Your Independent Journal from the Heartland
Three mornings a week, I’m a hospital chaplain here in rural Appalachia. I clock in, check the daily census of patients, and visit people who may be having the worst day of their lives.
The calculus isn’t difficult: Knock on the door, be present to whomever and whatever is on the other side. Offer compassion, maybe even coax a smile. Remember what the world can look from a hospital bed.
The need is there, but as with 10 other rural medical centers in Ohio (seven located within the state’s designated Appalachian region) this hospital has been listed as “At Risk” by federal agencies already curtailing Medicaid spending - an existential message to those communities their hospitals can no longer be taken for granted.
Driving this nationwide dilemma is the sweeping “One Big Beautiful Bill,” whereby whole blocks of Medicare funding are being diverted elsewhere, and will within a decade strip 10-15 million Americans of the medical care they rely on for their quality and length of life.
Measured in dollars, the Congressional Budget Office’s latest cost estimate finds $911 billion will be deducted from Medicaid funding for that same period. If that number proves accurate, it will stand as one of the largest defunded programs since the onset of World War I.
All of which translates to fewer Americans with health insurance, and therefore fewer who seek help with what’s ailing them. Lower occupancy rates for hospitals follow, with small rural hospitals absorbing the hit first and foremost.
The downstream consequences are many, and vary according to geography and zip code. The states are the first line of defense for those newly without health insurance, but the responses range widely in terms of fairness and practicality. Case in point, some are invoking work requirements that on their surface seem workable, yet don’t take into account the costs of housing, transportation or childcare.
Often missing from the criteria to close rural hospitals is the financial impact on local communities if not regions. Boston University associate professor of health law, policy and management, Timothy Callaghan makes the point:
“The loss of a rural hospital is devastating for a local community, because not only do you lose the hospital and the ancillary services that surround that hospital, you lose a lot of other jobs, which can [increase] the economic loss in that community.”
More specifically, those loses involve a decrease in per capita income, employment and retaining high school graduates. Conversely, rural hospital closures are linked to increased poverty, bankruptcies and reliance on emergency department services at distant facilities.
Chances for Medicare’s full restoration are slim to none, but some “At Risk” facilities have already begun reimagining how they deliver quality care:
• Broadband updates to support telehealth and preventive services;
• Expansion in scope of practice for nurse practitioners and physician assistants;
• Collaboration with other rural hospitals to share resources, and negotiate better contracts with Medicaid administrators;
• Increases in the number of mobile units, allowing for direct care across service regions.
If there’s anything approaching a silver lining here, it’s that these cruel cuts in Medicare funding give more control to local healthcare providers. Key decisions can be made with less interference from federal regulations. That’s cold comfort to a hospital on the verge of extinction, but the alternative is even worse.
Don Rollins is a retired Unitarian Universalist minister in Jackson, Ohio. Email donaldlrollins@gmail.com.
