It Will Take National Single Payer to Save Rural Hospitals

After 30 years of service to a rural Nebraska community, the Curtis Medical Center will close.  Troy Bruntz, CEO of Community Hospital which owns the Center, announced that the cuts to Medicaid in the budget reconciliation act of 2025 were the immediate cause.  Those federal budget cuts have “made it impossible for us to continue operating all of our services, many of which have faced significant financial challenges for years,” said Bruntz. 

The closing of the Curtis Medical Center is just the beginning of the projected damage.  About 15 million are expected to lose health care coverage from the Medicaid cuts and other provisions in the budget reconciliation bill passed on July 4.  

In addition, the Shep’s Center, a North Carolina rural research institution, predicts that 338 rural hospitals will close leaving vast holes in rural health care.

But before the new cuts kick in (conveniently, most take effect after the midterm election in 2026), rural health care is already in terrible shape.  Rural Americans live sicker and die younger than the rest of the country.  On average their lives are cut short by 3 years.  

Now this massive hospital closure in our future threatens to make a failed system worse.  Studies show that when a rural hospital shuts down, the mortality rate rises by 5.9%!  

There have been 153 rural hospital closures since 2010—that’s the year of the passage of the Affordable Care Act that was supposed to assure coverage and care for everyone.

It’s not just that with the hospital closings residents will have to travel longer and farther for care, a life-threatening circumstance especially in emergency conditions.  When the hospitals close, health care workers lose their jobs and the economy of a town can collapse.  

“It’s almost like the apocalypse happened,” Mayor Sheldon Day of Thomasville, Alabama, said of the closing of that town’s hospital.  “Every rural community in the country is facing this battle,” he said.  “But closing hospitals is not an option.  If you don’t have basic health care, you’re going to kill your community.”  The Thomasville hospital closed twice, and its future is currently uncertain.

Williamson is a town of less than 3,000 in West Virginia just across the Tug Fork from Kentucky.  Williamson Mayor Charlie Hatfield puts it another way.  “When you lose your community hospital,” he says, “tumbleweeds.”

This coal mining region of southern West Virginia and eastern Kentucky is home to the 14 Appalachian Regional Hospitals.  They were built by the United Mine Workers of America to serve a neglected region.  Coal mining families of the area feel a special bond of ownership to these hospitals.  Every family lost someone in the mines or in the wars to organize the union whose Health and Welfare Fund made those hospitals possible.   As coal operators sacrificed the life and limb of miners on the altar of profit, making little health care available, it was the UMWA that stepped up to fund the hospitals. 

When the roving picket movement of the early 60’s sought to bring the union back to unorganized mines, they gathered at their hospital in Hazard.  As one miner put it, “Those are my bricks.”  Now 9 of those 14 hospitals are on the Shep’s list of those at-risk for closure.

Dr. Kenneth Williams, an internal medicine physician, is a local hero in Holly Springs, a town of 7,000 in northwest Mississippi not far from the Tennessee border.  In 1999 when the town’s hospital was slated to close, Dr. Williams gathered the forces to purchase the hospital, saving it to serve the 38,000 people of Marshall County.  

“You have to be there for your community and the patient. It’s not all about the dollar. you have to fight for them,” said Dr. Williams.  

Now the battle to save the hospital rages again.  The privatized plans called Medicare Advantage are growing in rural areas and have gained a majority of Medicare patients in the country.  These profit-centered plans routinely deny coverage for necessary care, threatening the financial existence of struggling rural hospitals.  Referring to the Medicare Advantage plans, Dr. Williams said:  “They don’t want to reimburse for anything—deny, deny, deny.  They are taking over Medicare and they are taking advantage of elderly patients.”  

Now Dr. Williams’ Alliance Healthcare System in Holly Springs, with 3 years of negative margins, is among the 8 Mississippi rural hospitals on the Shep’s list of those threatened with closure. 

It’s not that legislators have been unaware of the crisis.  Many in congress hail from rural areas and have pushed a number of solutions.  They have created the Critical Access Hospitals, Sole Community Hospitals, Medicare Dependent Hospitals, Rural Emergency Hospitals, and other categories enhancing the payments from publicly-funded programs, mostly Medicare.  The effort is pitifully inadequate.  Even with additional funds, about half of the Sole Community, Medicare Dependent, and Low-volume Hospitals had negative margins in 2023.

Of the 1300 Critical Access Hospitals, all of which get additional funding, 20% are at immediate risk of closing, another 20% at risk in the next 5 to 7 years, and 60% had an operating loss in their last fiscal year. 

Patchwork plans to shore up the problems created by a profit based health care system are not working.  They cannot be made to work.  Period.  The Medicaid and Medicare public plans created to fill the chasms left by private insurance are now controlled by the profiteers and have become the main source of filling the coffers of the insurers. 

Our country must abandon the foolish notion that healthcare and insurance corporations can be regulated into acting in the public interest.  They don’t strive to serve rural farm families and workers nor the urban residents who live on the wrong side of the tracks.  They locate in the wealthiest areas, avoiding the rest of us.

So long as our health care is in the hands of these corporations, that long will the rural hospitals be abandoned.  The miserly $50 billion that congress added for rural hospitals for 5 years beginning in 2026 is miniscule when compared to the $84 billion that the Medicare Advantage plans are overpaid annually out of public Medicare funds.

Private insurers gouge the employer-based plans as they loot the public plans, storming through the land like a Kentucky tornado leaving destruction in its wake.

A health care system based on private companies that must operate in the interest of their shareholders rather than in the interest of their patients or the public can never bring us a humane, ethical health care system.  Corporate law insists that they serve the shareholders.  They cannot be regulated into morality.  They must, by law, work to maximize profit.  The actions that promote profit also deny, delay and avoid care.  Health insurance companies, by their nature, are detrimental to the health of the nation.

We have a failed health care system.  So says the prestigious Commonwealth fund.  The U.S. health care system costs us twice as much per person as other wealthy nations pay.  It abandons over 100 million to medical debt.  It placed the U. S. in 2023 at 55^th in the world in life expectancy just below Panama and Albania.  A new study predicts that the U. S. will drop to 66^th in life expectancy by 2050.

The U. S. comes in last among comparable nations at saving the lives of patients whose conditions are amenable to treatment.  The health care system is destroying the health care workforce and the health care infrastructure.  It leaves a majority who forego care because of cost.  It leaves us defenseless in the face of pandemics yet to come.  It is killing us.

To save the rural hospitals—and to save ourselves–we must lift up a demand equal to the crisis we face.  End profit in health care.  Enact a national single payer plan, an enhanced Medicare for All, free from profit and covering everyone.  Nothing less can save the rural hospitals or heal the nation.   

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