From Becker’s Financial Management

There are 432 rural hospitals vulnerable to closure, according to a Feb. 11 report from Chartis, a healthcare advisory services firm.

Chartis analyzed 15 vulnerability indicators and found that 10 were statistically significant in predicting hospital closures, including: Medicaid expansion status, average length of stay, occupancy, percentage change in net patient revenue and years of negative operating margin.

Of the 48 states with rural hospitals, 38 have at least one at risk of closure, according to the report. The states with the highest number of vulnerable hospitals are:

1. Texas: 47
2. Kansas: 46
3. Mississippi: 28
4. Oklahoma: 23
5. Georgia: 22

Arkansas (50%) has the highest percentage of rural hospitals at risk of closure, followed by Mississippi (47%) and Kansas (47%).

The percentage of rural hospitals at risk of closure by state is as follows:

More than 41% of hospitals

• Arkansas
• Florida
• Kansas
• Mississippi
• Tennessee

31% to 40%

• Georgia
• Missouri
• Oklahoma
• South Carolina
• Texas

26%-30%

• Alabama
• North Carolina
• South Dakota

21%-25%

• Illinois
• Louisiana
• Maryland
• Nebraska
• New Mexico
• Wyoming

16%-20%

• Kentucky
• Ohio

10%-15%

• California
• Indiana
• Michigan
• Minnesota
• Montana
• New York
• Pennsylvania
• Virginia
• West Virginia

1%-9%

• Arizona
• Colorado
• Hawaii
• Idaho
• Iowa
• North Dakota
• Utah
• Wisconsin

0%

• Alaska
• Connecticut
• Delaware
• Maine
• Massachusetts
• Nevada
• New Hampshire
• New Jersey
• Oregon
• Rhode Island
• Vermont
• Washington

From Becker’s Leadership and Management

President Donald Trump has signed an executive order creating the Make America Healthy Again Commission after Robert Kennedy Jr. was confirmed Feb. 13 as HHS secretary in a 52-48 Senate vote.

Mr. Kennedy will chair the commission, which is tasked with investigating “the root causes of America’s escalating health crisis,” with an initial focus on pediatric chronic disease, according to a Feb. 13 White House fact sheet on the executive order.

The commission will release its childhood chronic disease assessment in the next 100 days and will follow up with a strategy to improve children’s health within the next 180 days. The key priorities of the investigation include funding studies on what causes disease, promoting healthier food, expanding preventative treatment options and increasing health research transparency.

“The commission aims to restore trust in medical and scientific institutions and hold public hearings, meetings, roundtables and similar events to receive expert input from leaders in public health,” the release said.

The commission also has four policy directives to help reverse chronic disease:

• Ensure open access and transparency to federally funded health research data while preventing conflicts of interest.
• Focus federally funded health research on high-quality studies to help understand the cause of American illness.
• Work with U.S. farmers to ensure food in America is affordable, abundant and healthy.
• Provide flexible health coverage and expand treatment options to support lifestyle-based disease prevention.

The release pointed to information consistent with CDC data that found 6 in 10 adults in the U.S. live with at least one chronic illness, and 4 in 10 have two or more. It also touched on a spike in autism rates, childhood cancers and overmedication, with more than 3.4 million children in the U.S. on medication for attention-deficit disorder and attention-deficit/hyperactivity disorder, with diagnoses on the rise, according to Children and Adults with Attention-Deficit/Hyperactivity Disorder data.

It also pointed to information consistent with a 2023 Gallup poll that found only one-third of Americans have trust in the U.S. health system.

During his two confirmation hearings on Jan. 29-30, Mr. Kennedy frequently discussed his Make America Healthy Again agenda, which aims to cut chronic disease, tackle obesity and diabetes, and improve food policy, prevention-based care and environmental health.

In his new role, Mr. Kennedy’s portfolio will comprise HHS agency and program oversight, as well as a nearly $2 trillion budget. Among the agencies under his purview are CDC, CMS, FDA and the National Institutes of Health.

Elected by his fellow Appalachian state governors, Maryland Governor Wes Moore is now ARC’s 2025 States’ Co-Chair. He is the 72nd States’ Co-Chair in ARC’s history.

