Tennessee's reluctance to expand Medicaid under the Affordable Care Act is still being blamed for the high number of hospital closures in the state — the most in the U.S. outside of Texas. And this week brings one more. The Decatur County Commission decided to close its only hospital this week, citing the increased taxpayer subsidies.
Decatur General Hospital has struggled to keep its doors open for years, inking a management deal with Springfield-based NorthCrest Medical Center in 2016. The remote facility claimed harm from some of Obamacare's new admission standards that drove down insurance reimbursement. Meanwhile, the hospital did not get the intended benefit of more people with insurance.
The rural county of 11,000 on the banks of the Tennessee River is represented in the state legislature by Republican Steve McDaniel, who says more folks on TennCare would have helped.
"I can tell you this, that if we had expanded the Medicaid program as Governor Haslam had proposed, this hospital likely would not have closed," McDaniel said.
McDaniel says now he would have voted in favor of Insure Tennessee if he'd been given the chance. The legislation to extend TennCare coverage to the working poor didn't survive its first committee vote during a special session in February 2015.
Rural hospitals in Tennessee can represent as much as 20 percent of the community's employment and income. And they're seen as necessary in order to attract big manufacturing plants or other industrial businesses.
"When you don't have a medical facility with a hospital and ER, it puts you at a huge disadvantage when it comes to recruiting jobs," McDaniel said.
Decatur County General has not specified a plan for winding down, but it will have to give the state 60 days' notice before closing for good. The facility was already on the endangered list of the Tennessee Hospital Association, which also lobbied hard for Medicaid expansion.
"Decatur is one more beat on the drum," THA president Craig Becker said.
He hopes to find some kind of option for isolated places like Decatur County, such as a free-standing emergency department. For the rest of Tennessee's at-risk hospitals, Becker is starting to be more insistent about making painful cuts, before they also have to shut their doors.
"It's a real hard sell to these hospitals to tell them maybe they don't need a full-service facility," he said. "We'll just keep on trying to save all the ones that we can."