We must have doctors to have our health. We must have nurses to have our health. We must have hospitals to have our health. We must have nursing homes to have our health. We must also have other health-related institutions to have our health. When we have our health, we have a chance to get everything we need. When we lose our health, we lose everything.
It has become extremely difficult to sustain hospitals in rural areas. When hospitals close, then doctors leave, nurses leave, nursing homes leave, and people leave. People also die. When hospitals leave, our health begins to slide down the slippery slope of loss. Having our health gives us a shot at everything we need.
The loss of rural hospitals can be rather abstract for those who are not experiencing the loss of their particular hospitals. To overcome this abstraction, I want to share the situation of two rural hospitals that are struggling just to stay afloat. I went through this with Perry County and its hospital some years ago. We struggled mightily for a long time, but the Perry County hospital closed in spite of all our efforts.
Wilcox County is one of 10 rural counties in Senate District 23, which I represent. It has a small hospital that means so much to this rural community. Its name is J. Paul Jones Hospital. It started in 1957 under the Hill-Burton Act. It has been in existence and has been serving the community for 60 years. It’s the only hospital in Wilcox County. It is now in critical care itself.
The hospital system keeps two rural clinics alive. It also manages the ambulance service. There are 48 employees at the hospital, and the ambulance service has another six full-time and 10 part-time employees. There are three doctors in the county. If the hospital goes, so will the two clinics, the three doctors, and the combined 60-something jobs. It will devastate a county already struggling with declining population, high unemployment rates and poverty, an aging population, and more. When we lose our health, we lose everything.
All these concrete examples of loss mean a lot. However, theses institutions – hospitals, doctors, nurses, ambulance service, jobs, and more – give hope to the county. If they go, hope also goes. Any chance of luring new economic entities is greatly diminished. Any chance of growing the population disappears. Any chance of keeping young people in the county dissipates.
The second county is Greene. It is not in Senate District 23, which I represent. But I am very familiar with its struggles. The Greene County Hospital was established in the early 1950s under the Hill-Burton Act. It has existed and has served the area for more than 60 years. It is in a powerful struggle just to continue to exist.
The Greene County Health System includes a 20-bed hospital, a 72-bed residential care facility (nursing home), a physician clinic, and a home health care entity. Without any one of these components of the Greene County Health System, all others cease to exist. The Health Care System operates at a $100,000 loss per month. It used to have 180 employees. It is now down to 144, and some of these are part time. Still it's one of the largest employers in Greene County. If it goes, all these jobs go.
Both Greene County and Wilcox County struggle because so many of their patients do not have Medicare or private insurance. About a third of Greene County’s patients have Medicaid. Medicaid reimburses at just 32 cents on the dollar. Almost a third of the patients are on Medicare, which reimburses at 70 cents on the dollar. Very few (5 percent) have private insurance, which reimburses at 80 cents on the dollar. Too many have no insurance and no money to pay, but these healthcare providers never turn anyone away. They just keep serving.
Neither Greene nor Wilcox would be facing a death knell if Alabama had expanded Medicaid, as did most other states. These rural hospitals could continue to exist and serve with ease. It is still not too late to save rural hospitals.
Everything is stacked against these and other rural health systems. Everything is stacked in part because so much is already stacked against these poor, rural counties. They already have lost so much. We cannot allow these hospitals to fail. If they close, they will never reopen because of all the regulations required to open hospitals. We will have a permanent setback. When we lose our health, we lose everything.
Epilogue – Institutions are always greater than the sum of their parts. This is especially true when we are dealing with institutions that help save lives and prevent deaths such as hospitals. Their concrete impact is great, but they also contribute to the hope of the community. When we lose hope, we lose everything.
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