Staff Editorial

Rural hospitals in crisis

The main entrance and emergency entrance to the Washington County Hospital and Clinics in Washington, Iowa on Thursday,
The main entrance and emergency entrance to the Washington County Hospital and Clinics in Washington, Iowa on Thursday, Sept. 26, 2019. (Jim Slosiarek/The Gazette)

Iowa’s rural hospitals are in a crisis. New reporting out this week from The Gazette and Iowa Watch shows that across the state small rural hospitals are cutting services and shifting to outpatient care, just to stay alive.

It’s not just one single cause. Population declines, the difficulty of recruiting physicians, cuts to Medicaid reimbursement, hospital consolidation and competition have driven rural health care to a breaking point. States that rejected expanding Medicaid to all low-income adults under the Affordable Care Act were hit the hardest. Kirk Norris, CEO of the Iowa Hospital Association, told Iowa Watch, “For the first time in 30 years combined margins for Critical Access Hospitals are a negative 2.8 percent. Health care administrators will tell you that you need between 2 and 4 percent to be sustainable.”

Solving the problem will take a multifaceted approach from politicians on a state and federal level, hospitals, and insurance companies. But securing necessary health care access for rural residents is an issue that can’t wait and will take bipartisan leadership.

One of the proposed solutions includes expanding Medicare for all, which the majority of the Democratic candidates for president support. However, the plan has received pushback from hospitals and Republicans who believe that it will hurt hospitals who already struggle with low reimbursement rates. The Democratic counter argument is to increase reimbursement rates for rural hospitals. But the solution is contested in an election cycle that is revealing America’s deep divide.

Hospital consolidation is another factor compounding the health care crisis in rural areas. Sen. Chuck Grassley has called for increased oversight of nonprofit hospitals to make sure they are meeting the care requirements for their tax-exempt status. Sen. Elizabeth Warren has also encouraged increased oversight of for-profit and nonprofit hospital mergers.

Other solutions include rolling back regulations that were not designed for small facilities. These proposals allow hospitals to share the burden of facilities and maintenance with other health care providers.

In 2017, Grassley and Minnesota Sen. Amy Klobuchar introduced a bill that would allow small rural hospitals and critical access hospitals to be designated as rural emergency hospitals, allowing them special disbursement designation under Medicare.


When a rural hospital closes, it compounds the economic problems already facing America’s small towns. While all proposed solutions may not have bipartisan support, enough of them do that it’s imperative our elected officials take immediate action to stop the hemorrhage of health care from America’s rural areas.

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