To the editor:

We in Baraga County have the luxury of having a hospital quite close by and I am wondering if many readers know how small hospitals stay afloat. One way is to qualify for a designation as a Critical Access Hospital, which Baraga County Memorial Hospital (BCMH) has done. This designation is given to rural hospitals who provide critical services. To qualify, they must have 25 or fewer acute care inpatient hospital beds, must be more than 35 miles from another hospital, must provide emergency services 24/7 and must maintain an average length of stay of 96 hours or less for acute care patients. As a Rural Critical Access Hospital, reimbursement from Medicaid and Medicare is based on the ‘reasonable cost method’ (based on actual services provided) rather than the DRG (Diagnosis Related Group) method (bundles payment depending on the diagnosis rather than on the actual services rendered).

BCMH is very much affected by changes in Medicaid and Medicare. It has benefited from the Affordable Care Act (ACA) which was enacted in 2010 in many states, including Michigan. This ACA Medicaid Expansion started in 2014. The percentage of uninsured people dropped significantly by 2016. States with Medicaid Expansion have shown a statistically significant reduction in mortality rate; hospitals, especially rural ones, have improved financial health with Medicaid Expansion.

Our hospital will be negatively impacted by any plan to repeal the ACA or to significantly cut services to Medicaid and Medicare. Trump has a goal of imposing caps on Medicaid spending which would especially affect older adults, people with disabilities and low income parents and children. He has been trying hard to repeal the ACA and there is, in fact, a Supreme Court decision due a few days after the election concerning the Trump Administration’s attempt to get rid of the ACA once and for all.

Joe Biden will protect the Affordable Care Act and plans to give more choice to Americans and to make things less complicated in order to get good health care. He has promised to double federal investment in community health centers and expand funding for mental health services.

Anyone who favors another 4 years’ of a Trump presidency, needs to understand the ramifications of his policies on our local hospital. If you have any interest in our hospital and its fiscal future, I urge you to think twice before voting for Trump in the upcoming election.