(Bloomberg) — A Baton Rouge hospital is closing the only emergency room on the city's impoverished north side, a real-world ripple effect of the ideological clash over the Patient Protection and Affordable Care Act (PPACA).
The shutdown on April 1 serves as an early warning for hospitals in states such as Louisiana, where Republican Gov. Bobby Jindal turned down federal money to expand the Medicaid program for the poor. Charity hospitals will lose billions of federal aid beginning late next year, a cut that was supposed to be offset as more residents were covered by Medicaid.
The combination is a looming "double whammy," said Shawn Gremminger, a lobbyist for America's Essential Hospitals in Washington, which represents those that care for the poor.
"It's not survivable," he said. "Hospitals are going to close."
In Louisiana, Baton Rouge General's Mid City hospital was already caught in that vise. It was flooded with the uninsured after a nearby charity hospital was closed. Louisiana provided a one-time injection of funds last year from the federal aid program that's about to be cut. With that money gone, the hospital is closing the emergency room.
"It was unsustainable," said Mark Slyter, the hospital's chief executive officer.
While Republican governors in states including Indiana, Ohio and New Jersey have expanded their Medicaid programs under PPACA, Jindal, a potential 2016 presidential candidate, has remained steadfast in his opposition.
Jindal's approach
A health-policy expert who began his political ascent as chief of Louisiana's state hospital system in 1996, Jindal, 43, has said adding to the federal program would put almost half of Louisiana on government assistance. Jindal instead decided to turn management of the state's charity hospitals over to private operators, a step his administration says has resulted in reduced wait times and better care at a lower cost.
"Instead of expanding Medicaid, we have chosen to improve health care and expand access for all Louisianans by transforming our state-run charity hospital system," Shannon Bates Dirmann, a spokeswoman for Jindal, said in an e-mail.
In Baton Rouge, a city of 229,000, about one-fourth of whom live below the poverty line, the emergency room's closing has been met with protests by residents and lawmakers who say Jindal's policies are hurting the poor.
"The governor is putting ideology ahead of the welfare of the state," said state Rep. Alfred Williams, a Democrat from Baton Rouge. "He has an agenda and it's to run for president of the United States. And if that causes the people of Louisiana to suffer, then I believe he's OK with that."
Building pressure
Kathy Kliebert, the secretary of Louisiana's Department of Health and Hospitals, said Mid City's financial issues preceded the Medicaid decision and changes to the state hospital system. She said it was undermined by market forces as rival specialty hospitals lured away insured patients.
"Mid City has had financial problems for 10 years," she said.
Nationally, PPACA has eased the strain of caring for the uninsured. The law allowed for making Medicaid available to those earning as much as 138 percent of the poverty level, or about $16,200 for an individual. The expense is fully paid by the federal government through 2016 before being phased down to 90 percent.
Opting out
After the U.S. Supreme Court in 2012 said it was up to states to decide whether to expand the program, the decisions initially broke down along party lines as Republicans questioned whether the federal government would keep its pledge to pay for it.
