Worried about rural health care? So do many of your friends and neighbors

I’ve written about the “One Big Beautiful Bill Act” and the benefits it provides for farmers and ranchers in terms of farm program and tax provisions.

But it also makes big cuts in rural health care programs, the types of things that have historically been “make or break” for many small towns. Near the end of negotiations, Congress gave a boost to a new rural hospital fund in an attempt to remedy the cuts and win over the votes of some rural congressman and senators.

Let’s face it. If you don’t have access to health care, quality education and small businesses, many small towns die on the vine. Who wants to come home and farm, if you can’t raise your children in an area that has basic services?

I was fortunate to be born in a small town that actually had a hospital, even though many people in the area, including one of my older sisters, were born with an assist from a country doctor and midwives. That hospital is now affiliated with a major university hospital that’s about 30 miles away, now ensuring a quality network of doctors and surgeons.

Many of you are less fortunate. Doctors and even emergency responders are sometimes 100 miles away. The distance can be the difference between life and death.

Alan Morgan, CEO of the National Rural Health Association, recently visited about the state of rural health care, especially in light of the cuts to Medicaid hospital funding that were included in the OBBBA. He says it’s a challenging time for rural health nationwide.

“You’ve got challenges of just keeping the doors open of rural hospitals. We’ve had a rural hospital closure crisis. We’ve had nursing homes close. More than 500 have closed in the U.S. over the last 10 years, and you just got a challenge of providing high quality access to health care in these small towns. That being said, you really do have some good quality out there.”

He says one of the challenges rural hospitals face is the misconception that “rural” is a smaller version of “urban.”

“That’s a huge misconception. It is a unique healthcare environment, and that’s because your population is older, it’s sicker, it’s poor, you’ve got a higher percentage of elderly people, and you’ve got a higher percentage of people with high health needs, but in many cases, the inability to pay. And what we’ve done in hundreds of small towns across the U.S. is cluster these populations together, which makes it really difficult to operate healthcare, and in particular, keep hospital doors open.

Medical workforce issues impact farms, too

One of the big problems facing rural hospitals is finding people who want to live and work in rural America.

“If a young man or woman went through college and went through medical school and now they want to practice medicine, the big city and the bigger hospital pays more money than does a rural institution,” Morgan said. “That’s unstable from the very beginning.”

Fewer than 5% of the incoming medical students come from small towns, he said.

“You’ve got 95% or more of the incoming medical students coming from upper income urban families. They go to school in urban areas. They do the residency in urban areas, then we’re dumbfounded. They don’t want to practice in Flush, Kansas. It just doesn’t make sense,” Morgan said. We need to do a better job of making sure that our kids know there’s a future for them in health care.”

Morgan says, “You simply do not want to live in a community or work on a farm where you’re more than 30 minutes from a 24/7 emergency room a service. It’s just not safe.”

It also creates a situation where a lot of elderly have to move out of those communities, he said. And conversely, if you don’t have maternity care, you can’t get the young kids to move into those communities.

“So when you talk about maintaining 24/7 emergency room services and maintaining access to maternity care. You’re really talking about the future of rural America.”

Solutions evolving

Despite the challenges, Morgan says he sees some creative solutions evolving.

“What we’re seeing now, that I think is a great move, is rural hospitals and clinics networking, doing formal networking arrangements with other rural hospitals and rural clinics to be able to share purchasing power and other means to make sure that they’re viable, successful partnerships, whether formal or informal, with large institutions.”

Morgan says there are many different ways to make sure you maintain those access points, and having formal arrangements with large urban providers is one and a possible successful one. “But you just have to be careful that at the end of the day, you’re meeting the needs of the local community.”

Editor’s note: Sara Wyant is publisher of Agri-Pulse Communications, Inc., www.Agri-Pulse.com.