Regarding rural healthcare

I initially felt like I should write a column about the President declaring war on Chicago, but aside from a joke about how the Blues Brothers need to once again battle Nazis in their home city and a general sense of bafflement about how we got to this point without any of our Constitutional guardrails even attempting to function, I don’t have much to say about it. So instead, let’s discuss rural healthcare.

Cardinal News recently reported that three medical facilities in the Shenandoah Valley will soon be closing. The three primary care facilities, which are operated by Augusta Medical Group, are located in Buena Vista, Churchville, and Weyers Cave. Patients will instead be asked to visit other Augusta Medical Group care providers, all of which are a pretty long haul from these three communities.

Augusta Medical Group released a statement saying that the consolidation “is also part of Augusta Health’s ongoing response to ‘The One Big Beautiful Bill Act’ and the resulting realities for healthcare delivery.”

It’s not hard to figure out how we got here. The One Big Beautiful Bill (which we’ll henceforth refer to as the OBBB because its very name infuriates me) cuts about $1 trillion in Medicaid spending. The hospitals that are most reliant on Medicaid are also the hospitals that have the lowest operating margins, which are generally rural hospitals.

“But wait!” you say. “Doesn’t the OBBB also contain some kind of special protection for rural hospitals?”

Yes, but more realistically, no. There is something in the bill called the “Rural Health Transformation Program,” a $50 billion, five-year fund to ostensibly mitigate the impact of these severe Medicaid cuts. However, this fund doesn’t make direct payments to rural hospitals; instead, it makes the funds available to states, and the states will need approval before spending the funds. Who makes those approvals? None other than Centers for Medicare and Medicaid Services Administrator and TV snake oil salesman Dr. Mehmet Oz, continuing his life’s work of harming our nation’s most vulnerable with bad medical advice.

I suppose there’s an outside chance that some of this rural health fund will trickle to hospitals that need it, but given that the Trump administration thus far has served as a machine that turns taxpayer dollars into yacht payments, I have my doubts.

Obviously, it’s concerning that any rural hospital would close because of the OBBB’s Medicaid cuts. But as a resident of Patrick County, this literally hits close to home.

Almost two years ago, I wrote a column about the former Pioneer Community Hospital in Patrick County, which closed its doors in 2017 after filing for bankruptcy the year before. In February of 2018 when I was still a full-time journalist, I found myself standing inside the hospital along with 200 other folks, including state and local elected officials. Then-Governor Ralph Northam was in town to sign Senate Bill 866 into law, the first bill of his governorship. The bill was authored by Sen. Bill Stanley and was designed to keep Pioneer’s certifications and licenses current so that when a new owner purchased the hospital, they would have fewer hoops to jump through to get it back up and running.

Eventually, the hospital was purchased by Foresight Health Group. I would never, ever refer to the folks at Foresight Health Group as a bunch of scam artists targeting desperate rural communities.

Anyway, that didn’t pan out, but last November, the hospital was purchased by Braden Health Group. Per Cardinal News, Braden Health is a for-profit healthcare company that specializes in reviving small, critical-access, and fee-for-service hospitals in rural areas.

I never had a good feeling about Foresight, but Braden seems like the real deal. For one thing, unlike Foresight, they’ve demonstrated their desire to reopen the Patrick County hospital through such acts as “fixing up the building” and “mowing the grass.” I believe they have every intention of reopening the hospital.

I don’t want to jinx anything, but my big concern now is that despite their best intentions, Trump’s Big Beautiful Bill will prevent them from reopening. The profit margins in for-profit healthcare are already razor thin, and the OBBB makes those margins thinner if not entirely nonexistent. No matter how well-intentioned, a for-profit healthcare company isn’t going to operate at a loss just because it’s a nice thing to do for an underserved community.

Of course, none of this would be an issue if we had universal healthcare in this country, the nut so difficult to crack that only 32 out of 33 developed countries have pulled it off. But that would be socialism, and we certainly can’t have that. Better to bleed out in the back of a Toyota Tercel racing to the hospital in Mt. Airy, just as our Founding Fathers intended.