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Federal spending on rural health care is uncertain and rarely discussed

Regional hospitals provide critical services and are economic engines
Rural health care providers face a constant battle for federal dollars needed to keep hospitals and clinics open.

WASHINGTON – Representatives of Colorado’s rural health care providers met with their senators and representatives in Washington this week to garner support for the Save Rural Hospitals Act.

The legislation would reverse strict federal regulations that rural hospitals must meet for payment, as well as eliminate other Medicare and Medicaid reimbursement cuts that lower payments to hospitals.

Colorado providers attended the Rural Health Policy Institute hosted by the National Rural Health Association, which provides support for rural health facilities.

Rural facilities can include large hospitals, Rural Health Clinics and Community Health Clinics.

“Health care infrastructure in a rural community, we really think, is the hospital and rural clinic,” said Michelle Mills, CEO of the Colorado Rural Health Center. “If they aren’t there, usually the town dies because of the fact that they are one of the largest employers in town.”

In La Plata County, Mercy Regional Medical Center in Durango is the largest private employer and provides more than 1,350 full- and part-time jobs. Neighboring Montezuma County, more rural by comparison, is served by a single Critical Access Hospital – Southwest Memorial Hospital. Critical Access Hospitals are small hospitals that rely on federal funds to operate.


“When I talk to people, no one seems to oppose (the act),” Sen. Cory Gardner, R-Colorado, said after a speech at the NRHA conference.

Health care providers in rural areas deliver treatment to populations that tend to be older, sicker and poorer. The cost of care is high, as is the number of patients qualified for Medicare and Medicaid. This means that rural hospitals rely on Medicare and Medicaid payments to stay profitable.

“If (Medicaid) gets cut, we definitely will see hospitals close in Colorado,” Mills said.

According to the CRHC, one-third of the La Plata County population qualifies for Medicare and Medicaid. In Montezuma County, more than 50 percent of residents use the safety-net programs, with 35 percent qualifying for Medicaid, CRHC’s data shows.

The pair of programs survived potential funding slashes in 2017 when efforts to repeal the Affordable Care Act failed and again when Republicans took out language from their tax overhaul that would have cut the programs.

At Mercy, 65 percent of patients use Medicare or Medicaid. Between the two safety nets, the medical center had $45 million in patient care costs that exceeded the reimbursement payments received from the Medicare and Medicaid services, said Mercy spokesman David Bruzzese.

Last year, 12 rural Colorado hospitals operated at a deficit. Mills said she expects that number to go up.

“Death by all of these cuts is a big part of the problem,” Mills said. “With the high amount of people on Medicaid in our rural communities, it’s a huge concern.”

Because of their status as sole provider and largest employer, rural health facilities paint themselves as an essential part of community infrastructure. Both political parties in Washington have highlighted infrastructure spending as party priorities in 2018.

Spending on bridges, roads and waterways dominate party platforms with sparse mention of rural health facilities. An eight-page White House infrastructure outline for $1.5 trillion in spending makes no mention of rural health facilities. Inserting these facilities into the conversation will be a challenge going forward, Mills said.

“(Medical facilities) are critical as a part of a rural community,” Mills said. “It’s not like in Denver where there’s a hospital on every corner so you can just go to another one.”

Gardner echoed the sentiment in a speech to the NRHA conference.

“Denver has more construction cranes in the sky than New York and LA,” he said. “But it’s places like the Eastern Plains and the Western Slope that continue to suffer.”

Colorado politicians in Washington have also sought to expand internet broadband in rural communities, where residents either have no connection or slow connection. Gardner introduced a bipartisan bill Thursday that would reduce regulation on states, companies and places wanting to build broadband infrastructure on federal land. Rural providers would benefit from the expansion.

“We have some hospitals where it will take hospitals four hours to upload data because the bandwidth speeds are so low,” Mills said.

La Plata and Montezuma counties are also considered Medically-Underserved Areas, meaning the counties don’t have a sufficient number of primary care providers or have a significant low-income population. Expanded broadband in areas lacking doctors would mean greater access to telehealth, allowing Coloradans in rural communities to avoid long commutes to doctor appointments.

“People, ultimately, don’t have what they need to be able to connect in a lot of our rural communities,” Mills said.

Community Health Centers, another essential rural provider, were victims of fiscal discord on Capitol Hill in the past few months, as their funding lapsed Sept. 30. Early Friday morning, Congress passed a two-year funding extension for CHCs – positive news for the three centers in Southwest Colorado.

With failed efforts to repeal the Affordable Care Act, efforts to gut Medicaid and Medicare funding and lapses in critical funding, rural health facilities in Colorado continue to operate in clouds of uncertainty.

“It’s unsettling for the health care community,” Mills said. “They just don’t know what’s going to happen. It’s really hard for the financial sustainability of the community.”

Andrew Eversden is an intern for The Durango Herald and a student at American University in Washington, D.C.

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