A look at a rural clinic in Kentucky shows how it could get harder for states to provide health care for people on Medicaid — and how other clinics could be affected — if Congress imposes cuts.
JUANA SUMMERS, HOST:
In the hills of eastern Kentucky, what used to be a big-box store was converted years ago into a bustling health clinic. Now with President Trump’s tax and spending plan making its way through Congress today – which could cut billions of dollars from Medicaid – the future of this clinic and others is in doubt. Kentucky Public Radio’s Sylvia Goodman recently visited health care workers in Appalachia.
SYLVIA GOODMAN, BYLINE: Cars steadily trickled in and out of a packed parking lot recently on the side of a mountain in the small city of Hazard, where Primary Care Centers of Eastern Kentucky operates its main facility. Leslie Deaton, a nurse practitioner with the center for 13 years, says she grew up just down the road, as she showed me through the maze-like facility.
LESLIE DEATON: It did.
UNIDENTIFIED PERSON: Yeah.
DEATON: It used to be the Kmart. And so when I was younger, we walked up here.
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DEATON: So to see this turned into my home clinic – pretty amazing.
GOODMAN: Hospitals and clinics are some of the biggest employers here, especially after the state expanded Medicaid in 2014. State data show half of the people here are covered under Medicaid.
DEATON: Since the coal is gone, you know, mainly it’s health care here.
GOODMAN: The Republican plan would cut hundreds of billions nationally from the program over the next 10 years, according to the Congressional Budget Office. And nearly 300,000 people could lose Medicaid coverage in Kentucky, according to an analysis by the research group KFF during the congressional debates.
TAWNYA BROCK: It feels, to me, like we’re stepping back in time.
GOODMAN: That’s Tawnya Brock. She worked as a nurse in the region for decades and serves on the boards of the Kentucky Rural Health Association and the National Association of Rural Health Clinics. Medicaid reimbursements keep many rural clinics in business.
BROCK: So my fear is you will see hospitals close, you will see clinics close, and we’ll lose those service lines that we have for these patients. And so it’s not good. I have a great concern.
GOODMAN: The people who support the Medicaid cuts say they’ll eliminate, quote, “waste, fraud and abuse.” Kentucky Congressman Brett Guthrie told Fox Business most of those losing Medicaid coverage are able-bodied people.
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BRETT GUTHRIE: These are people absolutely choosing not to work.
GOODMAN: Opponents to the cuts say that new work requirements would end up kicking out many who have reasons for not working and those who don’t report correctly. And another part of the plan has providers worried. The Kentucky Hospital Association says new restrictions on how much hospitals can get reimbursed will decimate the region. The group says the bill could endanger 20,000 jobs as hospitals already operating on slim margins close or cut services. Here’s Jim Musser with the Hospital Association.
JIM MUSSER: If cancer treatment goes away in your local hospital because the Medicaid dollars are gone, that affects everybody, not just Medicaid patients. And I don’t think they’ve quite thought about the economic impact.
GOODMAN: Back in Hazard, Greg Burke runs Beacons of Hope, a substance abuse rehab center. Appalachia has seen the worst of the opioid epidemic, and Burke says his program is almost entirely funded by Medicaid.
GREG BURKE: It’s the only reason. That’s how we function. That’s how we operate.
GOODMAN: Burke says the people he helps fight addiction are the region’s future workforce.
BURKE: Listen, I’m going to tell you right now, you take Medicaid away from this area, and it’s nothing but dust. You’re going to be left with basically abandoned little towns and probably some very, very sick people.
GOODMAN: He says cuts to Medicaid threatened to set back years of work to combat poor health outcomes.
For NPR News, I’m Sylvia Goodman in Hazard, Kentucky.
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