Rural hospitals ‘hanging by a thread’
Monday, Nov 10, 2025 - Posted by Isabel Miller
* Background is here and here if you need it. The Southern Illinoisan…
Southern Illinois physician Dr. Jeff Ripperda says the region’s healthcare system is hanging by a thread and that new federal changes could have lasting consequences for hospitals and patients.
Ripperda, a family and addiction medicine physician at Shawnee Health Care in Murphysboro, said hospitals across the region already operate on razor-thin margins. […]
Ripperda said the largest healthcare network in Southern Illinois operates at about a 6.6% profit margin, while several others range from 1% to 4%. He said that with such thin margins, hospitals already struggle to balance revenue between profitable and unprofitable services and can’t afford to lose much income and remain stable. […]
“Right now, about 7% of people in Southern Illinois don’t have health insurance,” he said. “That number is projected to rise to about 12% because of H.R. 1.” […]
According to the Illinois Health and Hospital Association , approximately two-thirds of Illinois counties are rural, with more than 500,000 residents enrolled in Medicaid. Most small hospitals in these areas have fewer than 150 beds and depend heavily on Medicare and Medicaid, leaving many with tight or negative budgets.
* Crain’s…
Illinois joined the rest of the U.S. today in applying for a piece of the $50 billion the federal government will allocate to rural health over the next five years, with a plan that seeks $1 billion.
The U.S. Centers for Medicare & Medicaid Services instructed each state to apply for that exact amount, $200 million per year, the Illinois Department of Healthcare & Family Services said in a statement. […]
The state Healthcare Department provided few details about its application, saying it would share the details of its plans for the rural health dollars once it knows how much the state will receive. […]
While hoping for the federal support, the Healthcare Department said the funding would only serve to ease the pain of other drastic cuts contained in the law. The major cut to rural providers, along with other hospitals, comes from Medicaid cuts and changes to Medicaid enrollment rules widely assumed to cause a significant decrease in its rolls, a corresponding increase in the uninsured and huge reimbursement losses.
* KFF Health News…
Nationwide, health care workers like Kopplin and thousands of others — from patient advocates to technology executives — flocked to town halls or online portals during the seven weeks state leaders had to craft and submit their applications for the Rural Health Transformation Program to the federal Centers for Medicare & Medicaid Services. That deadline was Nov. 5.
“We will give $50 billion away by the end of the year,” CMS Administrator Mehmet Oz said Nov. 6 at a Milken Institute event in Washington. He said all 50 states had submitted applications. […]
CMS’ Oz repeated the idea of getting “big hospitals to adopt smaller institutions” at the Washington gathering after applications were filed. He used similar language at a rural health summit hosted by South Dakota-based Sanford Health. “How do we get big hospitals to adopt smaller hospitals? Not to take them over, but to keep them viable by giving them good telehealth services, specialty support, radiology support,” he said at the October event. […]
The word “telehealth” appears 36 times in the rural health program’s 124-page application guidelines. But Don Robbins Jr., chief executive of a small hospital on the Illinois-Kentucky border, chuckled at the idea of using the funding for that purpose.
Robbins, whose 25-bed Massac Memorial Hospital [in Metropolis, Illinois] averages five to seven patients in its beds each day, said his hospital does not regularly offer telehealth. Even if it did, he said, patients living more than a mile outside of town couldn’t use it because they don’t have a good internet connection.
The small hospital reported a $31,314 loss in September, Robbins said. “I think if we get anything out of it,” Robbins said of the rural health program, “we’ll be lucky.”
* The Hill…
Under the [rural health fund], $25 billion will be allocated to all states equally, meaning each state with an approved application would receive the same amount regardless of the size of its rural population.
The other $25 billion will be awarded at the discretion of Oz, based on criteria including whether states have adopted Health and Human Services Secretary Robert F. Kennedy Jr.’s “make America healthy again” policies. […]
The CMS has outlined several approved uses for the funds, which include prevention and chronic disease management; payments to health care providers; and hiring new workers with commitments to serve rural communities for a minimum of five years.
