Baton Rouge, La., is about to lose a crucial hospital emergency room because the administration of Gov. Bobby Jindal (R) has refused to expand Medicaid under the Affordable Care Act, and won’t put up funds to keep the facility open, Michael Hiltzik noted at the Los Angeles Times (2/6).The scheduled closure of the emergency room of Baton Rouge General Medical Center-Mid City means patients needing emergency treatment will have to travel as much as 30 minutes longer to reach the nearest ERs.The ACA was designed to encourage states to expand Medicaid — almost entirely at federal expense — as a means of cutting the uncompensated medical care hospitals had been forced to provide for low-income individuals and families. Much of that care has been customarily delivered through the ER.In the expectation that Medicaid would pick up the slack, the ACA reduced so-called disproportionate share hospital payments, which went to hospitals serving a large number of the uninsured. So institutions in states that have refused to expand Medicaid, like Louisiana, have faced a double-whammy — they still have to serve a large number of uninsured patients, but they have less money to do so.The ACA has reduced uncompensated care costs across the board — by $5.7 bln in fiscal 2014 compared with what they would have been otherwise, according to the Department of Health and Human Services. But most of that effect is seen in Medicaid expansion states. The crisis has continued for hospitals in non-Medicaid expanding states. The problem is so acute that the Tennessee Hospital Assn. offered to pick up the state’s cost of expansion. That wasn’t enough: Conservative Republicans who dominate the state legislature on (2/4) voted in a Senate committee to kill a compromise plan by Republican Gov. Bill Haslam (R) to expand Medicaid to cover more than 250,000 low-income uninsured adults.Read More.Source: The Progressive Populist/DISPATCHES