By Shefali Luthra, Kaiser Health News

CONNELLSVILLE, Penn. – Judy Keller, 69, has always relied on Highlands Hospital for medical care, just as her parents did before her. When she walks through the halls, she recognizes faces from the community and even from her days working as a school teacher. The 64-bed facility, she says, is a mainstay of this rural Southwest Pennsylvania town.

“This hospital all my life has been here,” said Keller, now retired. “[It] helps a lot of people who don’t have adequate health care coverage — and I don’t know what they would do without it.” Aside from providing health care to a largely poor population, it provides hundreds of jobs in a town that locals say never recovered after industries such as coal mining and glass manufacturing disappeared.



But in the wake of this fall’s presidential election, Highlands — like many other rural hospitals — will likely face new financial challenges that will intensify long-standing struggles, experts say. The Affordable Care Act, which President-elect Donald Trump has vowed to repeal, threw a number of lifesavers to these vital but financially troubled centers. And its full repeal, without a comparable and viable replacement, could signal their death knell.

Highlands provides one window into how some of these shifts could reverberate in small towns across the country. And ironically, 64 percent of people here in Fayette County — one of the state’s poorest — voted for Trump. Pennsylvania, which has the third largest rural population in the nation, played a pivotal role in his upset victory this fall.

The health care law expanded Medicaid to tens of thousands of previously uninsured patients, providing new revenue streams for rural hospitals, which often serve a poorer, sicker patient population. The law also created a program that allowed some of these facilities to buy prescription drugs at a discount, though Highlands qualified for that program independently of Obamacare.

“All these rural hospitals are operating on thin margins. The removal of any income source or coverage, or expansion of bad debt, is going to create significant financial hardship,” said Alan Morgan, CEO of the National Rural Health Association.

Rural hospitals have long operated on the edge. In the past six years, more than 70 such facilities have closed, citing financial duress. Almost 700 more have been deemed at risk of following the same path. Meanwhile, the need for reliable health care remains pressing. Conditions such as heart and lung disease are widespread in rural areas. Addiction to the prescription painkillers known as opioids is acute. Nationally, the Medicaid expansion offered a bit of stability for some rural hospitals at risk of closure. Researchers say it disproportionately benefited such facilities — particularly here and other states with large rural populations, such as Illinois, Kentucky and Michigan.

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