Some hospitals close in nearby states that (like SC) refused to expand Medicaid

This is according to Bloomberg:

Pam Renshaw had just crashed her four-wheeler into a bonfire in rural Folkston, Georgia, and her skin was getting seared in the flames. Her boyfriend, Billy Chavis, pulled her away and struggled to dial 911 before driving her to the nearest place he could think of for medical attention: an ambulance station more than 20 miles away.

The local public hospital, 9 miles from the crash, had closed six weeks earlier because of budget shortfalls resulting from Obamacare and Georgia’s decision not to expand Medicaid. The ambulances Chavis sought were taking other patients to the next closest hospital. It took two hours before Renshaw, in pain from second- and third-degree burns on almost half her body, was flown to a hospital in Florida.

At least five public hospitals closed this year and many more are scaling back services, mostly in states where Medicaid wasn’t expanded. Patients in areas with shuttered hospitals must travel as far as 40 miles (64 kilometers) to get care, causing delays that can result in lethal consequences, said Bruce Siegel, chief executive officer of America’s Essential Hospitals, a Washington-based advocacy group for facilities that treat large numbers of uninsured or low-income patients. …

OK, now, before someone makes smart remarks about how the poor woman got burned… I thought that sounded very much like something that could have happened right here in SC…

The hospitals that closed were disturbingly close to home — in Virginia, North Carolina and Georgia.

And overall, “Hospitals have dismissed at least 5,000 employees across the country since June…”

54 thoughts on “Some hospitals close in nearby states that (like SC) refused to expand Medicaid

  1. Mark Stewart

    Keep closing them, too. Of course, that doesn’t mean that alternate forms of care aren’t need as a substitute in their place.

    We need to consolidate acute care facilities to the point that they are 80% busy treating the most serious cases. A patient like this woman is going to be life-flighted anyway to a burn center; far better to just do that from the beginning.

  2. Bryan Caskey

    Don’t they take people in Columbia SC to Augusta, GA for burns? I don’t think there are all that many burn centers. I looked at Google Maps, and Folkston, GA is really close to Florida. It’s way in southern GA. My guess is they took her to Jacksonville, FL, which is only 43 miles away.

  3. Brad Warthen Post author

    Personally, I think it was a mistake to illustrate the story with that anecdotal lede. The point is some hospitals are closing, others have cut back on staff and service….

    As I indicated above, this illustration is distracting, particularly since a reader’s first thought is likely to be, “She did WHAT? How did THAT happen?”

    Had I been the editor on this, I would have told the writer, “If you MUST use an anecdotal lede (and frankly, I could do without one here), find another, more representative example…”

  4. Bill

    Simple reading comprehension skills will tell you,ACA is not the problem.Republican governors in poor states,along with greedy insurance companies,are doing everything possible to sabotage,’Obamacare’.

    The plan to shut down the government went into effect as soon as Obama was reelected.

    A recent email from my congressman,assured me Republicans have a superior alternative for health care reform.So they suddenly realize reform is needed,but it has to be done their way…What a joke.

    1. Juan Caruso

      “Simple reading comprehension skills will tell you,ACA is not the problem.Republican governors in poor states,along with greedy insurance companies,are doing everything possible to sabotage,’Obamacare’.” -Bill

      Really? Are you another medical malpractice lawyer mysteriously not reigned-in by ACA tort reform?

      No socialist medicine country in the world besides the U.S. allows lawyer parasitism to feed off healthcare to half the extent of the U.S.

      How can you reconcile such an obvious, built-in flaw? No answer is required, because you don’t have a logical one that even holds water. Bud will say, lawyers make it safer for patients. I say, most patients would gladly forgo the right to litigate for the right to choose their physicians and hospitals.

      If those like Bud who place so much value in malpractice litigation wish to retain the right to sue by incredible high U.S. standards (lack of limitations) then I would happily agree to allow you and those of your mind to pay the applicable premium. – Not the rest of us!

