The public option could leave rural communities with no option

The 2020 election cycle is heating up and presidential hopefuls are introducing a variety of policy proposals in an effort to stand out in a crowded primary field. Health care remains a top concern for voters, so it should come as no surprise that candidates’ plans to implement government insurance systems – from Medicare for all to the public option – have dominated the national conversation. As candidates continue to roll out their health care plans, it is important to understand the real-world implications of these policies for communities across the country.

This is especially true for rural communities. Rural hospitals across the country are struggling. Since 2010, over 100 rural hospitals around the U.S. have had to close their doors. And today, nearly one-fourth of our nation’s rural hospitals are at risk of closure. Hospital closures often have profound negative health and economic consequences for their local communities, as income levels fall and unemployment rises.

More can and should be done to protect and increase access to high-quality, affordable health care in these communities. But the government insurance systems touted by many presidential hopefuls would hurt the very same people these candidates are trying to help.

Policy experts assert that the Medicare for all system supported by Sen. Bernie Sanders (I-Vt.) and others, would cause “some hospitals, especially struggling rural centers, [to] close virtually overnight.” Others predict these hospitals would need to lay off “hundreds of thousands of workers” and abandon “lower-paying services like mental health.”

Meanwhile, the push for the public option from other candidates has been deceptively sold as a less risky, more moderate alternative to Medicare for all. But a new study shows that in reality the public option could also be very damaging to our rural communities. 

The study, from Navigant Consulting, finds that under the public option, our nation’s already-struggling rural hospitals could face severe cuts that would put over half, or 1,037, of U.S. rural hospitals across 46 states “at high-risk of closure.” Even rural communities’ whose hospitals are not at “high-risk” of closure could face diminished quality of and access to care as rural hospitals would be forced to make cuts. This could lead to the “elimination of services and reduction of clinical and administrative staff, as well as damage the economic foundation of the communities these hospitals serve.”

This tracks closely with previous research which warns that instituting a government insurance system could threaten our nation’s already at-risk hospitals. Another study, prepared by KNG Health Consulting for the American Hospital Association and the Federation of American Hospitals, found that hospitals would face $62 billion in cuts that “would compound financial stresses they are already facing, potentially impacting access to care and provider quality.” They could be forced to provide fewer services, lay off medical professionals or even close their doors – meaning patients would be forced to travel farther and wait longer to access the care they need.

Not only could the public option harm rural communities, but it would also force all Americans to reckon with massive new costs, unaffordable tax increases and degradation of patients’ access to high-quality care under a system run completely by Washington bureaucrats.

For one thing, by disrupting the private marketplace where millions of Americans shop for coverage that matches their needs and budgets, a government insurance system would drive premiums up for those with private plans. With affordability already a prime concern for health care consumers, our leaders shouldn’t be promoting policies that would force families to pay more.

Survey data shows that voters prioritize improving our current health care system over the public option. This point is reiterated by another poll which finds that the majority of Americans, including Democrats and Democrat-leaning independents, want our elected officials to build and improve upon on what’s working, and come together to fix what’s broken in health care. Rather than promoting risky government insurance systems that could have profound negative impacts on our rural communities, our leaders should listen to the American people and advocate for real solutions to create a better health care future for all Americans.

Lauren Crawford Shaver is the executive director of the Partnership for America’s Health Care Future. She was previously the deputy assistant secretary for public affairs in health care at the U.S. Department of Health and Human Services (HHS) and has worked on numerous Democratic political campaigns over the last decade.