The chickens are coming home to roost

To the Editor:

By now, everyone in Macon County and the surrounding counties knows that Angel Medical Center in Franklin is closing the Labor and Delivery Unit (LDU) in July. While most of the focus, justifiably, is on the impact on our local families, it is also important to understand how and why this happened.

Regardless of your feelings about the insurance and health care industries, they are businesses that must make money, or at least break even to stay in business. While the Mission Health press releases are confusing at best, this was ultimately a business decision. That is our current health care reality.

The critical path for the closing of the LDU at Angel began in 2014 when the North Carolina legislature rejected the Medicaid Expansion that was a part of the Affordable Care Act (ACA).  Several Republican-controlled states chose the same path after the Supreme Court ruled that Medicaid expansion under the ACA was optional. Largely as a result of those state-level decisions, medical care in rural areas like ours, has suffered.

From then until now, at least 80 rural hospitals have completely closed their doors. Most of those are in states that did not opt for Medicaid expansion under the ACA. Three are in North Carolina. Many more undoubtedly reduced services.

Rural areas like Macon County have high poverty rates. However, incomes for much of the population are high enough so that individuals are not eligible for traditional Medicaid, but not eligible for subsidies under the ACA.  Consequently, they have no medical insurance.

Federal law requires hospitals to treat anyone who shows up at the emergency department.  Prior to the ACA, the federal government reimbursed hospitals for the costs incurred by the uninsured that were treated in emergency departments.  The ACA removed that reimbursement provision and Angel suffered large losses in its emergency services when the ACA came into effect — and undoubtedly still does. No one envisioned that states would not accept billions in federal dollars to improve health care for its citizens.

Had North Carolina chosen to expand Medicaid in 2014, it would have resulted in a $2.7 billion infusion of funding into the state as we were recovering from the recession. In 2015 it would have been over $3 billion.  Current estimates are about $3 billion a year. These were federal tax dollars that you have already paid that go to other states. This would have generated thousands of high-paying health care jobs in rural areas. 

These federal funds would also have generated almost $100 million in state income tax revenue in addition to the local sales and property tax revenue. That was new revenue at no cost to the state. Even with the increased state contribution from 2017 through 2020, the income and sales tax revenue on the federal 90 percent contribution would cover most of the state cost.

You can thank our current Sen. Jim Davis, R-Franklin, and his Republican colleagues for their role in the closure of the LDU at Angel Medical Center. They opposed the Medicaid expansion.  Give them a call.

John Gladden


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