  5. William

    One of the reasons hospitals and doctors are refusing to expand their Medicaid practices is because Medicaid is a losing battle. Several specialists have told me they’re lucky to break even on Medicaid paid procedures, and many times they end up losing money. Which is why many doctors are not accepting new Medicaid patients.

    On that note, here’s an e-mail message sent out by USC HR today, I’m sure the formatting will get messed up, but the important things are the 2nd and 4th columns, these are the increase in premiums deducted from each paycheck. For example a faculty member using this plan will see his monthly premiums increase by nearly $5000 per year, likely with higher deductdibles as well:

    To: All University of South Carolina Employees
    From: University Payroll Department
    Subject: 2014 Payroll Deduction Rate Changes
    Date: November 22, 2013

    Due to changes in some state health plans, beginning with the December 15, 2013 pay date, the employee rates for a number of payroll deductions will increase. The Benefits Office distributed information about these changes during the annual open enrollment in October. The table below provides the new deduction amount as well as the increase each pay period. Any deductions not included in the table below continue at the previously billed rate with no changes.
    Deduction 12 month
    semi-monthly deduction amount 12 month
    semi-monthly increase amount 9 month
    semi-monthly deduction amount 9 month
    semi-monthly increase amount
    BlueChoice Health HMO -Enrollee Only $ 172.71 $ 47.80 $230.28 $ 63.73
    BlueChoice Health HMO -Enrollee Spouse $ 460.92 $ 111.03 $ 614.56 $ 148.04
    BlueChoice Health HMO -Enrollee Child $ 301.10 $ 77.44 $ 401.47 $ 103.25
    BlueChoice Health HMO –
    Full Family $ 645.30 $ 149.58 $ 860.40 $ 199.44

    1. Kathryn Fenner

      Health care costs rise constantly. Obamacare has nothing to do with the state plan, which was not affected at all by it!

          1. William

            I did, so then why did USC’s HR department send out the e-mail stating that premiums are going up for HMO participants by as much as 25%? How is that not affecting the state insurance plans? Maybe you’re stating that those increases aren’t caused by Obamacare, but merely coincidental.

  6. bud

    The 64 billion dollar question is just how much the ACA contributed to the increased costs. Probably some. But insurance costs have been going up faster than the rate of inflation for decades. It hard to know what would have happened absent the ACA. My frustration with conservatives/libertarians is just exactly what they would do given the huge mess we had pre-ACA. Medical savings accounts and a buying across state lines provision just won’t cut it.

    1. Juan Caruso

      “The 64 billion dollar question is just how much the ACA contributed to the increased costs. Probably some. But insurance costs have been going up faster than the rate of inflation for decades.” -Bud

      Bud, too bad you don’t think before reflexively spouting the political propaganda. – It diminishes the quality of your comments.

      Since ACA promised (a central premise) to reduce health care cost by $_2,500, the President has left you with no valid argument, regardless of historical increases (higher than inflation rate) in healthcare premiums!

      The real 64 billion dollar question is how educated people like yourself and KF can be so jaded that you can deny the reality.

  7. bud

    What political propaganda? I’m just asking a simple, and important question. What portion of the increases in health insurance costs are the result of the ACA? Just for the record. I don’t like the damn ACA. It’s a Heritage Foundation plan developed by conservatives in the 90s and adopted by Mitt Romney for MA. What I support is the elimination of the age requirement for Medicare. The reality that conservatives fail utterly to acknowledge, and shamefully so, is that 40 million people were without any kind of health insurance pre-ACA. Medical cost in the USA were BY FAR the most of ANY country in the world and life expectancies were falling behind other developed countries. And conservatives don’t seem to give a damn about any of that.

    1. Kathryn Fenner

      And the ACA is not fully implemented by a long shot….

      National Health Service works great for me! Let’s do it !

      1. William

        What about those of us who it doesn’t work for? I know people who are considering taking the penalty over the increased premiums because they skyrocketed and they weren’t eligible for any kickbacks.