The law gives Oz broad discretion on what he can approve, and there is no specific requirement for states to direct funds to rural hospitals or the CMS to approve only funding for rural districts
- Flyin' Elvis'-Utah Chapter - Monday, Nov 10, 25 @ 11:50 am:
As a resident of this area, meh, they overwhelmingly voted for it.
When their hospitals close in Murphysboro, Anna, Metropolis, and the like most residents of this area will look at you with a straight face and blame Pritzker.
You ain’t changing that with any number of facts.
- Sue - Monday, Nov 10, 25 @ 12:03 pm:
The answer to this problem is not the ACA which is directing 10’s of billions a year to insurance companies on behalf of millions of Americans who exceed the income levels originally excluded from receiving subsidies- its a complex problem perhaps beyond the ability to legislate a fix- one possibility would be to require health providers to charge the uninsured and non- medicaid eligible the same rates charged to insured patients. Insurance provided by employers now exceeds 27 K per employee- why should anyone think the ACA can possibly work without costing taxpayers 100’s of billions a year
- ArchPundit - Monday, Nov 10, 25 @ 12:12 pm:
=== charge the uninsured and non- medicaid eligible the same rates charged to insured patients.
What problem do you think you are solving here? If they cannot afford insurance they cannot afford out of pocket even at the negotiated rates.
Every industrialized country seems to solve this basic problem and yet the United States cannot largely because we refuse universal coverage. How you get to universal coverage varies by country, but they cover everyone.
- Norseman - Monday, Nov 10, 25 @ 12:14 pm:
The ACA is the best we can hope for given the framework imposed by our political environment. However, the MAGA GOP continues its task of destroying it provision by provision at a time. How many 2 weeks are we away from a MAGA plan - about 200 from initial promise.
- Sue - Monday, Nov 10, 25 @ 12:26 pm:
The problem with Universal coverage of course will be reimbursement rates or do they envision all health care workers become govt employees and hospitals govt owned- the medical industry would never accept this and medical card and outcomes would decline
- ArchPundit - Monday, Nov 10, 25 @ 12:36 pm:
==The problem with Universal coverage of course will be reimbursement rates or do they envision all health care workers become govt employees and hospitals govt owned- the medical industry would never accept this and medical card and outcomes would decline
And yet every other industrialized country has figured it out. In fact, we already do public reimbursement rates for 40 percent of the population. And that is likely to increase as people are pushed off of private insurance with the reduction in ACA subsidies. Everyone needs to be in the risk pool and covered or we cannot maintain the system that all of us with insurance greatly benefit from.
- Annonin' - Monday, Nov 10, 25 @ 12:46 pm:
Guessin’ Boss Toss and SmileyLaHood are especially proud of their votes after readin’ this item. Wonder if US Sen hopeful Tracey might share his thoughts. Maybe other GOPies like ToniMac could ’splain how the facilities should be funded.
Seems like Oz and the FP’s other bootlicks ought be checked every time they try pointing to the $50 billion and pretend like it will make every thing fine.
- JS Mill - Monday, Nov 10, 25 @ 12:48 pm:
=The problem with Universal coverage…=
The anti universal coverage people have been postulating problems since forever. If it is such a problem why are western nations with universal health care healthier than the US? The real “problem” is that some people don’t want to pay the cost.
- AlabamaShake - Monday, Nov 10, 25 @ 12:58 pm:
**The answer to this problem is not the ACA which is directing 10’s of billions a year to insurance companies**
You’re right. We should get rid of the insurance companies
- Pundent - Monday, Nov 10, 25 @ 12:58 pm:
=the medical industry would never accept this and medical card and outcomes would decline=
Delicne from what? When you rank #10 out of 10 industrialized countries you have nowhere to go but up.
https://www.commonwealthfund.org/publications/fund-reports/2024/sep/mirror-mirror-2024
- Friendly Bob Adams - Monday, Nov 10, 25 @ 1:11 pm:
F Elvis- I think you’re quite right in terms of who will be blamed. Sad but true….
- ArchPundit - Monday, Nov 10, 25 @ 1:16 pm:
Universal coverage does not necessarily mean single payer or an entirely public health system. You would likely need to move towards at least some non-profit insurers or some sort of public option that could be administered by for or non-profit insurance or the government itself. Lots of choices, but there the current system is unsustainable for providing health care outside of metro areas.