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Opened in 2006, the Iron County Medical Center in Pilot Knob is now $7.6 million in debt and is operating under protection of the federal bankruptcy court. 

Regarding David Nicklaus’ column “USDA stands in rural hospital’s way” (June 25): This column is an alarming indictment of the Department of Agriculture’s misreading its mandate to address quality-of-life issues in rural America. But Nicklaus ignores the larger context of Missouri’s rural health care crisis. While allowing that five rural Missouri hospitals have closed since 2010, Nicklaus concentrates on Iron County Medical Center in Pilot Knob, which could become the sixth to close.

Referring to the USDA, Mr. Nicklaus is wrong in concluding: “Of all the government agencies with a stake in the case, the only one not focused on keeping the hospital alive is the one that’s supposed to promote the quality of rural life.”

This lets the Missouri Legislature off the hook for hastening the closure of these rural hospitals. By refusing federal funding to expand Medicaid benefits under the Affordable Care Act, our lawmakers are robbing rural Missourians of access to health care. They are robbing rural hospitals of the revenue they need to survive and robbing rural towns of the economic benefits of a regional health care facility.

It’s easy to blame the anonymous USDA bureaucrats in far-off Washington, D.C., for the plight of Pilot Knob’s hospital. My questions: Where are state Sen. Gary Romine and Rep. Chris Dinkins, who represent Pilot Knob in the Missouri Legislature? And why do the good citizens of Iron County elect Republicans who refuse to champion accessible health care for their constituents?

Andy Ayers • St. Louis