On April 3, municipal ballots in Iron County, about 90 miles south of St. Louis, will ask voters whether to approve a half-cent sales tax. Its purpose is to raise about $350,000 a year for the Iron County Medical Center in Pilot Knob. In a sign of how badly it needs the money, the county’s hospital district declared bankruptcy last month.
These are desperate times for the nation’s rural hospitals, squeezed by rising costs, a shortage of doctors and a limited patient population made up of people who often are older, sicker, poorer and less likely to be insured than those in urban areas. Rural hospitals are having trouble keeping their doors open.
Some 1,825 of the nation’s 4,840 community hospitals are in rural areas. Since 2010, 82 of them have closed, three of them in Missouri. The National Rural Health Association says 700 more could close within the next 10 years. A handful of rural hospitals have sought bankruptcy protection.
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It’s even tougher in states like Missouri that opted not to expand their Medicaid programs under the Affordable Care Act. In addition, rural counties tend to have few companies offering employer-paid health plans. Counties with older, sicker and sparser populations have trouble attracting private insurers offering policies on the Healthcare.gov marketplace.
The result, for the Iron County Medical Center, is difficulty filling the hospital’s 15 beds with people who can pay for their care. Private insurance companies won’t cover all of the costs, which results in a lot of uncollectable debt. The center can bill Medicare patients’ debt to Medicare, but not all of it is covered. Patients are often too poor to pay it, so the hospital winds up owing Medicare millions of dollars for unreimbursed costs.
In January, Joshua Gilmore, chief executive officer at the Iron County Medical Center, told The Mountain Echo newspaper in Ironton that the hospital was $7.6 million in debt at the end of 2017 and was losing about $70,000 a month.
The hospital has qualified for federal programs and grants. It has brought in cost-cutting experts. But even if the sales tax referendum passes, the hospital will still be in the hole. A county of 10,600 people can’t generate enough retail sales to cover its share of the catastrophe of rural health care delivery in America.
President Donald Trump, who got 74 percent of Iron County’s vote in 2016, has undermined Obamacare’s health insurance marketplace. The GOP Congress has talked about cuts to Medicare and Medicaid. The Republicans who Iron County sent to Jefferson City and Washington voted against programs that would have helped. Places like the Iron County Medical Center are where all the hot air about the American health care system comes face to face with the reality that the local vote wrought.