          1. William


            Okay I’ll try again. What about those of us who pay for 100% of our own health insurance who’s premiums are going up almost exponentially and are above the income level where we’d qualify for kickbacks like those who’s premiums are going up but getting money back from the system to lower their premiums. If they can get discounts, why can’t I?

      2. Bart

        And this will be the end result of the rule of unintended consequences. Once it is recognized by everyone in Washington and across the low information voter bloc that ACA in its present form will not work as intended, the only fix left will be to pass and enforce a National Health Service and the general public will be at the mercy of the government to dispense health care to all except the ones who can afford to go to a private doctor or go out of the country. Concierge doctors will become fashionable and then it will truly be an even greater divide between the haves and have nots involving access to health care. The doctors portrayed on British programs, i.e., Doc Martin, are not as keen as their characters are and are not able to diagnose a patient by simply looking at them for a brief moment.

        And as usual in any society whether it is capitalist, socialist, communist, dictatorship, monarchy, or representative, the “higher ups” will always be moved to the front of the line and everyone else must wait their turn even if it takes 12 hours in an emergency waiting room.

        As soon as private enterprise is out of the picture, the health care science and research advances will no longer be profitable and without massive government funding, it will slow significantly. For the moment, big pharma is still involved in research and developing new drugs. Hospitals will have fewer staff members and the small clinics will become the norm. Another unintended consequence will be the quality of doctors available to treat patients.

        There is no such thing as a perfect system but at some point, there will be a “one size fits all” health care system in America, it is inevitable. And, as usual, the public will become accoustomed to it and over a few decades except for the hardcore opponents, it too will become a natural part of the American landscape.

        1. Bryan Caskey

          The White House announced a one year delay of online enrollment for small businesses looking to purchase health coverage through federal Obamacare exchanges, another high-profile setback for I guess they just can’t get it to work.

          Does anyone understand what is going on anymore? I can’t keep up with what is happening when and what is delayed.

          This thing was never going to work. But hey, if you like your chaos and destruction, you can keep your chaos and destruction.

  8. Bart

    Seems as if selective memory is at work here for some. It is important to remember that Obama called in the insurance and big pharma industry to solicit their help in passing ACA. Now that it is law, both are reaping unbeliveable rewards, increased premiums, and lower risks because by law, the premiums will be spread evenly across all age and health spectrums. The new plans that require uniform coverage for all who purchase insurance is nothing but a win-win for insurance companies. How many people in the age group from 45 and up are going to need maternity benefits but they must pay for them. This is just one example. The cost of drugs has gone up drastically since the passage of ACA and the coverage under each plan varies and deductible is increasing, not decreasing. Even generics are going up in price and many drugs that were once at the lower level cost and moved up into higher priced tiers.

    If a family cannot afford insurance, they will be subsidized and in the end, the shortfall will be made up by the taxpayers, not the beneficiaries of ACA. And you can bet that it is highly likely that the tax code will be changed to help the pharma industry for taking losses if there are any.

    Medicare for all bud says. Well bud, the monthly premiums for Medicare are increasing across the board each year. And like Medicaid, doctors are hesitant to take new Medicare patients and some are refusing to accept Medicare. My doctor no longer accepts Medicaid and has restricted new Medicare patients to a few a year. He has shared that eventually he won’t take either except for the ones on Medicare who are already patients.

    And for the record bud, all along you have been singing the praises of ACA to the heavens and now you don’t like the damn thing? Make up your mind.

  9. Doug Ross

    If you increase the demand for a service without increasing the supply, prices will rise. Adding X million additional insured without increasing the supply of providers will do that. Setting price controls will force providers to make economic decisions in their best interest. If the set price is below what they feel their service is worth, they will not offer that service.

    It’s basic ECON 101. There are unintended consequences whenever you try to mess with the free market. This is what you get when you pass a bill without thinking through those consequences. Democrats own this 100%.

