Obamacare Policies Hit Rural Communities Hard: Needs To Be Revised

In 2010, Congress passed, and President Obama signed, the Affordable Care Act (ACA), also known as Obamacare. While the ACA has expanded health insurance access for millions, certain policies within the law have led to serious challenges—especially for small, independent hospitals in rural areas.

One of these policies, the Hospital Readmissions Reduction Program (HRRP), penalizes hospitals financially if patients with conditions like heart failure or COPD are readmitted within 30 days. Although the program aims to improve care and reduce preventable readmissions, it has placed smaller hospitals in a tight spot when caring for patients with advanced, complex conditions that often require ongoing attention.

A former hospital worker shared how their boss predicted the impact of the ACA when it was signed into law. “Our hospital has been independently run since 1904. I’m proud of our board and president for keeping us afloat all these years,” he said. “But with the new policy denying reimbursement for COPD and heart failure patients readmitted within 30 days, I predict that within five years, our hospital will be forced to merge with a larger facility.”

He was right. By 2015, that hospital, like many others across the country, had merged with a larger network—a trend accelerated by an ACA provision that streamlines hospital mergers. Intended to reduce costs and expand access, these mergers have brought unintended consequences for rural communities.

While joining larger hospital systems can bring benefits, such as higher pay and improved resources, it also centralizes essential services. Local jobs in billing, scheduling, and administration, which were once provided by local residents, are now handled in urban centers, reducing rural employment opportunities and lessening the economic impact of these facilities on small towns.

This centralization has also made it harder for patients to see doctors, as hospital staff are now consolidated in larger facilities with overcrowded schedules. Many specialized services, previously available locally, have moved to hospitals in big cities. This requires patients to drive longer distances, often navigating traffic and difficult parking.

The HRRP has faced criticism from healthcare professionals, who argue that the penalties disproportionately impact smaller hospitals. While the program intends to improve discharge planning and follow-up care, in practice, it often forces hospitals to add costly administrative staff to meet the regulatory demands without actually improving patient outcomes.

“Many of the patients we see with severe COPD or heart failure are in the later stages of their disease, so avoiding readmissions isn’t always possible,” one healthcare worker noted. “They’re often readmitted for complications we can’t control, yet Medicare penalizes us even if they come back with an unrelated issue.”

Healthcare experts say that these financial penalties add strain to smaller hospitals and may ultimately reduce the quality of care in rural areas. In some cases, hospitals are forced to merge or reduce local staff to avoid penalties, leaving rural patients with fewer options for advanced care. Many are now required to travel to larger cities for specialized treatments that were once accessible locally.

As these issues come to light, some advocates are calling for Congress to revisit the ACA and amend policies that encourage hospital mergers. They propose new legislation that could break up large hospital systems while still allowing for inter-hospital collaboration to reduce costs and improve care. Restoring independent hospitals could bring back essential local jobs in scheduling, billing, and other areas while improving healthcare access for smaller communities.

Advocates argue that patients in rural areas would benefit greatly from more specialists nearby, reducing the need to travel long distances for routine care. They believe revisiting the ACA could help rural patients and local economies alike, creating a healthcare system that better serves communities beyond major cities.

In my humble opinion, many aspects of Obamacare need to be reevaluated, if not completely revised. With over 20,000 pages, the bill may need to be scrapped and rewritten from the ground up. Better yet, perhaps it's time to consider scrapping the entire system and allowing capitalism to work—something that has never truly been tried in healthcare.