“We are bankrupting many hospitals, forcing these hospitals to provide care to people who have no legal right to be in our country.”

Sen. JD Vance (R-Ohio) during a Sept. 17 rally

During a recent Wisconsin presidential campaign rallySen. JD Vance (R-Ohio) was asked how a Trump administration would protect access to rural health care in the face of hospital closings such as two this year in Eau Claire and Chippewa Falls.

In response, he turned to immigration.

“Now, you might not think that access to rural health care is an immigration issue,” said Vance, former President Donald Trump’s running mate. “I guarantee you it’s an immigration issue because we’re bankrupting many hospitals, forcing those hospitals to provide care to people who have no legal right to be in our country.”

Over 150 rural hospitals have closed or removed inpatient services since 2010, researchers from the University of North Carolina-Chapel Hill reported. The loss of a hospital can reverberate throughout the community – reducing access to timely care and disrupting the local economy.

The federal government made efforts to keep distant rigs afloat, but it is it was not an easy problem to solve.

What it is Does it affect rural hospitals?

Experts said Vance’s statement implies that immigrants who are in the country illegally are straining the resources of these hospitals, which often operate on thin margins, taking time and energy from other patients without paying their bills.

We’ve reached out to both Vance and Trump campaign staffers for additional information. They didn’t answer.

Hospital finance experts and industry representatives generally disagreed with Vance’s claim, noting that many other factors figure into the closings.

“When we talk to members of rural hospitals, that’s not what we hear,” said Shannon Wu, director of payment policy at the American Hospital Association, a trade group of more than 5,000 hospitals nationwide.

Brock Slabach, chief operating officer of the National Rural Health Association, said state border hospitals face challenges in treating immigrants who are in the country illegally. “But I’ve never had anyone in my discussions directly link them to a hospital closing,” he said.

The specific situations that lead a rural hospital to close its doors are unique to each facility, the researchers said, but many face some of the same stressors.

Rural hospitals tend to have a low patient volume, which presents its own set of problems. They are often located in small communities, and some residents may choose to travel to hospitals in larger cities where they can receive more complex care, what researchers call “hospital bypass.”

That small number of patients can cause financial losses for small rural hospitals, said Harold Miller, president and CEO of Center for Healthcare Quality and Payment Reforma national health care payment and delivery systems policy center.

Hospitals have fixed costs, such as running emergency departments, and must have a high enough volume of patients to cover them, he said.

“If a patient comes into the ED and doesn’t have insurance or can’t pay, it doesn’t increase the cost to the hospital at all because the doctor is already there,” he said, using an abbreviation for the emergency department.

Rural hospitals treat a larger proportion of patients covered by Medicare and Medicaid compared to urban hospitals, according to the American Medical Association. Public insurance programs for older and low-income Americans generally pay providers less than private insurers.

Still, Medicare is “one of the best payers” for small rural hospitals, Miller said. That’s partly due to facilities with a “critical access hospital“The designation is paid more by Medicare — and in some states, Medicaid.

Hospital industry officials and some experts say Medicare Advantage plans are growing popularity it also hurt rural hospital bottom lines, as the private insurance companies that offer the plans tend to be less reliable payers than traditional Medicare.

For starters, the negotiated rates paid through Advantage plans can be lower, especially for those critical access facilities. Advantage plans also introduce additional layers of costly and staff-intensive administrative tasks to ensure payment.

“They’ll deny the claim or say the patient really didn’t need that service through prior authorization, so hospitals don’t get paid for the service from someone who has insurance,” Miller said.

The insurance industry trade group AHIP rejected the claim that Medicare Advantage plans hurt rural hospitals, citing a federally supported study that says the plans actually increase the financial stability of rural hospitals.

But the study did not compare actual payments between Medicare Advantage and traditional Medicare plans and looked at only 14 states.

People who do not have legal immigration status generally cannot get Medicaid or Medicare coverage. But a provision of Medicaid law allows some immigrants in the country to gain temporary coverage, said Hayden Dublois, director of data and analytics for the think tank Foundation for Government AidsnotAUTHORIZED.

