rural health care are expected to be discussed during the 2020 legislative session, which begins on Feb. 4.
States around the country are dealing with a health care crisis, including Alabama, where 13 hospitals have closed within the state in about a decade. Seven of those were in rural parts of the state, according to the Alabama Hospital Association.
Speaker of the House Rep. Mac McCutcheon, R-Huntsville, said there are still questions surrounding ways to solve the issue.
“Having health care in any community is so important,” he said. “When you start looking at the overall rural health care plan to include the hospitals, there’s just a lot of questions out there.”
Both President Pro Tempore Sen. Del Marsh, R-Anniston, and McCutcheon questioned whether hospitals are absolutely needed in rural communities.
“There are many of those communities that you could not justify a hospital being there. We wish we could put a hospital in every community, but you just can’t justify it on the financial side,” Marsh said. “We’ve got to make sure we can provide adequate health care to our citizens."
He suggested they look at medical transport as one solution for people to receive the care they need.
“Maybe that’s the answer. Where at least if you’re in a rural community and you know you’re going to have good access to transportation to medical care, that could be a solution to come of these problems,” Marsh said.
McCutcheon suggested depending on more clinics instead of hospitals.
“Is a hospital facility what is needed in certain areas to provide the proper care?” McCutcheon said.
Marsh wants to target efforts at why hospitals have left in communities.
“Is it because there are not enough doctors?” he said.
He anticipates future legislation that would encourage more doctors to work in rural areas.
Alabama Hospital Association Executive Vice President Danne Howard said having a clinic is not the same as having a hospital.
“Having a clinic instead of a hospital has a domino effect impacting access to health care," she said.
She said clinics do not offer the same care as a hospital, so people will leave rural areas for urban facilities. Howard continued to say those urban facilities end up strained and meeting their bed rate capacity.
Howard claimed the underlying problem for the lack of health care includes the volume of uninsured patients. She said clinics would not solve the problem because they would still provide uncompensated care.
Both McCutcheon and Marsh said Medicaid expansion was not on the table this session.
“Because of the politics itself I think Medicaid expansion is a term that will not be discussed," McCutcheon said.
The governor can expand Medicaid without state lawmaker approval. However, the legislature would have to fund it. Gov. Kay Ivey has questioned in the past where the money would come from to fund it.
The hospital association and Alabama Democrats have continually pushed for Medicaid expansion.
“We are always going to keep Medicaid expansion out there. It is something we believe that can happen in this state,” said Sen. Bobby Singleton, D-Greensboro.
Fourteen states including Alabama have not expanded Medicaid according to the Kaiser Family Foundation.
“We’re continuing to advocate for Medicaid expansion,” Howard said.
Howard said most recent 2016 estimates say 350,000 Alabamians would receive coverage under expansion.
But she continued to say the association is looking at different models to sustain health care, asserting one answer will not solve the problem. Howard pointed to telehealth has one method.
“Rural hospitals taking advantage of some rural telehealth programs," she said.
But the biggest obstacle is broadband access, she said. State lawmakers have worked to expand broadband services during the 2019 legislative session.
Howard said it is a reality that some hospitals will not survive to 2021 if current conditions stay the same.
The association said many hospitals are fragile, claiming 88 percent of rural hospitals operate in the red.
“We can’t sustain what we have now," she said.