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.
- Norseman - Monday, Nov 10, 25 @ 1:20 pm:
=== The problem is … ===
The problem is that there will always be problems. It’s policymakers’ job to identify the best possible solution. Preferably based on data and studies. Of course, that’s not the reality we live in. ACA was a good solution with fewer problems. The MAGA GOP is doing its best to increase the number of problems.
- Demoralized - Monday, Nov 10, 25 @ 1:31 pm:
This is what happens when the medical system in the United States is a for-profit system. It’s survival of the fittest and damn the consequences.
Healthcare should be right. And in a civilized society the Government should pay for that right. Problem is we have too many people in this country who are all about themselves. Until we switch to a universal healthcare system nothing will get better.
- Candy Dogood - Monday, Nov 10, 25 @ 1:32 pm:
===As a resident of this area, meh, they overwhelmingly voted for it. ===
In fairness to his voters, Mike Bost lied about his intentions and then hides from the public.
He will continue to lie to the public and continue to hide from them.
- Crispy - Monday, Nov 10, 25 @ 1:35 pm:
@Sue, adding on to others’ comments, not only are health outcomes better in other industrialized countries that have universal coverage, costs are lower, too. Why would you advocate for a system that not only delivers poorer healthcare, but also costs between ca. 4% and 7% more of GDP? The U.S. system costs significantly more but yields poorer results.
- Pundent - Monday, Nov 10, 25 @ 1:35 pm:
=Lots of choices, but there the current system is unsustainable for providing health care outside of metro areas.=
It’s a system where problems are exasperated by for profit insurers and medical networks that are being taken over by private equity investors. And none of those outside influences lead to better care. In a healthcare environment where profit is more important than patient care and outcomes only the strongest will survive.
- GoneFishing - Monday, Nov 10, 25 @ 1:44 pm:
Stupid comment but why do community hospitals need a 7% profit margin. Shouldn’t someone come in and take over all these various hospitals and operate them for the common good?
- Jerry - Monday, Nov 10, 25 @ 1:45 pm:
Why dont we get rid of “welfare at work” (employer subsidized health insurance) Sue? Its a relic from the Great Depression and completely unworkable in our modern economy and just a handout to Big Insurance.
- GoneFishing - Monday, Nov 10, 25 @ 1:49 pm:
Even worse why isn’t Massac Memorial Hospital part of Lourdes Hospital in Paducah KY. It’s only 20 minutes away. Why is there a hospital in Murphysboro and Carbondale, again about 20 minutes apart. I lived in this area and never undestood it. I live in Dupage county now and the hospitals are that far apart but we have 900k people in the county.
- Sue - Monday, Nov 10, 25 @ 1:54 pm:
Guys- in no other country are docs and nurses paid what they make in the US-are folks advocating for matching the health care systems in Europe also advocating a big haircut for medical professionals- good luck selling that-Nurses in Europe nor anyone else in the medical food chain make what we pay our health care workers
- Sue - Monday, Nov 10, 25 @ 1:54 pm:
Guys- in no other country are docs and nurses paid what they make in the US-are folks advocating for matching the health care systems in Europe also advocating a big haircut for medical professionals- good luck selling that-Nurses in Europe nor anyone else in the medical food chain make what we pay our health care workers
- OneMan - Monday, Nov 10, 25 @ 2:00 pm:
==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 ==
I suspect that by offering financial incentives for them to do so. A decent % of radiology images are now read remotely, often outside the US. I guess most rural hospitals don’t have a radiologist on staff now; if they do, odds are they are not local.
As much as they like to hype telemedicine, robotics, and technology, none of those things can deliver a baby yet. Also, why would a ‘big hospital’ use a middleman when they could offer telemedical services themselves to folks? At the end of the day, a significant percentage of medical care requires local hands, eyes, and equipment.
- ArchPundit - Monday, Nov 10, 25 @ 2:00 pm:
Sue, some doctors will make less, but ER and primary care doctors would probably do better overall. Nurses are not quite the same comparison as our nurses have a greater scope of practice than most European nations and in Europe they have greater benefits and job protections. That said, yeah, we might reduce the rate of increase in take home pay, but with health insurance costs increasing at a slower rate that helps reduce overall costs for both nurses and doctors.
- Demoralized - Monday, Nov 10, 25 @ 2:16 pm:
@Sue:
Those people don’t graduate college with 10’s if not 100’s of thousands of dollars in student debt. You provide them school for free.
Do you or do you not believe healthcare should be a right?
- Norseman - Monday, Nov 10, 25 @ 2:16 pm:
Wealthy doctors don’t guarantee quality healthcare. Look at the data and you’ll see us behind on a lot of health indicators.
- Original Rambler - Monday, Nov 10, 25 @ 2:24 pm:
It seems to me that Flyin’ Elvis diagnosis is spot on. No doubt that will be reinforced by Fox News.
- Sue - Monday, Nov 10, 25 @ 3:17 pm:
Anyone willing to be honest will admit the ACA did nothing to slow the growth in healthcare costs but it did inflate the value of insurance companies which have increased in value daster then most other sectors of the stock market
- ArchPundit - Monday, Nov 10, 25 @ 3:31 pm:
Sue, you are incorrect. ACA has slowed the growth in healthcare costs
https://www.vumc.org/health-policy/affordable-care-act-effect-on-health-care-costs
- Pundent - Monday, Nov 10, 25 @ 3:34 pm:
=Anyone willing to be honest will admit the ACA did nothing to slow the growth in healthcare costs but it did inflate the value of insurance companies which have increased in value daster then most other sectors of the stock market=
The ACA should have been the starting point of a movement to a single payer system. It was by no means perfect or a final solution. But the GOP has undermined and gutted key provisions at every turn for the benefit of insurers and to the detriment of participants. And in the meantime we continue to wait for the President’s often promised fantastic health care solution that has been weeks away from arriving for the past decade.
- AlabamaShake - Monday, Nov 10, 25 @ 3:58 pm:
**Anyone willing to be honest will admit the ACA did nothing to slow the growth in healthcare costs**
The research generally disagrees with you. While its probably true that the ACA didn’t slow the growth as much as hoped, the vast majority if research does show that the growth in healthcare costs has been slowed from the ACA.
- Demoralized - Monday, Nov 10, 25 @ 4:06 pm:
==Anyone willing to be honest will admit the ACA did nothing==
The ACA got people insured. So there’s that.
Healthcare should be a right. Period.