State governments: if you haven’t expanded Medicaid, do it now. Under the Affordable Care Act, most of the cost of that expansion will be borne by the federal government. If you don’t expand, then don’t be surprised if your constituents blame you when their local hospitals close. Without Medicaid to cover people’s expenses, hospitals lose money caring for uninsured patients who can’t pay their bills.
The federal government: Congress needs to provide financial help to hospitals that serve large uninsured populations. That’s not an unrealistic expectation. The federal government used to provide such assistance, called DSH (or “dish” payments), but those payments were phased out with the passage of the Affordable Care Act, under the (now false) assumption that every state would expand Medicaid and, thus, there wouldn’t be many uninsured patients.
Unconvinced that I’ve described the problem accurately? Here is a picture showing the rate of hospital closures in states, before and after the Affordable Care Act. It shows that such closures rose significantly more in states that didn’t expand Medicaid:
If your local hospital closes or has already closed, don’t blame your local insurance company for being too stingy, your local employers for failing to offer enough insurance, or even Obama for crafting a flawed healthcare bill. Instead, consider blaming your local government, for not expanding Medicaid, or your local U.S. congressperson, for not voting to expand payments to hospitals inundated with uninsured patients.