The shutdown looms large in rural America, where hospitals struggle
A battle on the financing of health care in Washington has repercussions in places such as the hills and hollows of the Blue Ridge of Caroline du Nord.
The federal government is in a closure, centered on the opposition of democrats to the cuts in health care programs. When the Republicans see the opportunity to reduce the size of the government, their opponents argue that the cuts will reduce access to Medicaid – and overturn to affect the viability of rural hospitals which are already financially stretched.
It is a key element of a larger national debate linked to the increase in health care costs.
Why we wrote this
Washington’s dispute on Medicaid has repercussions in rural communities, like Spruce Pine, North Carolina, where hospitals have trouble covering costs.
Here, in the mountain city of Spruce Pine, in North Carolina, the local regional hospital of Blue Ridge has the beneficiaries of Medicaid in large part of its patients. He ended up on a list of five possible state hospitals that could close, due to his financial losses in the past three years.
Since 1955, the hospital has provided emergency care – and until 2017, a birth center – in one of the poorest corners of the Appalachians, a fiercely independent and politically conservative area which voted almost 80% for Donald Trump in 2024 (the other nearest hospitals, one in Marion and one in Asheville, are at least half an hour and an hour of road, respectively.)
To collect the funds to open the hospital even, the volunteers went with door-to-door, collecting money.
“I am shocked that they plan [closing the hospital]”Said John Richardson, an octogenarian folk artist in Burnsville, in North Carolina. He says that such a decision would decrease health care options for itself and others, in a region where the long winding mountain roads would sail, especially in the rain or snow, is more than a little delicate.
Rural hospitals and mounting costs
Nationwide, 48% of rural hospitals operated on financial loss in 2023, according to the American Hospital Association.
“In total, 338 hospitals have experienced three consecutive years of total negative margins, serve the largest share of Medicaid patients, or both,” wrote Democratic Senator Ed Markey of Massachusetts in a letter in June, warning republican colleagues in the way Medicaid cuts would affect rural and hospitals.
Republican One Big Beautiful Bill, signed by President Donald Trump on July 4, contained several major changes for Medicaid, the federal state health program for low -income Americans. The bill has placed new conditions on eligibility, including work requirements and more frequent eligibility checks. It has also limited the capacity of states to use supplier taxes to finance their Medicaid programs.
As a deadline for funding, the government arrived on September 30, with bipartite support necessary for adoption, the Democrats refused to support a bill unless it has attenuated health care cuts, including reductions in Obamacare subsidies as well as Medicaid changes.
Government stops from this dead end.
While many experts in health policy are concerned about the challenges facing rural hospitals, the conservatives defend the objective of reforming Medicaid and limiting its costs to federal taxpayers.
“By strengthening the integrity of Medicaid by eliminating waste, fraud and abuse, its resources can be refocused to provide better care to those that the program has been designed to serve: pregnant women, children, disabled people, low -income elderly and other vulnerable low -income families,” said a white house information sheet.
A report by Paragon Health Institute, a conservative reflection group, maintains that an increase in health care expenses during the Biden administration was motivated by “the policies that prioritize registration at all costs in both [Obamacare] Exchanges and in the expansion of Medicaid. »»
A bipartite effort for rural communities
The Big Bill of the Republicans also created a fund of $ 50 billion to strengthen rural hospitals at risk, but some experts say that the fund is too small to meet the challenges adequately.
The spruce pine illustrates the type of small cities affected by the flow. With a population of approximately 2,000 inhabitants, he has just seen his first freight train in almost a year last week, while he recovers the floods caused by Hurricane Helene a year ago. When the resident Tricia Niven reopened her coffee damaged by the floods, Blue Ridge Java de DT, hundreds of premises presented themselves to celebrate.
Given the sensitive policy surrounding the government’s closure, Ms. Niven hesitates to speak. His only comment: “We need the hospital.”
This hospital is already in danger. An agreement between the State and Hospital Corporation of America, which maintains the regional hospital system of companies, should end in 2029. HCA made investments and created efficiency gains. But the state also continued it on low staff levels and service problems.
When the delivery center here in Spruce Pine closed its doors in 2017, it is partly because expensive care was not properly covered, since 40% of women who gave birth were leaning on Medicaid to cover payments.
Mergers and monopolies
Before authorizing the merger of two hospitals in Asheville to create the consortium which includes Blue Ridge, the price ceilings obliged by the Legislative Assembly. But before the resulting hospital mission group was acquired by HCA in 2019, the system convinced the legislature to remove these ceilings.
“This has in fact created a monopoly created by the government,” said Victoria Hicks, resident of Spruce Pine, who was part of a community effort to keep the hospital viable. “It is therefore a bird’s nest on the ground,” she said, referring to the hospital system that worked long before it was bought by HCA. Now she adds: “We have seen what is happening when you let a profit company operate in this kind of conditions.”
Many Medicaid cuts will only take effect after the elections in 2026.
By defending their position in the closure, President Trump and other Republicans have focused on allegations concerning unauthorized immigration and health care funded by taxpayers, through Medicaid in particular.
They say that Mr. Trump’s great bill has imposed new restrictions, that Democrats are now trying to return, on federal funding for emergency treatment, to reduce access to unauthorized immigrants. According to KFF, an independent group of information policy on approximately 1% of Medicaid emergency financing is taking care of these immigrants, mainly for birth costs, an independent group of health policy. And neither the previous federal law nor the current democratic proposals give unauthorized immigrants direct access to Medicaid.
But the Republicans claim that the Biden administration has granted parole to a massive number of immigrants – making them eligible for health care funded by taxpayers and the fight against the system.
Here in Spruce Pine, the idea that the fate of the hospital can be linked directly to national policy seems incongruous for some, given the long -standing importance of the installation for many of those who make these boxes of these appeals.
“I know that when I was a child almost 70 years ago, I remember entering and sitting in the waiting room and waiting for my parents who visited someone,” said Joann Laskin, resident for life. “It has always been very important for this area.”