In his year-long position, Gov. Moore will work alongside ARC’s Federal Co-Chair and his fellow governors to continue investing in economic growth and innovation across the region. In fiscal year 2024, ARC invested nearly $365 million in 583 projects, which attracted an additional $5 billion in private investments across Appalachia.

Learn more about Gov. Moore and ARC’s leadership structure. And join us in thanking 2024 States’ Co-Chair Tennessee Governor Bill Lee for his leadership and contributions.

The Wright Center for Community Heath’s Clarks Summit and Mid Valley locations have learned national recognition from the National Committee for Quality Assurance for delivering top-quality, patient-centered care. Read more about the recognition.

Block grants, per Capita Medicaid funding, choices to expand Medicaid eligibility but receive less federal support, and Medicaid Work Requirements were hallmarks of the American Health Care Act which passed in the US House but failed in the US Senate in 2017. Per capita caps are fixed amounts of money per person enrolled in Medicaid that may or may not cover the cost of care. Block grants are a single lump sum to cover Medicaid expenses regardless of enrollment or cost of care. While some states have explored additional mechanisms to reduce the number of recipients by not expanding Medicaid to those in the coverage gap between 100% and 138% of the Federal Poverty Guidelines, more than 40 states have Medicaid Expansion, including Pennsylvania, with more almost 750,000 enrollees. Under the ACA, the federal government paid 100% of the cost of Medicaid expansion coverage from 2014 to 2016, with the federal share then dropping gradually to 90% for 2020 and each year thereafter, leaving states to cover the small remaining share. In 2014, Pennsylvania floated the idea of work requirements with gradual loss of coverage in year 2 if recipients were non-compliant, a mix of eligibility exemptions for special circumstances, and a 20-hour per week of work or 12 hours of job training. In 2018, analysts estimated work requirements would cost Pennsylvania Taxpayers 3.4 billion dollars over 6 years and would result in 85,000 consumers losing health coverage. With the current inflation rate, the cost would be over $4.2 billion and put more than 1.2 million at risk of losing coverage.  Pennsylvania has 2.9 million enrollees in Medicaid with 42% children and 33% representing people with disabilities, and pregnant women.

Consumer Affairs Journal of Consumer Research reports Pennsylvanians have the third most affordable healthcare costs in the United States. The state’s average combined annual costs for family coverage (premium plus deductible) are some of the lowest in the nation, and the state is the most affordable in other metrics like lower health insurance premiums and deductibles. According to recent polls from Kaiser Family Foundation, about half of US adults say it’s difficult to afford health care costs and 1 in 4 say they or a family member in their household had problems paying for health care in the past 12 months. Affordability is indicated as a barrier for many potential enrollees in coverage and the cause for disenrollment. Pennsylvania has taken steps to offer additional flexibility and afford options through Pennie, the state-based marketplace. Thousands have also benefited from Medicaid expansion for those falling between 100% and 138% of the Federal Poverty Limit. For more go to https://pennie.com/affordability/

Last week, Senators Tim Kaine (D-VA), Todd Young (R-IN), Jack Reed (D-RI), and Roger Marshall (R-KS) introduced bipartisan legislation to reauthorize the Dr. Lorna Breen Health Care Provider Protection Act, a law that had been successfully passed in 2022 to help prevent suicide, burnout, and mental and behavioral health conditions among healthcare professionals. Provisions of this law that made funding possible expired last year, and this new legislation would reauthorize grant programs for education on strategies to reduce burnout, peer-support programming, and mental and behavioral health treatments. Communities with a shortage of health care workers, rural communities, and those experiencing burnout due to administrative burdens will be prioritized. Read more about this bill.

Federal Poverty Level (FPL) guidelines are issued each year by the U.S. Department of Health and Human Services (HHS) based on information gathered by the Census Bureau. The Bureau uses that data to calculate the total cost of essential resources used by an average person in a year. FPLs are used to determine eligibility for certain programs and benefits, including savings on Marketplace Health Insurance, Medicaid, and CHIP coverage, as well as a basis for FQHC sliding fee scales. The 2025 guidelines establish $32,150 as the FPL for a family of four, a 2.9% increase from the previous FPL. View the full HHS chart.