  10. Lynn

    Health care IS NOT a functioning competitive market, never was and never will be. Health care is an example of what economist call market failure. Markets fail where the price mechanism is structurally unable to transmit the necessary information for supply and demand to function. As long as consumers, patients have less information than providers, physicians and hospitals and no one see a price tag a competitive market can’t work to balance quantity demanded with quantity supplied at an agreed price.

    The ACA is a reform of health insurance. Private and public health insurance is how the US finances health care service delivery. Health service delivery is not health. The ACA doesn’t reform how health services are produced or supplied. Physicians and hospitals are still paid to care for sick patients on a fee for service basis. They are paid based on the procedures they provide or preform. Do more services receive more revenue. You can provide more to the same people or fewer services to more people but health care expenditures increase because hospitals and doctors provide more services!

    The ACA is not causing hospitals to close. Hospitals close because as a business even a nonprofit business, when expenses continually exceed revenues something has to give, and the hospital (dry cleaner, grocery store etc.) closes. We’ve closed hospitals in South Carolina mostly in small rural counties. Bamberg County Hospital closed two years ago. Lee County used to have a small hospital in Bishopville but it closed 15 years ago. About 5 years ago a small hospital in Spartanburg County closed. We’ve closed hospitals owned and operated by the State of South Carolina. Think mental health and TB hospitals. We’ve closed hospitals owned and operated by the DOD in Beaufort, Charleston, Myrtle Beach and Sumter.
    With or without expanding Medicaid in South Carolina another four or five small hospitals may close in the next few years. With or without expanding Medicaid, another four or five hospitals will open in the next few years in South Carolina, one here in Columbia this spring in fact.

    Hospitals need a service area population of between 30,000 to 50,000 people to survive. If there aren’t enough people, hopefully people with insurance, hospitals can’t survive. Hospitals can survive if there are enough patients to support physicians and surgeons. When communities can’t support physicians they can’t support a hospital. Areas without sufficient population can’t support grocery or drug stores, restaurants, or movie theaters either. Some barely support churches. That is a simple fact of life, it is not Obamacare’s fault and my guess is Obamacare isn’t likely to fix it.

    1. William

      Nor is 30,000-50,000 people all on Medicaid.

      A procedure that a physician bills $500 for, under health insurance like BC&BS they may agree to pay $420, Medicaid will pay $260, if it cost the physicians $300 to break even on the procedure, Medicaid patients will put them out of business. Many physicians are refusing to take new Medicaid patients, so the only place they can be seen is the ER and if it’s not a life or death situation, they have the right to let you sit in the waiting room until your slot in the triage system comes up.

      1. Doug Ross

        This is what those in favor of single payer ignore – how are you going to convince the best doctors to accept less money? Will they be prevented from practicing unless they accept government payments?

        1. Kathryn Fenner

          No, but if the government is the health insurer, they will have a limited source of payments otherwise. At least that’s how it works in England.

          1. William

            The government is the health insurer in Medicaid as well, they tell doctors that make an offer of payment and the doctor can take it or leave it and get nothing.

            How many lawyers would be willing to take on a similar system? A government provided legal system which pays lawyers less than half their billable rate? I’m talking about public defenders, I’m talking about litigators, prosecution attorneys, or tax attorneys for example. Would they settle for a government determined pay scale?

          2. William

            So if the President said everyone must retain a lawyer or face a penalty, would lawyers be lined up to take on clients who will pay them less than their free-market clients are willing to pay? What about accountants, what if they said everyone must work with an accountant or auditor?

            I know several very successful lawyers, not ever have I heard one say they wished they worked for the government. I suspect that’s because they’d take a serious pay cut if they did.

    2. Juan Caruso

      “Health care IS NOT a functioning competitive market, never was and never will be.”

      For several reasons ($$$), none fair to the public at large, meaningful regulation of insurance companies has catered more to the lucrative wishes of insurance lobbyists than to obvious public needs.

      Please note that in the majority of states (SC included, for decades) insurance commissioners (the top regulators) have been attorneys. Got it?

