Voices: I’ve seen how rural hospitals save Utahns’ lives. Cuts to Medicaid threaten their very existence.

As a medical student, I have had the opportunity to work at a number of rural hospitals throughout Utah and across the Intermountain West. I was surprised to learn, however, that many rural hospitals not only serve residents of their rural communities, but also provide care to patients who do not live nearby.

During the month I spent in a small rural hospital in Idaho, for example, I helped take care of an impressive variety of maladies. Perhaps more impressively, my team cared for a startling diversity of patients — not just locals, but also tourists, travelers and seasonal workers. We evaluated a local lady who was feeling dizzy and also stabilized a man who was visiting the area when he got into a horrible car accident. We cared for a child with an asthma exacerbation from wildfire smoke — it was an especially bad wildfire season — and also sewed up a chainsaw laceration of a wildland firefighter who was deployed to the area to fight the fires. We performed an annual physical for a teenager ahead of his football season and also splinted the finger of a motorcyclist on a cross-country tour.

Rural hospitals are critical infrastructure for not just those who live in rural communities, but for people who ever visit a rural place. When we go on vacation, we expect that if we are injured or fall ill, there will be a hospital nearby. And for a state like Utah which counts on tourism, this is doubly important.

While working at the hospital in St. George, I cared for a patient who fell suddenly and severely ill while vacationing nearby. We took care of her in our hospital and she even spent time in our intensive care unit, but she ultimately recovered and was able to return to her home a few states away. While we hope that our vacations go smoothly and are not interrupted by illness nor injury, we rely on rural infrastructure if–and when–they are.

HR1, signed into law earlier this summer, made sweeping cuts to Medicaid spending, reducing spending by $911 billion over ten years and leading to an estimated 10 million people becoming uninsured in the next 10 years. These cuts disproportionately affect small rural hospitals, which typically serve a higher proportion of patients on Medicaid.

These hospitals often operate on slim margins, and many even operate on a deficit. Prior to the passage of HR1, many small rural hospitals were already being forced to cut services or closing altogether.

In response to political concern for disproportionate impacts to rural hospitals, the law also included the Rural Health Transformation Program (RHTP), a last-minute addition to the budget which appropriates additional funds for rural health. States individually apply for these RHTP funds to apply back to the rural communities which will be hardest hit by the cuts. Though it sounds promising, the RHTP is time-limited, only granting funds to states for five years, and comes with strict limitations on how funds can be used. The RHTP funding will expire before these devastating cuts will even be fully realized. Most importantly, the RHTP only includes $50 billion in funding over five years, which is a little over a third (37%) of the estimated loss of Medicaid funding in rural areas.

In other words, the cumulative effect of HR1 is to slash funding for rural health then offer back a third of the cut funding — with stipulations — as a consolation prize. It’s like a schoolyard bully stealing your lunch then making you beg for crumbs.

We do not close roads for being less-frequently travelled. Hospitals, like roads, constitute critical infrastructure which allow for people to live and play in rural communities across the country. Programs like the RHTP only partially offset the devastating cuts to Medicaid which will disproportionately affect rural hospitals.

Long term investment in rural hospitals is necessary to reverse the trend of rural hospital closure and to ensure that rural hospitals are there when we need them, even if we hope we never do.

Rachel Pernick is a medical student at The University of Utah School of Medicine. She was the first medical student from the U. to complete her clinical clerkship year based in Southern Utah. She is currently completing a clinical rotation with Utah Navajo Health System in Blanding, Utah, and hopes to practice primary care.

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