Almost 80 rural hospitals have closed across the country since 2010, and nearly 700 more are at risk of closing. These hospitals serve a largely older, poorer and sicker population than most, making them particularly vulnerable to changes in Medicaid funding.
During a yearlong reporting fellowship in 2017, reporter Bram Sable-Smith investigated the unique challenges facing these rural hospitals, and how changes in politics affected their communities. These stories won a health policy award from the Association of Health Care Journalists.
The GOP's American Health Care Act, proposed last summer to replace the Affordable Care Act, would have cut Medicaid by $834 billion. That would have been a problem for small rural hospitals like Pemiscot Memorial, which are disproportionately dependent on Medicaid. The hopsital serves an agriculture county that ranks worst in Missouri for most health indicators. Closing the county’s hospital could make those much worse.
For the nearly 700 rural hospitals in the United States on the brink of financial collapse, relatively small amounts of money can be the difference between life and death. There are variables that can strengthen their chances of survival.
Health policy researchers say the problem for rural hospitals is deeper than all those issues. Rural America’s dwindling populations make it nearly impossible to keep these community institutions afloat.
When Sarah Scantling went into labor this summer, she had to drive 30 miles and across state lines. Three years earlier, the only maternity ward where she lives in Pemiscot County, Missouri closed down.
It’s not uncommon for pregnant women in rural America to have to travel to give birth; the percent of rural counties without hospital obstetrics has increased in recent years to 54 percent, up from 45 percent in 2004.
Through a prescription drug discount program called 340B—named for the section in federal law that authorizes it—the Pemiscot County hospital in Missouri buys medicines at a steep discount from drug makers, sells it to local pharmacies and pockets the profits.
The drug discount program has become a financial lifeline for rural hospitals like Pemiscot County, nearly a third of which are struggling to keep their doors open. Now, a pending rule change may scale it back dramatically. It’s yet another hurdle for rural communities fighting to keep their healthcare local.
Bram Sable-Smith reported this series during a yearlong Reporting Fellowship on Health Care Performance sponsored by the Association of Health Care Journalists and supported by The Commonwealth Fund.