Missouri is one of the states that didn’t expand Medicaid under the Affordable Care Act, and as a result its smaller rural hospitals are closing. The New York Times has a story about a woman, pregnant with twins, who went into early labor and suffered a four-hour road trip to get to a hospital that would accept her as a patient.

The hospital that had been nearly around the corner from her house had just closed. An emergency room 20 or so minutes away (on bumpy country roads, while the mother was in active labor) wouldn’t accept her because they weren’t set up for obstetric emergencies, apparently. The emergency room called for an ambulance, which arrived 25 minutes later, to take the mother to a medical center in Cape Girardeau, nearly 80 miles away. Fortunately, the twins were healthy after being delivered by c-section. But the mother ended up traveling about 100 miles to get to an obstetrician, bouncing around in car and ambulance while in active labor. Those of us who have given birth can appreciate what she went through.

I notice many commenters to the story criticize the mother for having children. Sorry; having babies is a basic human thing to do. The troglodytes want to simultaneously deprive women of a right to have babies and a right to abortion at the same time, it seems. Poor pregnant women must seem terribly inconvenient to them. And many commenters blamed her for voting for Trump. But the mother in the story is African American, which suggests to me a low probability that she was a Trump voter.

At some point, instead of blaming people for getting on with their lives in spite of dysfunctional government, we need to blame dysfunctional government. Indeed, we may need to do some basic rethinking about what government is for.  We seem to have forgotten something.

Small hospitals in poor rural areas live or die by Medicaid, so states that didn’t accept the federal Medicaid expansion killed their own hospitals. See, for example, “Lack of Medicaid expansion played part in Fulton hospital closing” in the Columbia (Missouri) Daily Tribune, July 27, 2017.

When the owners of Fulton Medical Center announced Monday they would close the hospital because of mounting losses from uncompensated care and low patient numbers, they did not say it was because Missouri didn’t expand Medicaid.

They didn’t have to. The mayor of Fulton said it for them.

“That was one of the things they were hanging their hat onto to stop the bleeding and of course, that did not happen,” Mayor LeRoy Benton said.

The hospital lost $1 million between January and May, prompting University of Missouri HealthCare to put its minority stake up for sale and NueHealth on Monday to set Sept. 22 as the closing date. It will be the fourth rural hospital to close since advocates for Medicaid expansion began predicting that outcome if the state did not accept federal help to expand coverage for poor adults.

Now nursing homes are facing similar pressures. The uncertainty of federal health care policy as Congress debates repeal of the Affordable Care Act and Medicaid cuts, combined with cuts in state payments and a higher threshold to receive services, are straining the budgets of residential care facilities, said Nikki Strong, executive vice president of the Missouri Healthcare Association.

“We are looking at job losses all across the state,” Strong said. “Facilities have nowhere left to cut because they are currently underfunded. We are probably going to look at facility closures.”

The Fulton hospital was bought and saved at the last minute, but other hospitals around the state have closed, including the Twin Rivers Regional Medical Center that was a few minutes from the pregnant woman’s home.

Missouri has had a right-wing legislature for many years, and most recently they’ve been actively engaged in what I call the Kansas Two-Step:

One, cut taxes, especially for corporations, to attract job growth.

Two, cut essential services and education to make up the budget shortfall that inevitably follows, especially when the job growth doesn’t materialize.

The other essential functions of the legislature include thinking up damnfool ways to limit access to abortions while passing whatever “gun rights” bill the NRA is promoting. Oh, and protecting the rights of puppy mill owners. And that’s about it, as far as I can see.

But my next question is, why are obstetric services in particular hurt by hospital closing? Why wouldn’t an emergency room be prepared to deliver babies, even by c-section? The NY Times article doesn’t say, but I suspect the problem is that private for-profit insurance really does not like covering obstetric care and won’t unless forced to. Without some kind of mandate to cover it, pregnancy and maternity services are among the first considered “nonessential” and dropped by insurers. Apparently there’s no profit to be made from human gestation. Facilities that are mostly dependent on private insurance reimbursement may want to minimize the obstetric services they provide.

You’d think the allegedly pro-life state government would care about lowering Missouri’s above-average infant mortality rate, but I guess not.

You might remember we recently had a sudden change in the governor’s office. The new governor is Republican Mike Parsons. Here are some recent stories about him.

Parsons Signs Income Tax Cut.

Parsons Vetoed Program for Stroke and Heart Attack Victims.

Parson signs budget that blocks funding to Missouri Planned Parenthood clinics.

The Kansas Two-Step continues.

On a national level, of course, the Republican Party spent the entire Obama Administration claiming they had a better way to fund health care. Paul Ryan in particular had some nice talking points about “patient-centered health care” which, according to the details, basically meant getting government out of the way so that private insurers could make bigger profits by not paying for health care. But as we all remember when a Republican majority House and Senate had a clear path to passing any health care bill their black little hearts desired, they failed.

And, of course, who can forget this fool:

So many great options, he said. All of them involve weakening the Affordable Care Act without replacing it with anything. I notice he’s not talking about health care any more. On to bigger disasters!

I’m finally seeing some ads from Josh Hawley, the Republican running against Claire McCaskill. I’ve seen this one over and over and over —

OMG, we can’t have libruhls in charge of anything! That’s not Missouri’s way! Missouri’s way is to make a laboring woman suffer a four-hour trip to get to a hospital! Because we’re cutting back on health servvices! But rich people get tax cuts and we keep those puppy mills open!

The state is doomed.