"When people need emergency care, this facility is extremely important," said
In addition to saving lives, these hospitals are economic cornerstones, sometimes the biggest employer in the county. And the services they provide can make the difference between retirees and young families staying around or leaving for a city.
But running a rural hospital is often akin to bailing water out of a sinking boat using a coffee cup. Last year alone Gleason's facility had an operating loss of
By their nature, rural hospitals are greatly affected by unique situations in their small communities. While changes at larger hospitals are diluted through volume, any shift is felt much more acutely at facilities that might see an average of a patient a day. Such variations mean it's hard to make a universal statement about what
That could happen under the Republican plan to repeal and replace the Affordable Care Act. As introduced in
When the HELP Act was passed, it came with a 2019 sunset date, which was put in place so the state could asses the viability of the program under stepped-down federal reimbursement rates. What
A report from the
Though no state leaders have said definitively that the program couldn't survive, rural hospitals are concerned.
"It's not been a big-dollar panacea. It's not like it's a huge amount of money, but it is positive," Gleason said. "When you're working from a position of losing money and having to be subsidized by the county, any amount helps."
'A big impact'
More patients coming in with insurance has drastically changed the amount of uncompensated care at two rural hospitals in north-central
Bad debt is down 27 percent at
"That's a big impact.
Brandt said while overall
Still, he wants the program to continue. "Having more lives covered is important for general health care because it helps sustain the healthcare model across the board. If we do services and don't get paid for them, we're not going to be there for long."
At his hospital and others, the number of people accessing preventive care has increased. That change would have a long-term payoff in reduced emergency room costs if the program continues, hospitals say.
"If they didn't have insurance, they would come to our ER because we'd cover them. With the
"That's a win-win for us and for them. Trying to not tax our emergency services is important for us because we have a small staff that covers 24/7/365, and then they also have to cover all the 8-a.m.-to-5-p.m. operations that we do. So if we can help doctors sleep at night and work more during the day, everybody's happier, including the patient."
King said he's seeing fewer people pushing off care because they can't afford it.
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"It's that cowboy attitude. They don't like debt. They like taking care of themselves, and if they can't pay for something, they don't want to go in and incur debt. We would see them in the ER and they should have been in the clinic the week before."
Again illustrating how different each hospital and community is, Gleason in
One true constant across all rural hospitals is the economic role they play in their communities.
"One of the bigger things to look at is the chunk of the economy of White Sulphur that's paid for by Mountainview," said
The hospital employs 16 percent of the working class in
John Kelly, a 69-year-old veteran, was drinking coffee on Thursday morning at the soda fountain he owns in
"We all want the hospital to stay. I vote for every levy. It's a lot better than going to
Gleason said it's unclear what the future holds.
"Nobody really knows exactly what's going to happen at this point. I think the Affordable Care Act as it is right now is kind of collapsing in on itself and there needs to be some changes to it in order to keep it from happening. What those changes would be, I can't tell you. But it's really not working."
King said if expansion goes away, keeping small facilities like the ones in
"I can't say it's going to close all the critical-access hospitals; that's probably not the case. But it's going to make things more difficult."
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