Medicaid, who pays less than Medicare and private insurance, “it’s not exactly a financial advantage for hospitals,” and that may be part of what Vance is referring to, Dublois said.

In data from several states, Dublois found an increase in the number of people signing up for Medicaid without being able to verify their immigration status. But his research did not look specifically at how this population might affect the financial viability of rural hospitals.

Some states have acted in recent years to extend health coverage to people in the country illegally — offering insurance for more than 1 million low-income immigrants.

One of those states, California, has had nine hospitals close or end inpatient services since 2005.

People may pay out-of-pocket for care, the researchers said, or they may access private insurance through an employer.

Covering costs for the uninsured is just one financial stressor facing rural hospitals, said George Pink, assistant director of the North Carolina Rural Health Research Program.

“Will it be enough to run a bankrupt hospital? Probably not,” he said.

A financial decline can last for years, Pink said. As losses mount, hospitals may be forced to sell property or other assets, draw down any financial reserves and max out their credit.

“This is not an overnight phenomenon,” he said.

Our decision

Vance said providing care to undocumented immigrants has “bankrupted” rural hospitals and forced them to close.

Although that population is more likely to be uninsuredliving in the country illegally doesn’t mean people don’t have the ability to pay for health care — especially if they live in states that offer them insurance coverage.

Research shows that many factors contribute to rural hospital closings — not just financial losses from providing care to the uninsured, whether those people are illegal immigrants or U.S. citizens.

We rate Vance’s claim as false.

Our sources:

PBS NewsHour, “WATCH LIVE: Vance addresses campaign rally in Eau Claire, WI”, September 17, 2024.

HSHS Hospital Sisters Health System, “Information about the closure of HSHS Sacred Heart Hospital and HSHS St. Joseph’s Hospital,” accessed September 26, 2024.

Cecil G. Sheps Center for Health Services Research, University of North Carolina-Chapel Hill, “Rural hospital closures,” accessed September 27, 2024.

GAO, “Rural hospital closures: Affected residents had reduced access to healthcare services,” 22 December 2020.

Journal of Rural Health, “The impact of rural general hospital closures on communities—A systematic literature review”, November 20, 2023.

Rural Health Information Center, “Rural emergency hospitals (REH),” accessed September 30, 2024.

KFF Health News, “Federal Rural Hospital Rescue Program Feeling ‘Growing Pains’.,’” January 16, 2024.

Microsoft Teams Interview, Shannon Wu, Director of Payment Policy, American Hospital Association, October 1, 2024.

Zoom Interview, Brock Slabach, Chief Operating Officer, National Rural Health Association, October 1, 2024.

Cecil G. Sheps Center for Health Services Research, University of North Carolina-Chapel Hill, “Patterns of hospital bypass and inpatient care seeking by rural residents,” accessed October 1, 2024.

Zoom Interview, Harold Miller, President and CEO, Center for Healthcare Quality and Payment Reform, September 26, 2024.

American Medical Association,”Issue Brief: Payment and delivery in rural hospitals,” accessed October 15, 2024.

Rural Health Information Center, “Critical Access Hospitals (CAHs),” accessed September 30, 2024.

KFF, “Medicare Advantage enrollment, plan availability and premiums in rural areas,” September 7, 2023.

KFF Health News, “Small, rural hospitals are feeling the need as Medicare Advantage plans grow”, October 23, 2023.

Email interview, James Swann, Director of Communications and Public Affairs, AHIP, 21 October 2024.

Medicaid.gov, “Implementation Guide: Citizenship and Non-Citizenship Eligibility”, accessed on October 10, 2024.

Zoom and email interview, Hayden Dublois, director of data and analytics, Foundation for Government Accountability, October 1, 2024.

Commonwealth Fund, “How Differences in Medicaid, Medicare, and Commercial Health Insurance Payment Rates Affect Access, Health Equity, and Costs”, August 17, 2022.

KFF Health News, “States expand health coverage to immigrants as GOP slams Biden over border crossings,” 28 December 2023.

Telephone interview, George Pink, Assistant Director, North Carolina Rural Health Research Program, September 30, 2024.

KFF, “State health coverage for immigrants and implications for coverage and health care”, May 1, 2024.