Penny Blue was walking up the stairs of her Union Hall, Va. home in 2013 when a blood vessel burst in her brain. "I actually felt the pop in my head when it happened," she told USA TODAY. After sitting down and calling an ambulance she was quickly on her way to the closest hospital 15 minutes away, where she was stabilized. She was flown by helicopter to Roanoke Memorial hospital and remained in intensive care there for 13 days. If the same thing happened again, Blue might not be so lucky. 83967502007 If the rural hospital down the road were to close, the closest hospital would be at least an hour away in Roanoke. The 65-year-old said she has looked at the statistics of what her chances of survival and quality of life would be if she had to go that far. They aren't good. "Time, minutes and seconds, make a difference whether you live or die and your recovery, if you live, the quality of your life," Blue said. Her concerns are not idle. Rural hospitals like the one near her were already struggling financially beforePresident Donald Trumptook office in January. But the GOP tax and spending bill signed into law July 4 has made their problems far worse, hospital executives and health care experts say, and will likely speed up closures nationwide. Trump has said he's only cutting "waste, fraud and abuse" from Medicaid, the government insurance program for older people and those with disabilities. But those cuts will force states to make up the funding gap at a time when they are already strapped for cash or allow their rural hospitals to close. "The federal government has put us in a terrible and painful position," Colorado state Sen. Dylan Roberts, a Democrat, told USA TODAY. Rural Americans historically rely on Medicaid more than people in densely populated areas. And rural health care providers and facilities often need Medicaid reimbursements to stay open. Advocacy groups estimate that 700 rural hospitals ‒ about one in three ‒ as well as many rural clinics and nursing homes are at risk of closing in the next few years. Anestimate from KFFpredicted the cuts to federal Medicaid spending approved in the new law would exceed $155 billion in rural areas over the next 10 years. A majority of these at-risk hospitals and clinics are in Republican-held House districts, according toa mapcreated by the advocacy group Protect Our Care. Blue, who shows no outward signs of how close she came to death more than a decade ago, is frustrated by politicians who tell people in rural communities not to worry about the hospitals and clinics that could close because of their decision. "(Don't) tell someone that has an aneurysm not to panic … when every second counts," Blue said. Cuts to Medicaid and SNAP won't fully take effect until after the 2026 midterm elections, but health care systems often budget a year, or even two years into the future and closures have already begun. In southwest Nebraska, McCook-based Community Hospital said the day before Trump signed the bill into law thatit would shut downits clinic in Curtis, a town of about 900, citing financial challenges, including the incoming Medicaid cuts. Hospitals are also weighing whether more people will choose to go without health insurance when some premiums spike this fall. The law ends the Obama-era Affordable Care Act's enhanced premium tax credits, meaning the 24 million people who get insurance through the Affordable Care Act's marketplace will almost certainly see a spike in costs. "There are lots of hospitals in rural and low-income areas that have been operating at very slim margins for a long time, and they are looking at a coming health care cataclysm that begins this year," said Connecticut Sen. Chris Murphy, a Democrat. Ananalysis of hospital's financial vulnerabilitydone by the Cecil G. Sheps Center for Health Services Research at the University of North Carolina identified hundreds of hospitals across the country that could close, with the biggest number in Kentucky, Louisiana and California. On Aug. 7, Providence health system announced plans to close clinics, therapy and rehabilitation programs across two counties in Washington State,citing "multiple pressures," including state and federal Medicare and Medicaid cuts and higher costs due to inflation and tariffs. "These headwinds will only intensify when the cuts to vital safety-net programs that were included in the recently passed HR1, also known as the One Beautiful Bill Act, go into effect," the health care systemsaid in a statement. Responding to bipartisan concerns about the future of rural hospitals, the Senate added $50 billion in funding for a new "rural health transformation program." The fund will distribute $10 billion a year for five years, with half divided equally among states that apply. The Centers for Medicare and Medicaid Services has authority to distribute the rest. More:Will Rural America give up on Trump? These small-town activists think so. The law doesn't require the money to only go to rural hospitals, though and several of the nation's largest medical groups say it will not be enough to compensate for the Medicaid cuts, rising number of uninsured and new limits on payments. The White House and congressional Republicans have said the fund will protect rural hospitals. "Rural hospitals are going to be fine," Senate Majority Leader John Thune, a Republican from South Dakota, toldFox News' The Story With Martha MacCallumJuly 9. "We put a significant reinvestment into the bill to help out with rural hospitals in the event they're experiencing financial issues as a result of any of the changes that have been made." Roberts, the state senator from Colorado, said his rural constituents approach him constantly about what will happen if their clinics and hospitals close. He's keeping a close eye on mental health, dental and other specialty clinics in the poorest and most rural areas of his district, which he said will be the "canary in the coal mine." "It's going to hit everybody and a lot of these clinics were already operating on the margins before this bill passed, so they are certainly scared about what's next," he said. In Craig, Colorado, the 9,060-person community is transitioning from coal mining to a more diverse economy. "People don't stay if there is a not a hospital. It's crucial to transitioning a community like that and making sure it can remain a vibrant place," Roberts said. The local hospital closed their OB/GYN and maternity practices a few years ago, meaning women already have to drive an hour to Steamboat, Colorado to give birth. Roberts said the hospital has told him they are considering closing other practices as well. More:'Catastrophe': States scramble after Trump's cuts to Medicaid, SNAP In an effort to staunch the expected bleeding, Colorado created a provider stabilization fund with $25 million for each of the next two fiscal years. "It will be helpful, but it will in no way make up" for up to $800 million in Medicaid the state expects to lose every year, Roberts said. Michigan Senate Appropriations Committee Chairwoman Sarah Anthony said the future of rural hospitals was a "jarring" and "tense" part of a recent two-hour committee hearing. Michigan expects the cuts to create a $5.6 billion hole in rural Michigan's budgets over the next decade, she said. States are already grappling with a host of responsibilities the federal government has handed off, including paying a portion of food assistance benefits for the first time. Anthony said there is "no world in which we have enough" to fill that hole as state lawmakers. "What can states do to mitigate harm? There really isn't much," she said. A hospital, clinic or nursing home closing is an entire community issue, retired nurse Denise Parashac, 70, of Plains Township, Pennsylvania told USA TODAY. "Having that rural hospital in that area is really a life saver," she said. Politicians talking about using the cuts to trim waste and abuse from Medicaid may not be thinking about the "dire situation" those cuts mean for people in nursing homes, Parashac said. Medicaid is the largest payer for long-term care facilities, paying formore than 60% of thosein nursing homes nationally. When rural nursing homes close, the patients often have to move in with family who don't have the skills and training to provide round the clock care to people at the end stages of their lives, she said. When a community loses its local hospital, it puts more stress on other area hospitals, Parashac said. They will be more crowded, patients will skip care until a health problem becomes more serious and harder to treat, and the health providers that remain will have a harder time recruiting staff, Parashac said. "There's really a snowball effect," she said. This article originally appeared on USA TODAY:Rural America braces for hospital closures after Medicaid cuts
