Guest Editorial by Tim Size, Executive Director, Rural Wisconsin Health Cooperative, Sauk City and Past NRHA President
This is not a monthly test of your outdoor warning siren. I have worked in rural health for over thirty years. We have never faced a situation as threatening as the federal cuts that may hit rural hospitals. Senator Tom Coburn (an Oklahoma Republican) speaks for many when he said he understands the need to be careful when scaling back government spending. As he told Fox News, “to continue to waste $350 billion a year in the federal government, that’s pure waste or fraud or duplication.”
Waste is often in the eye of the beholder. From my point of view, a strong rural health system is not “waste or fraud or duplication.” America’s rural hospitals are the foundation of health care being local, not just urban. America’s rural hospitals are often at the center of a rural community’s economy. Weakening or eliminating rural hospitals weakens or eliminates local access to health care and local jobs. I am hopeful that Senator Coburn and other Members of Congress from both parties remain solidly behind rural hospitals. But it is clear that the debt crisis is fertile ground for the surfacing of longstanding anti-rural bias and or plain misunderstandings. In particular, rural hospitals seem to be in the crosshairs from a variety of directions.
After decades of trying to make an urban-based model of Medicare funding for rural hospitals work, Congress created the Critical Access Hospital program to create a stable network of rural hospitals throughout rural America. That success is now being threatened by a variety of proposals, ranging from eliminating some hospitals, across the board cuts or eliminating the entire program. There is a risk of rural communities being divided from one another, seeing less threat in one proposal versus another. I can only say that when your house is threatened by fire, it’s not the time for talking about which parts to protect and which to let go.
We know that most rural hospitals are financially just holding their heads above water. Under-payment by government programs has left them vulnerable. A sluggish economy and an increasingly competitive health care marketplace are taking their toll. Medicare and Medicaid are rural hospitals’ largest payers. Additional cuts are likely to tip many rural hospitals into the red and eventual closure. No one knows what is going to happen in Washington over the next few months. As the Serenity prayer teaches us: we need to have the courage to act, the patience to endure and the wisdom to know the difference. I hope for most of you, you will find this a time to act.
Go to NRHA’s Congressional Action Kit where you can easily find the phone, email and fax information for your Senator and Representative. Let them know of your deep concern for the future of rural hospitals and that you are asking them to stand with you and fight to protect that future for rural America.