By Sarah Jane Tribble for KFF Health News.
Broadcast version by Kathleen Shannon for Wyoming News Service reporting for the KFF Health News-Public News Service Collaboration

There’s a new morning ritual in Pinedale, Wyoming, a town of about 2,000 nestled against the Wind River Mountains.

Friends and neighbors in the oil- and gas-rich community “take their morning coffee and pull up” to watch workers building the county’s first hospital, said Kari DeWitt, the project’s public relations director.

“I think it’s just gratitude,” DeWitt said.

Sublette County is the only one in Wyoming — where counties span thousands of square miles — without a hospital. The 10-bed, 40,000-square-foot hospital, with a similarly sized attached long-term care facility, is slated to open by the summer of 2025.

DeWitt, who also is executive director of the Sublette County Health Foundation, has an office at the town’s health clinic with a window view of the construction.

Pinedale’s residents have good reason to be excited. New full-service hospitals with inpatient beds are rare in rural America, where declining population has spurred decades of downsizing and closures. Yet, a few communities in Wyoming and others in Kansas and Georgia are defying the trend.

“To be honest with you, it even seems strange to me,” said Wyoming Hospital Association President Eric Boley. Small rural “hospitals are really struggling all across the country,” he said.

There is no official tally of new hospitals being built in rural America, but industry experts such as Boley said they’re rare. Typically, health-related construction projects in rural areas are for smaller urgent care centers or stand-alone emergency facilities or are replacements for old hospitals.

About half of rural hospitals lost money in the prior year, according to Chartis, a health analytics and consulting firm. And nearly 150 rural hospitals have closed or converted to smaller operations since 2010, according to data collected by the University of North Carolina’s Cecil G. Sheps Center for Health Services Research.

To stem the tide of closures, Congress created a new rural emergency hospital designation that allowed struggling hospitals to close their inpatient units and provide only outpatient and emergency services. Since January 2023, when the program took effect, 32 of the more than 1,700 eligible rural hospitals — from Georgia to New Mexico — have joined the program, according to data from the Centers for Medicare & Medicaid Services.

Tony Breitlow is health care studio director for EUA, which has extensive experience working for rural health care systems. Breitlow said his national architecture and engineering firm’s work expands, replaces, or revamps older buildings, many of which were constructed during the middle of the last century.

The work, Breitlow said, is part of health care “systems figuring out how to remain robust and viable.”

Freeman Health System, based in Joplin, Missouri, announced plans last year to build a new 50-bed hospital across the state line in Kansas. Paula Baker, Freeman’s president and chief executive, said the system is building for patients in the southeastern corner of the state who travel 45 minutes or more to its bigger Joplin facilities for care.

Freeman’s new hospital, with construction on the building expected to begin in the spring, will be less than 10 miles away from an older, 64-bed hospital that has existed for decades. Kansas is one of more than a dozen states with no “certificate of need” law that would require health providers to obtain approval from the state before offering new services or building or expanding facilities.

Baker also said Freeman plans to operate emergency services and a small 10-bed outpost in Fort Scott, Kansas, opening early next year in a corner of a hospital that closed in late 2018. Residents there “cried, they cheered, they hugged me,” Baker said, adding that the “level of appreciation and gratitude that they felt and they displayed was overwhelming to me.”

Michael Topchik, executive director of the Chartis Center for Rural Health, said regional health care systems in the Upper Midwest have been particularly active in competing for patients by, among other things, building new hospitals.

And while private corporate money can drive construction, many rural hospital projects tap government programs, especially those supported by the U.S. Department of Agriculture, Topchik said. That, he said, “surprises a lot of people.”

Since 2021, the USDA’s rural Community Facilities Programs have awarded $2.24 billion in loans and grants to 68 rural hospitals for work that was not related to an emergency or disaster, according to data analyzed by KFF Health News and confirmed by the agency. The federal program is funded through what is often known as the farm bill, which faces a September congressional renewal deadline.

Nearly all the projects are replacements or expansions and updates of older facilities.

The USDA confirmed that three new or planned Wyoming hospitals received federal funding. Hospital projects in Riverton and Saratoga received loans of $37.2 million and $18.3 million, respectively. Pinedale’s hospital received a $29.2 million loan from the agency.

Wyoming’s new construction is rare in a state where more than 80% of rural hospitals reported losses in the third quarter of 2023, according to Chartis. The state association’s Boley said he worriies about several hospitals that have less than 10 days’ cash on hand “day and night.”

Pinedale’s project loan was approved after the community submitted a feasibility study to the USDA that included local clinics and a long-term care facility. “It’s pretty remote and right up in the mountains,” Boley said.

