In the fifth installment in its yearlong series No Mercy, Kaiser Health News continues to follow "how the closure of a beloved rural hospital disrupts a community's health care, economy and equilibrium."
In this installment, KHN describes how the Fort Scott, Kansas, community is attempting to close treatment gaps caused after the community's Mercy Hospital closed a year ago. Luckily for the people of Fort Scott, a federal qualified community clinic was still there, and the town's few physicians stayed. A hospital in a town 30 miles away took over emergency room operations at Mercy, at least for the time being.
Mercy is one of 120 rural hospitals that have closed across the country since 2010. Another 21% are endangered, according to one analysis of Medicare cost reports. Many are in states that refused to take Medicaid expansion, where the promise of universal coverage under the Affordable Care Act was shot down by a Supreme Court that decided states could make political decisions about whether to take it or not. "Frankly, it's not getting better," said Dr. Daniel DeBehnke, the study's co-author, told NPR.
There are grants the community health center in Fort Scott could get to cover the uninsured, but they haven't relied on them yet. It gets a higher government reimbursement rate for Medicare and Medicaid patients than Mercy Hospital did, so that helps pick up some of the slack. It’s maintaining basic levels of health care for the community, though it has required adjustments for everyone living there in planning their care, particularly for pregnant women who have to plan to deliver at the hospital 30 miles away. If labor starts unexpectedly, they have to visit the emergency room there in town.
But the ramifications of hospital closures are much larger for these communities. NPR reported, "Within weeks of Mercy's closing, a newly built $9 million grocery store closed. A few weeks later, the cancer center closed, and by October, the town's dialysis center had closed too." When the hospital closed, a lot of jobs went with it. One former employee of 27 years, Roxine Poznich, says she's using credit cards to buy her groceries as she tries to make a living from her bookstore. The town, though, is lucky to have a window and door manufacturing plant that employs about 400 people. That means Mercy wasn't the biggest employer for the area, while medical centers in small communities often are.
Most rural hospital closures are in those states that didn't take Medicaid expansion. The ACA changed reimbursement rates and federal support for smaller hospitals on the assumption that Medicaid funds from expanded coverage would replace them. Thanks to the Republican lawmakers and governors who decided poking the nation's first black president in the eye out of pure spite was worth making their constituents suffer without health insurance, and even without their hospitals.