Republican Opponents of Medicaid Expansion Hurt Rural Hospitals

All Things Considered:

CAPELOUTO: In America, no one gets refused services at an emergency room. And to help rural hospitals cope with taking care of the uninsured, they get what's called Disproportional Share, or DISH payments, from the federal government.
The Affordable Care Act was supposed to reduce that payment under the idea that everyone would have insurance or be on Medicaid. But Georgia is one of 20 or so states that decided to opt out of Medicaid expansion once the Supreme court gave them permission to do so. It's a major worry for the Rural Health Association, which lobbies for the 20 percent of Americans who live in rural areas.
Maggie Elehwany is one of their lobbyists.
MAGGIE ELEHWANY: The poorest areas in this country in the Deep South, in Appalachia, in certain pockets in the west, boy, a lot of those - really a tremendous amount of those - are the states that are opting not to expand Medicaid.
CAPELOUTO: Georgia decided against Medicaid expansion, even though the federal government pays 100 percent of the cost for three years and 90 percent thereafter. Governor Nathan Deal argues that it's foolish to believe the feds will keep paying that 90 percent and worries that states will be left to carry the burden in the long run.
Republican State Senator Dean Burke agrees.
STATE SENATOR DEAN BURKE: Increasing Medicaid doesn't necessarily make things better. You know, we need to increase jobs so that we get more people with regular insurance. And that will be where we can make a difference.
CAPELOUTO: But Burke is also a doctor in rural south Georgia, where he works at a hospital. He's not in the appeal Obamacare camp of the Republican Party. Rather he says the genie is out of the bottle, and he'd like to find a way to make it work for Georgia without stressing future budgets.
Looming large for rural Republicans like him is the potential closure of hospitals, once those federal DISH payments stop coming and the poor are still uninsured. Last month, he and his colleagues got some good news: Congress decided to keep the DISH payments in place for two more years.

It sure is nice of Republicans in taker states to reject a program that would bring even more money from taxpayers in New York and Connecticut into their crappy states.  However, it really hurts their residents in rural areas, especially considering that Obamacare was going to be paid for by reducing the DISH payments since the health insurance subsidies and Medicaid expansion would reduce the number of uninsured.  Hey stupidity and ideology go ahead of basic mathematics.