Pinedale’s DeWitt said the community was missing key services, such as blood transfusions, which are often necessary when there is a trauma like a car crash or if a pregnant woman faces severe complications. Local ambulances drove 94,000 miles last year, she said.

DeWitt began working to raise support for the new hospital after her own pregnancy-related trauma in 2014. She was bleeding heavily and arrived at the local health clinic believing it operated like a hospital.

“It was shocking to hear, ‘No, we’re not a hospital. We can’t do blood transfusions. We’re just going to have to pray you live for the next 45 minutes,’” DeWitt said.

DeWitt had to be airlifted to Idaho, where she delivered a few minutes after landing. When the hospital financing went on the ballot in 2020, DeWitt — fully recovered, with healthy grade-schoolers at home — began making five calls a night to rally support for a county tax increase to help fund the hospital.

“By improving health care, I think we improve everybody’s chances of survival. You know, it’s pretty basic,” DeWitt said.


Sarah Jane Tribble wrote this story for KFF Health News.


get more stories like this via email

Colorado now has 21 health providers treating patients regardless of their ability to pay, after Denver's Uptown Community Health Center won designation as a federally qualified health center look-alike organization.

Cherise Callighan, CEO of the Uptown Community Health Center, explained the look-alike designation means Uptown will not receive Health Center Program grant funding. She said all community health centers offer physical, dental and behavioral health, as part of their mission to deliver whole health integrated care.

"You can come in, you can get fluoride for your two-year-old, you can see a psychologist for whatever behavioral health needs you have, and you can see a physician or a nurse practitioner in order to take care of your diabetes," Callighan outlined. "It's a one-stop shop."

Colorado Community Health Centers care for 867,000 patients at more than 250 sites across the state and provide a range of primary care services in underserved areas. Uptown offers family medicine, internal medicine and OB/GYN services on a sliding fee scale based on a patient's ability to pay.

Callighan pointed out Uptown can expand access to care for Denver's most vulnerable residents because they now qualify for cost-based Medicaid and Medicare reimbursement. She added Community Health Centers help lower overall health care costs by ensuring patients receive preventive care and access to medicine.

People who do not have access tend to put off care, get sicker, and often end up in the emergency room.

"Getting them access to education on how to take care of their diabetes, their hypertension, their high cholesterol," Callighan emphasized. "Doing all that education up front with our providers and our nurses and our social workers decreases the cost of care because it keeps them out of the hospital."

Callighan added Uptown aims to continue the Sisters of Charity of Leavenworth ministry, which opened its first clinic to take care of the poor and vulnerable in the 19th century.

"To be able to provide health care to any person that walks through the doors," Callighan underscored. "If you needed health care, you got health care. If you could pay something, that was great. If you could pay nothing, that was fine too. And we're continuing that mission going forward."


get more stories like this via email

A bill which would have given pesticide companies legal immunity from health problems caused by their products did not make it through the legislature this year in Iowa.

A recent poll from the Iowa Association for Justice found 89% of Iowans oppose giving pesticide companies legal immunity, including 87% of Republicans.

Jennifer Breon, Iowa organizer for the group Food and water Watch, said the issue is about human health, which most Iowa lawmakers understand.

"Our legislators are Iowans as well," Breon pointed out. "Some of them are farmers. Some of them have probably used these products over the years and have family members who might have cancer or other health issues. And they have to wonder, you know, what's causing this?"

Registration records show the pharmaceutical company Bayer has four lobbyists in Iowa alone, a state where several companies often pool resources to hire just one.

More than 30 groups representing Iowans wrote a letter to House leaders calling on lawmakers to oppose the so-called "Cancer Gag Act."

Breon noted putting it on hold, at least for this year, had broad public support even outside the Statehouse in Des Moines.

"If you've seen the advertising all around Iowa on billboards and social media, this bill is backed by the industry and by Bayer in particular," Breon added.

While there is some debate about which pesticides are carcinogenic, it has been well documented they run off into groundwater. Iowa has the second-highest cancer rate in the nation and new cases are growing more quickly than in any other state.

By Anna Gustafson for the Pennsylvania Independent.
Broadcast version by Danielle Smith for Keystone State News Connection reporting for the Pennsylvania Independent-Public News Service Collaboration

Cindy Stewart worked for 54 years before retiring. Now, instead of enjoying retired life, the Allentown resident is worried about her Social Security benefits as the Trump administration plans thousands of job cuts and office closures at the Social Security Administration.

“I feel it’s something that I’m deserving of because I’ve paid 54 years and worked hard, and I really, truly count on it,” Stewart said. “And the way they talk, it’s going to be wiped away. They’re going to make it look like it’s not doing as well as it is, and they’re going to break it. It’s very upsetting. I think everybody’s so upset and frustrated, because what can we do?”

