Struggling rural hospitals will need Iowa’s help after ‘big, beautiful bill’ takes its toll

Now that Congress has sent the “big, beautiful bill” to the president’s desk, our focus needs to turn to how we handle the aftermath of its implementation.

We already know that in Iowa, at least 20 rural hospitals are seriously threatened with closing and six are almost certainly gone. The problem is greater than hospitals closing or individuals being denied immediate, necessary medical care. The impact is going to be felt by the communities that are home to those medical care centers.

Our challenge will be, as a state, how we handle the impact of loss for many of those on Medicaid coverage, and the drastic cutbacks on the Supplemental Nutrition Assistance Program. The real proof of the magnitude of the problem is that nationwide, 70 million people are on Medicaid and 40 million are beneficiaries of SNAP.  Furthermore, the effect is even greater in rural states.

Our first concern must be for care centers and hospitals.  Hospitals are rather mysterious places by design. This is because the nature of the work is confidential. Everyone is entitled to privacy when treated medically. In addition, the institution funding is a total dark web with government payments, insurance coverage, write-offs, etc.  So, they exist somewhat in isolation from the rest of town.

But the individuals who work at hospitals are not a secret. They are your neighbors, shop at the same stores, serve on their church communities, coach the little league softball and baseball teams, send their kids to our schools, and take a place on the school board or city councils.

But when the hospital closes, they will be different because (a) they will be unemployed and (b) they will find work someplace else.  It is not just the medical staff, nurses, doctors, techs, and the bookkeepers who chase the insurance companies for reimbursement (may God have mercy on their souls), but the electricians, the administrative staff, and the janitors, all or most who will be moving on and taking their kids out of the rural public schools.

We need to face the reality of the situation now.  The impact of this legislation is going to affect more than the patient.  It is a body blow not only to employees but to the very town in which the hospital resides. Yes, the bill includes $50 billion for rural hospitals affected by Medicaid cuts. It’s not nearly enough.

The solution isn’t rocket science. Rural states, like Iowa, are going to have to find money to replace the lost revenue from a former Medicaid patient who shows up at the hospital for treatment without insurance coverage. Both Iowa law and most hospitals’ mission statement requires that the patient receive treatment.  This may surprise the proponents of kicking patients off Medicaid, which flies in the face of their belief that if coverage is cut, then people would just decide not to get sick.) We can’t just lock them out.

The approach needs to be systematic and focused first on the rural hospitals most at risk. We need to examine and reduce or eliminate the cost of a rule, regulation, or statute that is not essential to the practice of good medical care.

The utility costs of the individual institution should be examined and either the state or the utility should determine whether the fees charged can be reduced or even eliminated. It is better to have less revenue from the cost of the operation of the buildings than none.

The mission and resources assigned to the Iowa Economic Development Authority should be amended to target rural health care.  The state’s entire economic development budget, which goes to various agencies, is about $40 million for next year (and should be increased). While it is great to lure foreign business entities to our state or convenience those that are departing, our first priority should be state resources for Iowans first, then others. The truth is that a hospital in a smaller community is an asset and should not be thrown out because of this legislation.

Those are a few of the steps that we can take to overcome these new laws. I reason that if towns like Marshalltown, Greenfield, Parkersburg and others can overcome and rebuild after tornadoes, we can do the same with this economic windstorm.