Bill Overview
Title: Rural Hospital Support Act
Description: This bill modifies and extends certain payment adjustments for rural hospitals under Medicare's inpatient prospective payment system. Specifically, the bill indexes payment adjustments for sole community hospitals and Medicare-dependent hospitals to FY2016 operating costs, if it results in higher payments for such hospitals. The bill also makes payment adjustments for Medicare-dependent hospitals and low-volume hospitals permanent (the adjustments currently expire at the end of FY2022).
Sponsors: Sen. Casey, Robert P., Jr. [D-PA]
Target Audience
Population: Individuals relying on rural hospitals for healthcare services
Estimated Size: 60000000
- Rural hospitals primarily serve rural populations, typically those living in rural or non-metropolitan areas.
- According to the U.S. Census Bureau, approximately 60 million people in the U.S. live in rural areas.
- Sole community hospitals are often the only source of care in remote areas.
- Medicare enrollment includes elderly people (65 and older), nonelderly people with disabilities, and certain illnesses, who are particularly reliant on these hospitals for services.
Reasoning
- Rural populations rely heavily on community hospitals for healthcare services due to limited alternative options.
- Medicare beneficiaries will be directly impacted due to the policy enhancing Medicare payments to these hospitals.
- Individuals in urban and suburban areas may not be impacted as they have access to larger hospital networks.
- The policy aims to maintain the viability of rural hospitals, potentially improving healthcare access and quality for rural residents.
- It is important to simulate various perspectives, including those who might not be directly impacted, to see the policy’s wider effects.
Simulated Interviews
Retired (Rural New Mexico)
Age: 70 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 15/20
Statement of Opinion:
- I depend on my local hospital for healthcare needs and any policy that supports it is vital.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 4 |
| Year 10 | 8 | 3 |
| Year 20 | 9 | 2 |
School Teacher (Rural Mississippi)
Age: 45 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 15.0 years
Commonness: 10/20
Statement of Opinion:
- The hospital is crucial for my ongoing condition treatments, so supporting it ensures better health care access.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 4 |
| Year 10 | 9 | 4 |
| Year 20 | 9 | 4 |
Farmer (Rural Montana)
Age: 30 | Gender: female
Wellbeing Before Policy: 8
Duration of Impact: 5.0 years
Commonness: 5/20
Statement of Opinion:
- I don't go to the hospital often, but it's good to know it's there when needed.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 7 |
| Year 10 | 8 | 7 |
| Year 20 | 7 | 6 |
Retired Farmer (Rural Kansas)
Age: 65 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 20.0 years
Commonness: 14/20
Statement of Opinion:
- It's harder to access other hospitals if ours closes, so this policy is beneficial.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 5 |
| Year 3 | 8 | 4 |
| Year 5 | 9 | 3 |
| Year 10 | 9 | 2 |
| Year 20 | 9 | 1 |
Software Engineer (Urban California)
Age: 40 | Gender: female
Wellbeing Before Policy: 9
Duration of Impact: 0.0 years
Commonness: 8/20
Statement of Opinion:
- This policy doesn't directly affect me, but I see its importance for rural areas.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 9 | 9 |
| Year 2 | 9 | 9 |
| Year 3 | 9 | 9 |
| Year 5 | 9 | 9 |
| Year 10 | 9 | 9 |
| Year 20 | 9 | 9 |
Coal Miner (Rural West Virginia)
Age: 55 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 12/20
Statement of Opinion:
- The hospital is key to my survival, so this support is appreciated.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 4 |
| Year 5 | 8 | 3 |
| Year 10 | 8 | 3 |
| Year 20 | 8 | 2 |
Student (Suburban Illinois)
Age: 22 | Gender: other
Wellbeing Before Policy: 7
Duration of Impact: 0.0 years
Commonness: 20/20
Statement of Opinion:
- I can't see much change for people in my situation.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 7 | 7 |
Retired Nurse (Rural Arkansas)
Age: 80 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 15.0 years
Commonness: 9/20
Statement of Opinion:
- Keeping my local hospital open is crucial at my age.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 6 | 3 |
| Year 3 | 7 | 2 |
| Year 5 | 8 | 2 |
| Year 10 | 8 | 1 |
| Year 20 | 8 | 1 |
Grocery Store Owner (Rural Georgia)
Age: 50 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 10.0 years
Commonness: 7/20
Statement of Opinion:
- I can manage without changes, but support is always good.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 8 | 5 |
Stay-at-home parent (Rural Maine)
Age: 32 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 15.0 years
Commonness: 11/20
Statement of Opinion:
- The hospital is essential for my children's healthcare needs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 5 |
| Year 5 | 8 | 4 |
| Year 10 | 8 | 3 |
| Year 20 | 8 | 3 |
Cost Estimates
Year 1: $500000000 (Low: $450000000, High: $600000000)
Year 2: $525000000 (Low: $472500000, High: $630000000)
Year 3: $551250000 (Low: $496125000, High: $661500000)
Year 5: $605062500 (Low: $544737500, High: $726812500)
Year 10: $735470000 (Low: $661923000, High: $883164000)
Year 100: $7430512500 (Low: $6687461250, High: $8916615000)
Key Considerations
- The policy would support hospitals critical to providing access to care in rural regions, preventing potential closures of isolated facilities.
- Although current payment adjustments are made permanent, there may be longer-term impacts on Medicare's budget and potential pressure for further policy adjustments.
- Policymakers should consider the balance between extending support to rural hospitals and the sustainable management of Medicare's fiscal obligations.