If you have ever felt stress after passing a highway sign warning, “No gas next 90 miles,” you understand the importance of my hospital. I am the chief executive of Lincoln Health, a 25-bed county-owned hospital in Hugo, Colo., a town of about 800. We are the only hospital on the I-70 corridor between Denver, 85 miles to our west, and Burlington, near the Kansas state line, some 80 miles to the east.
In 2021, a pileup involving dozens of cars on that highway brought more than 30 patients to our two-bed emergency room, where our small staff sprang into action to stabilize the most seriously injured patients. Our hospice team met with the family of a child who died at the scene of the accident. One fatality is too many, but without our hospital, there surely would have been more.
Nearly 200 rural hospitals have closed in the past two decades — the result of financial strain and staff shortages — but my hospital has been able to keep its doors open through sheer perseverance. Now, however, Congress is considering cuts to Medicaid that could wreak havoc on rural America’s fragile health care system. I worry about our future.
One proposal would reduce the portion of Medicaid dollars the federal government gives to states, such as Colorado, that have expanded Medicaid eligibility. Another would strictly cap federal payments to states, regardless of geographic differences in the cost of care.
Cuts to Medicaid could hurt the finances of hospitals across the country, but rural hospitals will be particularly affected. This is because rural patients are more likely to have health coverage from the government than from commercial insurers. (Nearly three-quarters of our revenue, for example, is from Medicaid and Medicare.) These programs are essential, but, unlike commercial insurance, they don’t always cover the total cost of care, which has been rising as drugs and supplies become more expensive. We also serve fewer patients than big city hospitals but still have fixed costs to stay operational. The result is that we run on minimal or negative operating margins.
According to the Colorado Rural Health Center, the state’s nonprofit office of rural health, roughly half of my state’s rural hospitals are operating in the red. Yet we’re relatively lucky: Colorado’s decision to expand Medicaid in 2014 has been a lifeline for us because it reduces the number of patients we see who can’t pay.
Our neighbors in Kansas and other states that have not expanded Medicaid are in worse financial shape. Other states have so-called trigger laws that will automatically stop their expanded Medicaid programs in the event of federal funding cuts. If these cuts happen, more rural hospitals will close, leaving the communities around them without access to health care and devastating their economic base.
Many of the services my hospital provides — primary care, a nursing home and assisted living, medical transport and hospice care — are not lucrative, but they are necessary. Before we opened an X-ray clinic in a remote area, residents would make deals with the local veterinarian for imaging. Cancer patients drove close to two hours for chemotherapy until we opened a small infusion therapy service.
But, despite our best attempts, we cannot offer all the services our community needs. No rural hospital can. Case in point: Lincoln Health stopped obstetric services nearly 20 years ago; we could no longer recruit specialists to attend to a shrinking number of births. Since then, at least two of our hospital employees have given birth alongside the highway while trying to make it to the nearest labor and delivery ward 85 miles away. We do what we can, encouraging obstetricians to come from Denver or Colorado Springs to provide prenatal care to our patients.
And inevitably, our doctors do end up delivering babies when local residents or travelers on I-70 show up at our door, too far along in their labor to make it to a bigger hospital. It’s not ideal, but it’s far better than having no care.
The proud conservative residents of our community often feel left out of Colorado’s more liberal politics. Our voices never seem to be as loud as those in the metro areas of the state. And yet, with the looming threat of Medicaid cuts at the federal level and budget proposals that would cut rural health care, we’re wondering if our voices are heard at all in this Republican administration and Congress. The nation’s food and fuel are sourced in rural areas. Supporting rural communities should be strategically important, and they can’t thrive without health care.
I know the financial peril my hospital will face if our Medicaid lifeline is severed. But the real damage — the kind that keeps me up at night — will be done to the hardworking people in my rural community. I worry about the residents of our nursing home who just want to grow old here. I worry about the people in Hugo who might forgo care entirely because they can’t get the time off work to visit a Denver hospital.
Forty percent of the children we see are covered by Medicaid. How will I break the news to their families that they may no longer have access to essential pediatric care? Who will take care of the next big highway accident victims? The list goes on.
Policymakers say they want to eliminate waste, fraud and abuse from Medicaid, but the cuts on the table go far beyond that. When Medicaid pays less or covers fewer people, it doesn’t mean we stop seeing those patients or incurring costs. Hospitals are obligated by law and our own ethics to care for any sick patient who shows up in our emergency room. Big hospitals may have enough clout to negotiate with insurance companies and raise their prices, shifting the cost onto privately insured patients in the form of higher premiums. Hospitals like mine often can’t shift those costs. We cut services, or we close.
I understand the motivation behind addressing waste where it exists. But I don’t see waste in Hugo. Rather, Medicaid ensures that primary and emergency care is still accessible here, and that drivers along I-70 will see the blue H on the highway sign and know that help is nearby.
Kevin Stansbury is the chief executive of Lincoln Health.
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