Hospitals may be the front line in the fight against COVID-19, but some of the troops are receiving less support than others. Rural hospitals have been shut out of some government aid.
The crisis comes from an apparently unintentional hole in the federal stimulus bill, known as the CARES Act. The law created a large fund for small businesses to be able to take out loans to cover increased costs during the pandemic. However, government-funded entities were excluded from applying.
That’s a problem for rural hospitals, which are mostly funded by the government to provide health care to rural communities. That includes more than two-thirds of the state’s rural hospitals, said Tom Henderson, CEO of the Texas Organization of Rural and Community Hospitals.
“These hospitals are going to be out of hundreds of millions of dollars statewide,” Henderson said. “Rural and community hospitals in Texas were already hurting before this. We don’t think it was intentional to carve us out legislatively. I imagine that it was just the result of rushed work trying to get help out to people.”
The state of Texas’ rural hospitals was already quite dire thanks to the high rate of the uninsured people who live here, especially in rural communities. Since 2010, 26 rural hospitals have had to close in Texas. With the suspension of elective surgeries, which are often the more profitable part of medicine, rural hospitals are seeing even less money roll in to tide them over.
It’s tempting to rate such health care centers lower during the pandemic. After all, more than thirty counties in the state, mostly rural ones, do not have a single confirmed case of coronavirus yet. However, outbreaks in other rural parts of the country show that massive spikes in the infection rates can occur outside of cities, and there is some indication Texas is heading that way as well. Combined with the fact that rural hospitals often have far fewer resources such as ventilators, and they can be quickly overwhelmed.
“There are a lot of counties that haven’t seen any cases, but we are starting to see surges in places like Dumas and El Campo,” said Henderson. “Hospitals have ground to a halt as they test everyone who comes in. There’s a misconception that because of the low population density that rural areas aren’t as much of a concern. That’s just false. These are tight-knit communities. They check on each other, hug on each other. They also see a lot of migratory traffic from people on the highways. I think it’s a grave mistake to not look here.”
In places such as the Rio Grande Valley, home to hundreds of small, poor communities, the lack of aid to community health centers is likely to hit very hard should outbreaks of any size happen. Michelle Serrano, communications strategist for the RGV Equal Voice Network, said that these government-funded centers are often the only health care around.
“There are limited health care resources in the RGV, particularly secondary health care,” she told us earlier this month. “It’s a perfect storm of a health care crisis when something like a pandemic hits, and this affects all age demographics. Most of this population is served by community clinics, and they’ve been closing down because they can’t get access to proper preventative protection equipment.”
The CARES Act did provide $100 billion to hospitals specifically, and that did include rural and community health centers. However, unlike city hospitals, these tend to operate on much more narrow margins. Over 40 percent of them actually run at a loss.
Rural hospitals are also suffering under some rule changes that have been implemented during the Trump Administration.
In November, the administration proposed new Medicaid fiscal accountability rules that would limit the amount of federal dollars that would go to hospitals from Medicaid. The Texas Hospital Association estimates that this will cost the state $11 billion.
Henderson hopes that new rounds of funding will fill in the gaps that were left by the CARES Act. Already, members of congress from both parties are scrambling to find a way to fix the oversight.
Gov. Greg Abbott specifically pleaded the case of rural hospitals in a letter to President Donald Trump asking for more disaster assistance.
“There are … many rural Texans with limited health care options who are already affected by COVID-19,” said Abbott. “For example, Shackelford County was forced to close their one medical clinic due to a lack of PPE (personal protective equipment). This could continue to occur in areas of the state with limited medical care resources as COVID-19 spreads to those communities. Texas state agencies alone have far exceeded the $5 million allowed through the emergency declaration.”
One specific thing Henderson wants the federal government to change is in Medicare funding for hospitals. Currently, aid in this area is being structured as a loan that must be repaid. Henderson said that it would be better if those loans were simply forgiven.
“We’re looking forward to the next round of bills, and there is significant congressional interest in addressing us,” he said.