Stewart was one of nearly 500 people who crowded into the cavernous Cathedral Church of the Nativity in Bethlehem on March 20 for an event billed as a “People’s Town Hall.” Organized by a number of Democratic organizations, including the Pennsylvania Democratic Party and the Democratic National Committee, the event was part of a national effort to host town halls in competitive congressional districts where constituents could air their anger, frustration and sadness over the plans and actions of the Trump administration, including possible cuts to Medicaid and worries about Social Security checks continuing to arrive.

Organizers invited U.S. Rep. Ryan Mackenzie, a Republican who defeated Democratic incumbent Susan Wild in the November election, to the town hall held in Mackenzie’s 7th Congressional District, but he did not attend. Instead, Mackenzie hosted his own telephone town hall at the same time. Wild, who served three terms in the House, attended the event.

The town hall drew a standing-room only crowd. In front of a group of federal, state and local Democratic lawmakers and officials, the crowd shared a long list of concerns about the Trump administration. Many of those who spoke became emotional during the evening, wiping away tears as they described the harm Medicaid cuts would pose and anger over members of the Trump administration criticizing the Social Security program, which serves approximately 69 million Americans, the majority of whom are retirees. 

“I can’t express how upsetting it is because we don’t know what’s going to happen,” said Darlene Horwath, who traveled from Kutztown to attend the town hall. “We depend on Social Security somewhat, and with the economy tanking also, are we going to be out in the street? What’s going to happen when everything’s gone? Because that’s what the direction is.”

Colleen and Russ Sutton, who are retired nurses from Bethlehem, also shared their worries about what will happen to Social Security and Medicare under Trump. 

“I’m concerned about Social Security and Medicare,” Russ Sutton said. “I mean, we’re both on it, and it affects us. I’m concerned about it, and it’s not an entitlement when you pay into it. So I’m tired of hearing the word ‘entitlement,’ because it isn’t. It’s like you buy insurance, you pay for it, and this is insurance that you paid for all your life.”

While the White House has insisted that cuts to Social Security, including eliminating thousands of jobs at the Social Security Administration and shuttering Social Security offices, won’t affect Social Security benefits, retirees at the town hall said they fear otherwise. 

“There’s no other recourse for us to do. I mean, the food banks and the services that are state-provided are at their limit,” Horwath said. 

Attendees said they hope Mackenzie hears his constituents’ concerns about Social Security, Medicare, Medicaid, and other federal programs that have been cut or are facing cuts. Sitting near an empty chair with a name card on it that read “Rep. Ryan Mackenzie,” attendees criticized the congressman’s decision not to attend the town hall.

“He won’t show up,” Colleen Sutton said. “That’s one of the reasons why there are other Democratic leaders here to answer questions for us.”

Wild also criticized Mackenzie’s absence. 

“In my first term, by the end of March, we had done three town halls, live ones, one of them in the reddest, reddest part of our district,” Wild said. “It was not a fun experience for me. It was a packed house, lots of people who definitely did not vote for me, but I sat there for two hours and I answered questions.”

Mackenzie’s office did not respond to the Pennsylvania Independent’s request for comment. During his phone town hall, Mackenzie addressed concerns about Social Security, Medicare and Medicaid, according to reporting by Lehigh Valley Live. 

“No changes should be occurring for Social Security or Medicare,” Mackenzie was quoted as saying. “Those are for seniors. And we want to make sure that we protect those benefits … [and] support making sure that the traditional Medicaid population, those vulnerable individuals, children, low-income seniors, individuals with disabilities, we want to make sure that the care is protected for them as well.”

In order to pay for President Donald Trump’s tax cuts for the wealthy and the mass deportation of immigrants, the Republican-majority House in February passed a budget resolution that calls for $4.5 trillion in tax cuts and a $2 trillion reduction in federal spending over the next 10 years. The resolution also instructs the Committee on Energy and Commerce, which oversees the Medicaid and Medicare programs, to cut at least $880 billion from its budget. Mackenzie and every other House Republican from Pennsylvania voted for that resolution.

In interviews with the Pennsylvania Independent, parents in the commonwealth said carving hundreds of millions of dollars from Medicaid would be devastating for children with disabilities and would end in people dying from a lack of affordable health care services.

Michelle Ritter, who provides mental health care services to children at a local clinic, said during the town hall that Medicaid cuts would be disastrous for the families she serves. She noted that the parents she works with, many of whom work more than one job to make ends meet, rely on programs like Medicaid and the Supplemental Nutrition Assistance Program, also known as SNAP, for mental health services for their children and food during the summer months when children are not in school.

“The world is scary when you can work so hard, and it is still too expensive to live,” Ritter said. 


Anna Gustafson wrote this article for the Pennsylvania Independent.


get more stories like this via email