South Texas healthcare on life support
The promise of Medicare Advantage is unraveling in rural South Texas, leaving critical hospitals in peril.
Texas leads the nation in rural hospital closures. Let that sink in. Since 2005, over 20 rural hospitals across our state have shut their doors, and more than 25 are on the brink right now.
In South Texas, where cities are far and doctors are few, this hospital crisis is amplified ten-fold. In addition to the unique challenges South Texas faces, there is a lesser-known factor pushing these vital facilities to the edge: Medicare Advantage. Medicare Advantage is a popular private health insurance option among Seniors, but this plan is destroying the last remaining healthcare providers in the region.
The Medicare Advantage Problem
You might be wondering what exactly Medicare Advantage is and how it’s different from traditional Medicare, well it’s pretty simple: Medicare is an health insurance plan provided by the federal government for senior citizens. Medicare Advantage is a private health insurance plan provided by private, for-profit health insurance companies.
Over half of all eligible Medicare beneficiaries are on a Medicare Advantage plan instead of traditional Medicare which speaks to just how wide this crisis has spread.
At face-value, Medicare Advantage plans seem like the better option, especially for patients. This is because Medicare Advantage covers additional healthcare services that traditional Medicare does not, including vision and dental coverage. The downside? Medicare Advantage reimburses healthcare providers at a much lower rate compared to traditional Medicare, which can make or break a rural hospital that is operating on a tight budget.
Beyond the reduced payments, Medicare Advantage is treated like a private healthcare plan, which means there is a lot of time and labor wasted just trying to get certain procedures and medications approved for patients.And unlike traditional Medicare, which is accepted at every healthcare provider, Medicare Advantage patients are trapped in-network, which makes it difficult for rural Texans to find a doctor who is in network.
The Political Problem
Unfortunately for rural Texans, there is not an incentive for state or federal politicians to fix this problem. State and federal lawmakers have passed policies aimed at supporting rural healthcare, but none of them are bold enough to meet this moment and stop the trend of hospital closures in Texas.
The solution is simple, but the very nature of our political system guarantees that this is going to be an uphill battle for patients, activists, and providers.
The Only Logical Solution
Senator Bernie Sanders (I-VT) has long-championed Medicare for All, a bill aimed at closing the traditional Medicare gaps by insuring vision, dental, and hearing aids for seniors, while also expanding the program to cover every single American, regardless of age. Under this plan, no vital healthcare procedure could be denied, because the goal is to heal people and not make a profit. Sen. Sanders’ bill also bans “duplicative care,” which means the for-profit health insurance companies won’t be able to undermine the public market as they do now.
Critics of Sen. Sanders claim he is trying to destroy private health insurance and take away choice, but that begs the question: what choice do most Americans have? Americans and especially Texans are not exactly big fans of these private health insurance companies, especially when they spend more time denying life-saving claims than actually providing healthcare to people.
We can either have a public insurance plan that covers everybody in the name of improving public health, or we can continue to let these private health insurance cartels continue to squeeze hospitals, doctors, and patients dry.