      As clarified earlier, competition across state lines had been an obvious remedy to escalating healthcare premiums LONG BEFORE passage of Obamacare. Yet, only six states (including Georgia) ever made a gesture to approve such common sense competition. Even today, not one of those 6 states has allowed sale of a single healthcare insurance policy across its state line.

      I think intelligent voters can guess why ($$$) that is. Want to blame this on “greedy corporations” as Bud offten does? Don’t fall into that convenient trap. Every SC insurer has attorneys on its board of directors (and frequently as CEO). Moreover, the current Insurance commissioner for SC is a former deputy insurance commissioner from Georgia (and, as you may have guessed an attorney).

      Please, let’s stop the constant nonsense about greedy corporations. Members of the bar are often opportunists of no less greed, and they have no shareholders to hold them accountable for their misdeeds. A primary cost component in healthcare premiums is due not to corporate greed, but to fear of malpractice litigation and emotionally incompetent juries.

      Unlike socialists and communist countries outside the U.S., malpractice awards are not limited. John Edwards has formed a new law firm to go back into the millionaire businees world.

      I ask, and the public certainly should ask American lawyers why they must be the exception to rational malpractice awards? Obamacare DID NOT even approach the obvious driver of cost escalations.

      The latest data indicated 53% of House Democrats are attorneys; 40% of House Republicans are attorneys, and 60% of U.S. Senators are attorneys. Yet, many of those who deny being members of the “low information voter bloc ” have never acquainted themselves with these salient facts, nor have they ever asked the appropriate question: Why so many lawyers in Congress, all of the Judiciary and the Executive branch?

      One does not have to be suspicious, one needs only be inquisitive and skeptical.

    3. bud

      Well said Lynn. What no one and I mean no one on the anti ACA bandwagon ever acknowledges is just how utterly flawed the old system was. It takes a lot of egg breaking to fix the hopelessly outdated system we had. Sure it’s painful. But for reasons owing to the disease, not the cure.

      1. Juan Caruso

        “What no one and I mean no one on the anti ACA bandwagon ever acknowledges is just how utterly flawed the old system was.” – Bud

        Wrong, Bud, obviously you had not bothered to read what I stated in the first response to Lynn.

        (second sentence of response preceeding yours)….
        “For several reasons ($$$), none fair to the public at large, meaningful regulation of insurance companies has catered more to the lucrative wishes of insurance lobbyists than to obvious public needs.” (second sentence of response preceeding yours).

        As readers can see, although I remain anti-Obamacare, I acknowledge the obvious flaws with the way healthcare insurance had been regulated.

        Go have some turkey and enjoy your Thanksgiving.

    1. Juan Caruso

      A couple of problems with that “good news”, BB.

      The Council of Economic Advisers (CEA) is not independent like the GAO. Rather, the CEA is an agency within the Executive Office of the President. The current Chairman of the CEA is Jason Furman, who wrote the underlying ‘good news’ article on Nov 13th was appointed by President Obama on June 10, 2013. Gee, we low information voters don’t see any conflict there, do you?

      But, even worse for Obamcare managers, the good news is not based on financial historical fact, it is based on projections — just like global warming. Hmm! I see no reason to be skeptical, do you?

      1. bud

        And Fox News is a reliable source of information? Actually the reason the projections are low is because actual costs over the last few years are lower than before.

        1. Juan Caruso

          Fox News? How does that organization even enter into this discussion, Bud?

          It has been sourced by no one in this thread.

          1. Bart

            I’m acually surprised he didn’t include Bush the way Obama does – for everything. Apparently Fox News is so powerful that it is capable of stopping Obama, Democrats, liberals, and the Senate from doing anything.

    2. Mab

      The only saving grace for FoxNews, Bart,, is Charles Krauthammer. However, balance that with Newt’s presence on CNN and it’s a wash — a free for all. Get your news from people you trust. WHERE ARE THEY?

        1. William

          Well there’s always telemedicine with a doctor in Mumbai who’s reciting from a prepared script of questions and responses.


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