Dr. Vance Mason (not seen) examines Ariel Zetina (not seen), who is eight months pregnant, at Inner City Health Center in Denver, Colorado on March 15, 2017. Dr. Mason has been volunteering one day a week at ICHC for 16 years. Inner City Health Center was founded in 1983 and offers medical, dental, and mental and behavioral health services to the uninsured and underserved populace of Denver County and surrounding Colorado communities. Services are offered to patients based on a sliding scale, and 65% of the patient population is below  200% of the federal poverty level. ICHC serves more than 22,000 patients annually.  / AFP PHOTO / Jason Connolly        (Photo credit should read JASON CONNOLLY/AFP/Getty Images)

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Medicaid has been the linchpin for keeping many rural hospitals open as healthcare costs rise and rural populations shrink. In some rural areas, those hospitals are the biggest employers and help keep whole towns afloat while, of course, providing critical and life-saving care that would otherwise be miles and miles away.

That applies to obstetrical care more than just about any other kind of health care, as this report from Kaiser Health News details. Medicaid covers 45 percent of all births nationally every year, but covers 51 percent of births in rural areas.

Medicaid covers nearly 24 percent of rural, nonelderly residents and offers some financial stability to rural facilities by reducing uncompensated care costs at hospitals that would otherwise be in dire straits. In some cases, it enables them to provide costly but vital services, such as high-risk maternity care.

Medicaid pays the tab for close to 45 percent of all U.S. births annually, and about 51 percent of rural births, according to research. In Ohio, Medicaid pays for about 52 percent of births, according to 2016 state data, the most recent available.

But efforts to control Medicaid costs are consistently high on Republicans’ to-do list. The Trump administration has encouraged states to introduce work requirements and other changes to Medicaid—changes that would almost certainly reduce the number of people it covers and the money rural hospitals receive. Ohio lawmakers have recently signaled they intend to require that Medicaid enrollees also be employed.

If Republicans succeed in slashing Medicaid, they’ll succeed in doing away with maternity care in much of rural America. Even now, about 45 percent of rural hospitals don’t have maternity care, with almost 1 in 10 rural counties losing hospital-based obstetrics programs between 2004 and 2014. “When rural hospitals are squeezed, they have to look at what fixed costs they can shed,” Katy Kozhimannil, an associate professor at the University of Minnesota School of Public Health told KHN. She continued, “The fixed costs of providing obstetrics services are very clear, and very distinct.” Obstetrics is expensive.

And supposedly “pro-life” Republicans want to make childbirth not just more common, but more dangerous and more expensive by cutting Medicaid even further. 

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More than one-half of births in rural America are covered by Medicaid