A Tangible Solution to a Growing Problem

By: Kayla Roberson

How Texas’s growing issue with healthcare access could be solved with bipartisan supported Medicare Expansion.

Closed Rural Healthcare Center in Texas. Photo by CHRISTOPHER COLLINS

Access to quality health care has long been a priority for members of the Texas legislature and for residents of the state, when polled. The state has one of the highest rates of rural hospital closures and maternal mortality rates in the nation, and there has been little progress done to help improve access to healthcare in the state, despite many proposed bills from both Republican and Democrat members. Thought to be a controversial issue, Medicare expansion is a tangible solution to address the staggering rates of rural hospital closures and high rates of maternal mortality in Texas. Medicare expansion has been a controversial topic that has plagued the legislature for many sessions, as the topic has been brought to the legislature to many times, yet it seems as if there is no clear path forward for the issue. Similarly priority issues such as the state’s high maternal mortality rate and rural hospital closures have slowly been able to gain traction in the legislature. Many legislators on both sides of the aisle have highlighted health care as a priority over the past few legislative sessions, yet the legislature has been unable to pass medicare expansion, to help rural hospitals keep their doors open. Medicare expansion could be a tangible step toward securing access to healthcare in rural counties and the state’s maternal mortality rate.

Texas has one of the highest rates of Severe Maternal Mortality and Morbidity in the country, with a rate of 182.3 cases per 10,000 live births according to the Department of Human Health Services Maternal Mortality and Morbidity Review Committee, DSH MMMRC (DSH). Many lawmakers have voiced their concern for the state’s high rate of maternal death, which disportionately impacts rural and Black communities. According to the DHS MMMRC, women and pregnant individuals in rural communities face higher rates of maternal morbidity, due to lack of access to maternal care. Access to health care has become a growing issue for people in rural Texas counties, due to a growing number of rural hospital closures, and according to data found by the Texas Organization of Rural & Community Hospitals, TORCH, 15 hospitals in rural counties have been closed, since the 84th Texas legislative session in 2015. These closures have often contributed to financial issues stemmed from keeping hospitals open due to lack of substantial Medicare reimbursement (Luke).

Texas is one of twelve states that has not passed a substantial medicare expansion policy, and it seems as if there is growing pressure for Texas to join the rest of the country. Lawmakers from urban Texas cities have been using various strategies to gain support for expansion from conservative colleagues who represent rural districts. Representative Celia Israel of Austin, has tried to appeal to colleagues by noting how the lack of medicare expansion is affecting rural communities, by noting how lack of Medicare expansion is impacting access to healthcare in rural communities.

“We have lost so many rural hospitals in Texas, and one of the reasons we wouldn’t have lost those rural hospitals is if we had said yes to expanding Medicaid ”-Rep. Celia Israel (D-Austin)

An analysis of data compiled from TORCH and the DHS MMMRC of maternal mortality rates in rural counties where a hospital has been closed, has shown some correlation between the issues.

Graphic by Kayla Roberson. Data Source: TORCH and DSH MMMRC
Graphic by Kayla Roberson. Data Source: TORCH and DSH MMMRC
Graphic by Kayla Roberson. Data Source: TORCH and DSH MMMRC

Of the 12 counties where a rural hospital has been closed, nine have had a maternal mortality and morbidity rate that has surpassed the state average of 184.1 cases per 10,000 live births. In rural counties such as Jones, Colorado and Harderman, maternal mortality rates have steadily increased over time since 2015. Both Jones and Colorado county have lost two rural hospitals, since 2015, which correlates to growing rates of severe maternal mortality in the counties. Additionally, research collected by TORCH found that both Jones and Harderman counties’ rural hospitals are not financially equipped to handle Obstetrics, which provides maternal care during and throughout a pregnancy. A majority of women in rural counties rely upon Medicare to access necessary healthcare, and many rural hospitals are unable to receive the necessary Medicare reimbursement needed to stay afloat to continue to serve rural communities.

The Medicare expansion laws that have been filed and introduced into the legislature have focused on expanding Medicare eligibility, in addition to proving additional funds to aid hospitals with Medicare reimbursement. It is vital that these two components are applied, as rural hospitals will likely see an increase in patients using Medicare, should Medicare expansion pass, and the need for increased Medicare reimbursement will be vital to keep these hospitals financially stable .

The DHS MMMRC, has recommended improving healthcare access for rural communities, and various organizations have acknowledged and prioritized passing Medicare expansion, in order to not only help rural communities, but all Texans. The current state of Medicare in Texas, is contributing to the high rates of maternal mortality in rural communities, and expanding Medicare would help solve the issue and provide better medical outcomes for rural Texans. It might be past time for the legislature to work together in order to support both rural and urban communities, and gain bipartisan support for Medicare Expansion

Works Cited

Evans, Marissa. “Voters in Four States Have Approved Medicaid Expansion by Ballot. Will Texas Do the Same?” The Texas Tribune, The Texas Tribune, 12 Feb. 2019, www.texastribune.org/2019/02/12/texas-legislators-filed-bills-put-medicaid-expansion-decision-ballot/.

Luke, Charles. “Will Failing to Expand Medicaid Close Rural Hospitals?” Reform Austin, 26 Jan. 2021, www.reformaustin.org/healthcare/will-failing-to-expand-medicaid-close-rural-hospitals/.

Marks, Elena. “Opinion: Texas Can’t Afford to Pass on Medicaid Expansion.” Houston Chronicle, Houston Chronicle, 29 Mar. 2021, www.houstonchronicle.com/opinion/outlook/article/Opinion-Texas-can-t-afford-to-pass-on-Medicaid-16061434.php.

Salahuddin M, Patel DA, O’Neil M, Mandell DJ, Nehme E, Karimifar M, Elerian N, Byrd-Williams C, Oppenheimer D, Lakey DL. (2018) Severe Maternal Morbidity in Communities Across Texas. Austin, TX: University of Texas Health Science Center at Tyler/University of Texas System.

Searing, Adam, et al. “Expanding Medicaid Would Help Keep Rural Hospitals Open in 14 Non-Expansion States.” Center For Children and Families, 20 May 2020, ccf.georgetown.edu/2020/05/12/expanding-medicaid-would-help-keep-rural-hospitals-open-in-14-non-expansion-states/.

Texas Department of State Health Services. “Table 28 Infant, Neonatal, Fetal, Perinatal, and Maternal Deaths by Public Health Region, County and City of Residence .” Texas Department of State Health Services, May 2017, www.dshs.state.tx.us/chs/vstat/vs11/t28.shtm.

Texas Maternal Mortality and Morbidity Review Committee and Department of State Health Services. (2020). Texas Maternal Mortality and Morbidity Review Committee and Department of State Health Services Joint Biennial Report. Texas Department of State Health Services. https://dshs.texas.gov/legislative/2020-Reports/DSHS-MMMRC-2020.pdf

TORCH. Texas Rural Hospital Obstetrical Access. Texas Organization of Rural & Community Hospitals, 2018.https://www.torchnet.org/advocacy--rural-hospital-information.html

TORCH. Texas Rural Acute Care Hospital Closures. Texas Organization of Rural & Community Hospitals, 2019 .https://files.constantcontact.com/1355b334201/296968d0-ae9d-4259-9729-12256b5f3414.pdf