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CLAYTON, Neb. (AP) \u2014 A major reason Rick and Jane St. John chose to live in the small town of Clayton, Nebraska, was because of its hospital.<\/p>\n
The couple has a child with nonverbal autism and epilepsy, which requires up to three hospital visits a week. And Creighton’s Critical Access Hospital has become a lifeline for Jane. Not only is she employed there, but doctors saved her life three years ago when she contracted bacterial pneumonia. Doctors said if she had waited another day to receive treatment, her organs would have started to shut down.<\/p>\n
read more:<\/strong> What experts think about the $50 billion local health fund included in President Trump’s big bill<\/p>\n “And if we had to drive an hour to the hospital in Yankton, South Dakota,” an emotional Rick St. John said, “her life could have been at stake.”<\/p>\n<\/div>\n So the St. Johns couple was shocked to hear that Avera Creighton Hospital was facing a financial crisis. A $50 billion government fund meant to transform rural health care is of little use. It’s an issue that millions of Americans in rural areas are finding are no windfall for vulnerable hospitals near their homes.<\/p>\n Hundreds of rural hospitals across the country are facing closure due to longstanding funding problems. The problem was exacerbated last summer when the Trump administration slashed Medicaid, the government’s safety net for low-income Americans. Medicaid reimbursement has long supported hospital profits.<\/p>\n read more:<\/strong> Trump administration expands local health funds with conditions<\/p>\n Outcry over the funding cuts prompted Republican lawmakers to create a new $50 billion in local health funding, but critics say the money is meant for innovative health care delivery solutions, not to support hospitals struggling to withstand the current pressures.<\/p>\n “It’s not profitable to keep the lights on, and once the lights are turned off, they don’t come back on,” said Dr. Ben Young, an infectious disease expert and policy expert at the Wellness Equity Alliance, a public health advocacy group.<\/p>\n Rural Americans’ health care fears reflect broader national concerns about access and rising prices as the cost of living rises, and could be crucial in this year’s midterm elections.<\/p>\n The $50 billion Rural Health Transformation Program, which President Donald Trump included in the Tax and Spend Act last year, was billed by Republicans as a way to support rural hospitals. Last summer, Health Secretary Robert F. Kennedy Jr. touted it as the “largest injection in history” to rural hospitals and promised to “restore and revitalize these communities.”<\/p>\n Hospital and health industry experts warn that while the fund – $10 billion a year allocated to all states over five years – will provide some support to struggling rural hospitals, it will not provide relief. One reason is that the amount won’t come close to offsetting the $137 billion that local hospitals are expected to lose over the next 10 years, according to the health research nonprofit KFF. Millions of people are expected to lose their Medicaid benefits as a result of new Medicaid work requirements that go into effect in 2027, but the changes the Trump administration is maintaining are meant to crack down on fraudsters rather than cut off eligible enrollees.<\/p>\n read more:<\/strong> Louisiana’s high reliance on Medicaid puts the state on the front lines of health care cuts<\/p>\n Administrators say the new $50 billion fund is not intended to shore up failing rural hospitals or maintain the status quo, but to transform rural health care through technology, workforce and other innovations. “It gives states the tools to design solutions that last, rather than Band-Aids that fail,” Dr. Mehmet Oz of the Centers for Medicare and Medicaid Services Administration said in a December video.<\/p>\n The White House echoed that sentiment Wednesday, saying the fund is intended to fund “big ideas” to improve rural health care access over the long term.<\/p>\n “Decades of mismanagement by career politicians in Washington have left rural care options limited,” said White House Press Secretary Khush Desai.<\/p>\n The state’s application lays out a wide range of proposals. Some proposals aimed to improve emergency medical services and modernize rural facilities, while others aimed to provide healthier school meals, expand physical fitness programs, strengthen telemedicine, and expand AI-powered technologies to help monitor patients.<\/p>\n Teresa Guenther, CEO of Avera Creighton Hospital, insists her hospital is not in danger of closing. But she acknowledged that Medicaid cuts are painful, a sentiment shared by most rural hospitals, she said.<\/p>\n “Medicaid cuts are going to affect us, and we, and many others, need to understand what that means going forward,” she said. Her hospital hopes to get a piece of the $50 billion fund to help patients manage chronic conditions such as diabetes and cover staffing costs.<\/p>\n Nebraska, which received an initial $218 million in local health grants, will spend about $90 million on healthier food options in schools, hire more health care workers and mobile sensors to remotely monitor patients with chronic conditions in rural areas, among other things. But it would provide $10 million to rural critical access hospitals at risk of closure to “rightsize” them by eliminating inpatient care, which typically has low bed occupancy.<\/p>\n clock:<\/strong> Who is affected by the Trump administration’s Medicaid, SNAP work requirements?<\/p>\n Republican state Sen. Barry DeCay said hospitals like Creighton Hospital are essential despite low occupancy rates. The hospital is in his district. Even his mother received life-sustaining treatment there after hip replacement surgery. He worries that Medicaid cuts could hurt all of the state’s rural hospitals.<\/p>\n “I’m going to work as hard as I can to get as much money as possible to rural hospitals, whether it’s in my district or other rural districts across the state,” he said.<\/p>\n Rick St. John admitted he knows little about how Nebraska will spend federal funds, but believes the money should be used to help hospitals like Creighton stay intact.<\/p>\n “This hospital is very important to this region, and it’s not just about health care,” he said, citing job losses if the hospital loses services or closes.<\/p>\n The fund has faced pushback from hospital groups over issues that are becoming important to voters in 2026.<\/p>\n The Colorado Hospital Association sent a letter to state lawmakers in December, accusing them of ignoring input from local hospitals during the application process.<\/p>\n The Nebraska Hospital Association supports Republican Sen. Deb Fischer’s 2024 re-election bid based on support for rural health care, criticizing both the cuts and the $50 billion fund. Mr. Fisher voted in favor of Medicaid cuts last summer.<\/p>\n This and other efforts by states to limit Medicaid spending sends a message that “access to health care is not a priority,” the group said.<\/p>\n Some Republican state lawmakers around the country have expressed concerns about some of the funds and are looking for ways to use them to help struggling rural hospitals.<\/p>\n Under pressure, some regional states have stepped up to help on their own.<\/p>\n Wyoming has enacted a law allowing local hospitals to file for Chapter 9 bankruptcy. Chapter 9 bankruptcy is typically created to allow cities in financial trouble to restructure their debts and repay creditors while protecting them from lawsuits.<\/p>\n In North Dakota, during a special session to allocate federal rural health funds for the state, the Republican-led Legislature passed an unrelated bill aimed at bailing out rural hospitals with low-interest loans of up to $5 million through a state-owned bank.<\/p>\n Hospital board member Matt Hager said the plan is expected to keep the hospital open in the vast rural area where 5 percent of the surrounding county’s residents are employed.<\/p>\n Young, an expert with the Wellness Equity Alliance, sees dark days ahead for rural hospitals.<\/p>\n “I’m not optimistic in the short term,” he said. \u201cBecause these hospitals are facing an immediate cash crunch, are barely able to operate financially right now, and need operational support now.\u201d<\/p>\n Swenson reported from New York. Associated Press writer Jack Duras contributed to this report from Bismarck, North Dakota.<\/em><\/p>\nInsufficient rural health funds billed for treatment<\/h2>\n
Nebraska will spend much of its grant money on innovation.<\/h2>\n
Hospital groups step up opposition to the fund<\/h2>\n
Countries where aid is difficult<\/h2>\n