The Missouri Hospital Association said Medicare payments to hospitals in the state have been reduced $15 million a year because of a tiny hospital in Nantucket, Mass. An obscure part of the Affordable Care Act sets a floor for Medicare payments to hospitals in a state based on pay to rural hospitals. Because wealthy Nantucket is considered rural, reimbursements in the state have risen at the expense of hospitals in other states, including Kansas and Nebraska. Midwest states are part of a coalition trying to address the issue.

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