When you’ve got ever felt stress after passing a freeway signal warning, “No gasoline subsequent 90 miles,” you perceive the significance of my hospital. I’m the chief government of Lincoln Well being, a 25-bed county-owned hospital in Hugo, Colo., a city of about 800. We’re the one hospital on the I-70 hall between Denver, 85 miles to our west, and Burlington, close to the Kansas state line, some 80 miles to the east.
In 2021, a pileup involving dozens of automobiles on that freeway introduced greater than 30 sufferers to our two-bed emergency room, the place our small workers sprang into motion to stabilize essentially the most significantly injured sufferers. Our hospice staff met with the household of a kid who died on the scene of the accident. One fatality is simply too many, however with out our hospital, there certainly would have been extra.
Practically 200 rural hospitals have closed prior to now 20 years — the results of monetary pressure and workers shortages — however my hospital has been capable of preserve its doorways open by means of sheer perseverance. Now, nevertheless, Congress is contemplating cuts to Medicaid that might wreak havoc on rural America’s fragile well being care system. I fear about our future.
One proposal would cut back the portion of Medicaid {dollars} the federal authorities provides to states, akin to Colorado, which have expanded Medicaid eligibility. One other would strictly cap federal funds to states, no matter geographic variations in the price of care.
Cuts to Medicaid may damage the funds of hospitals throughout the nation, however rural hospitals will likely be notably affected. It’s because rural sufferers usually tend to have well being protection from the federal government than from industrial insurers. (Practically three-quarters of our income, for instance, is from Medicaid and Medicare.) These applications are important, however, in contrast to industrial insurance coverage, they don’t at all times cowl the whole value of care, which has been rising as medicine and provides turn out to be dearer. We additionally serve fewer sufferers than large metropolis hospitals however nonetheless have mounted prices to remain operational. The result’s that we run on minimal or unfavourable working margins.
In keeping with the Colorado Rural Well being Heart, the state’s nonprofit workplace of rural well being, roughly half of my state’s rural hospitals are working within the pink. But we’re comparatively fortunate: Colorado’s determination to broaden Medicaid in 2014 has been a lifeline for us as a result of it reduces the variety of sufferers we see who can’t pay.
Our neighbors in Kansas and different states that haven’t expanded Medicaid are in worse monetary form. Different states have so-called set off legal guidelines that can robotically cease their expanded Medicaid applications within the occasion of federal funding cuts. If these cuts occur, extra rural hospitals will shut, leaving the communities round them with out entry to well being care and devastating their financial base.
Most of the companies my hospital gives — major care, a nursing house and assisted residing, medical transport and hospice care — are usually not profitable, however they’re crucial. Earlier than we opened an X-ray clinic in a distant space, residents would make offers with the native veterinarian for imaging. Most cancers sufferers drove shut to 2 hours for chemotherapy till we opened a small infusion remedy service.
However, regardless of our greatest makes an attempt, we can not supply all of the companies our group wants. No rural hospital can. Living proof: Lincoln Well being stopped obstetric companies almost 20 years in the past; we may now not recruit specialists to take care of a shrinking variety of births. Since then, a minimum of two of our hospital staff have given beginning alongside the freeway whereas attempting to make it to the closest labor and supply ward 85 miles away. We do what we are able to, encouraging obstetricians to come back from Denver or Colorado Springs to supply prenatal care to our sufferers.
And inevitably, our medical doctors do find yourself delivering infants when native residents or vacationers on I-70 present up at our door, too far alongside of their labor to make it to a much bigger hospital. It’s not ultimate, but it surely’s much better than having no care.
The proud conservative residents of our group usually really feel disregarded of Colorado’s extra liberal politics. Our voices by no means appear to be as loud as these within the metro areas of the state. And but, with the looming risk of Medicaid cuts on the federal stage and finances proposals that may lower rural well being care, we’re questioning if our voices are heard in any respect on this Republican administration and Congress. The nation’s meals and gas are sourced in rural areas. Supporting rural communities ought to be strategically necessary, and so they can’t thrive with out well being care.
I do know the monetary peril my hospital will face if our Medicaid lifeline is severed. However the actual injury — the type that retains me up at night time — will likely be achieved to the hardworking individuals in my rural group. I fear in regards to the residents of our nursing house who simply wish to develop outdated right here. I fear in regards to the individuals in Hugo who may forgo care completely as a result of they’ll’t get the day off work to go to a Denver hospital.
Forty p.c of the youngsters we see are lined by Medicaid. How will I break the information to their households that they might now not have entry to important pediatric care? Who will deal with the subsequent large freeway accident victims? The record goes on.
Policymakers say they wish to eradicate waste, fraud and abuse from Medicaid, however the cuts on the desk go far past that. When Medicaid pays much less or covers fewer individuals, it doesn’t imply we cease seeing these sufferers or incurring prices. Hospitals are obligated by legislation and our personal ethics to take care of any sick affected person who reveals up in our emergency room. Massive hospitals could have sufficient clout to barter with insurance coverage firms and lift their costs, shifting the fee onto privately insured sufferers within the type of greater premiums. Hospitals like mine usually can’t shift these prices. We lower companies, or we shut.
I perceive the motivation behind addressing waste the place it exists. However I don’t see waste in Hugo. Reasonably, Medicaid ensures that major and emergency care continues to be accessible right here, and that drivers alongside I-70 will see the blue H on the freeway signal and know that assistance is close by.
