The only hospital in my rural county closed. Now, emergency care is 30 miles away | Opinion

When California takes problems seriously, it shows. Our state, for example, recognizes a human right to water, and has an extensive network of resources deployed to prevent water system failure, including major investment of state funds, mandatory consolidation of small water systems and even receivership. While implementation hasn’t always been perfect, our commitment is clear: It is not okay for residents to go without water.

When California doesn’t take a problem seriously, it also shows. Unlike water systems, when hospitals fail, the reaction is a collective shrug from everyone except those directly affected. In January, the Madera Community Hospital — the only hospital in all of Madera County, where I live — was forced to close its doors due to financial loss. Now, our nearest emergency healthcare facilities are at least 30 miles away, in neighboring counties. A lot can happen in the time it takes to travel 30 miles, especially when someone’s health is on the line.

A study of California hospital closures found the mortality rate increased in rural communities by 5.9% upon the closure of a hospital. Yet the closure of Madera Community Hospital is just the tip of the iceberg.

Throughout California, small rural hospitals are on the brink of closure and in need of immediate assistance to ensure continued access to life-saving care for their communities. At this point in time, over half of California’s 337 hospitals are operating at a financial loss. This is due, in large part, to the low reimbursement rates of Medi-Cal and Medicare. These government programs reimburse at less than the cost of care, which forces hospitals to rely on private insurance patients to cover the gap. The hospitals that serve majority Medi-Cal and Medicare recipients are therefore at a severe fiscal disadvantage. Coupled with the significant costs of responding to the COVID pandemic and capital expenses like seismic requirements, many hospitals have now eaten through their financial reserves and are out of time.

The financial deficit faced by hospitals across the state is most prevalent in rural communities. Of the 55 rural hospitals in California, 16 (29%) are at risk of closing. With smaller populations, rural hospitals are more vulnerable to having a higher balance of Medi-Cal and Medicare patients, especially in areas serving low-income communities. Nearly 80% of the patients served at the Madera Community Hospital were recipients of these government programs, which made inadequate reimbursement rates a significant financial burden. Hospitals such as these are forced to rely on alternative sources of income, such as grants or subsidies, but with rising costs it is difficult to keep up and many are falling behind.

Kaweah Delta Medical Center, a 613-bed hospital in the rural county of Tulare, is cutting up to 200 jobs to remain operational, citing inadequate reimbursement rates. Meanwhile, El Centro Regional Medical Center in Imperial County is seeking local government assistance to maintain base hospital status so that paramedics can continue to operate in the county.

Hospital closures in rural communities such as these create significant public health-risks by reducing access to life-saving healthcare. With smaller populations spread across large expanses of land, rural areas often have a limited number of healthcare facilities. Just like in Madera, when a hospital closes, individuals are forced to travel longer distances for care. The barriers to access are even greater for disadvantaged populations lacking transportation.

It is time for California to declare that hospital closures are not okay, and that residents losing access to health care is not okay. Swift and immediate action is needed to preserve hospitals and protect the lives of all California residents. This will require state intervention to prevent mass closure, especially in rural locations where there is no alternative for emergency care.

California’s hospitals — particularly rural hospitals — need a lifeline, and the care can no longer be delayed. California must do better.