Franconia, New Hampshire — For more than two decades, Susan Bushby, a 70-year-old housekeeper from a rural ski town in New Hampshire’s White Mountains, has been relieved to know she only has a short drive to the community health center.
The inn-like medical building, located on a hill overlooking the city, served as a second home for Bushby and many other patients. The front desk staff knew their names and never missed an opportunity to celebrate a birthday or anniversary. Staff photos of the wildlife that make this place so attractive hung on the walls, and bumping into a neighbor in the waiting room was routine.
But last month, this website of Ammonosuc Community Health Services in Franconia, a town of about 1,000 people, Closed forever.
Officials charged Cuts in MedicaidIt is the federal program that millions of low-income Americans rely on to obtain health care. The 1,400 patients, about half of whom are elderly and some of whom face serious health challenges such as early-stage cancer and dementia, must drive at least 10 miles (16 kilometers) along rural roads to reach the nearest health center, which is also located near a regional hospital. Second place is twice as far.
“I was very upset. I was absolutely angry,” said Bushby, who cried as she discussed the challenges of starting over at a new health center. “I really like it there. I don’t know, I’m really going to miss it. It’s very hard for me to explain, but it’s going to be sad.”
The Franconia Center’s closure reflects its financial difficulties Community health centers And rural health care systems more broadly amid Medicaid cuts and alarming spikes in health insurance prices. the Government shutdownwhich ended last week, was prompted by Democrats’ demand to extend the tax credits, which ensure low- and moderate-income people can afford health insurance through the Affordable Care Act, or ACA.
Marsha Luce, whose family moved from the Washington, D.C., area in 2000, is particularly concerned about the impact on her 72-year-old husband, a former volunteer firefighter who had his left ear and part of his jaw removed because of cancer. He also suffers from heart and memory problems.
She worries about the long waits to see his doctor and the loss of relationships built up over decades in Franconia.
“It’s going to be difficult,” she said. “But it’s a relationship that we’ll miss. It’s a relationship where you can talk to people and tell them something and then say, yeah, well, I got cancer. Oh, let’s see. Oh, yeah. That’s in your chart. Do you know what I mean?”
More than 100 hospitals have closed over the past decade, according to the Center for Healthcare Quality and Payment Reform, a policy and advocacy group, and more than 700 more are at risk of closing. HealthFirst Family Care Center, a facility in Canaan, New Hampshire, also announced that it will close its doors at the end of October due in part to “changes in Medicaid reimbursement and federal funding” for these facilities.
“Because of these cuts to Medicaid, we’re going to see rural hospitals, in particular, get hit hard,” New Hampshire Sen. Maggie Hassan, a Democrat, told The Associated Press. “Obviously, failing to extend the ACA tax credits right now is going to exacerbate the problem. … These providers are going to be seeing more and more uninsured patients. That means they’re going to have to make really tough decisions.”
The sustainability of the centers is crucial, because they act as a safety net for the country’s primary care, treating patients regardless of insurance coverage or ability to pay.
Although federally funded community health centers like the one in Franconia have expanded their reach in recent years, treating 1 in 10 Americans and 1 in 5 rural Americans, they have often done so in the face of significant financial constraints, according to data from the National Association of Community Health Centers.
On average, centers are losing money, relying heavily on cash reserves, making changes to service, and sometimes closing locations to survive, NACHC found. According to the association, nearly half have cash on hand for less than 90 days. The future is even bleaker as at least 2 million patients at community health centers are expected to lose Medicaid coverage by 2034, and another 2 million newly uninsured will shift to care centers.
“There is nothing left to prune without cutting the care itself,” said Peter Sheen, the society’s chief science officer.
When Trump’s bill was approved this summer, Ammonosoc CEO Ed Chanchala knew he was in trouble.
Chanshala, a meticulous planner and strategist, predicted that his network of five health centers in New Hampshire that relies on more than $2 million in federal funding — out of a $12 million budget — would face a $500,000 shortfall, in part because of Medicaid funding cuts. He also expected the bill’s work requirements and a spike in health insurance premiums to have an impact.
Chinchala knew it needed to make some cuts to save its centers, and focused its attention on Franconia because the building was leased, while the other facilities owned it.
“We have no other choice,” Chanshala said, adding that the closure would save $250,000. Finding additional cuts is difficult, he said, given that the centers provide services to anyone below 200% of federal poverty levels. If additional services are cut, Chinchala fears that some patients will end up in the hospital emergency room or “stop participating in the health care period.”
“Having to withdraw from society is devastating on a relationship level,” he said. “People can still get health care. We’ll help them with transportation, but obviously it’s a sad process. When a business leaves a community, regardless of whether it’s health care or something else, there’s an emotional tear in the fabric.”
The closure sparked a bit of controversy. Just a lot of sadness.
Most patients come from the small towns of Franconia, Easton, Lincoln and Sugar Hill, communities whose economies depend on hikers, skiers and leaf peepers. Many of them are older, sicker and more contagious than the rest of the state.
Luce, who volunteers with a local Head Start program and delivers food to schools in Franconia, said the shutdown has mostly left her frustrated with politicians, adding that she wishes lawmakers in Washington could “live the way regular people live” for a few months.
“They will have a much different idea of what happens in the real world,” she added.
Patients like Jill Brewer, president of the Franconia Board of Selectmen, whose family has been going there for decades, worry about the future and whether the closure signals a gradual collapse of the health care system in this part of the state.
“Is this kind of the first domino to fall?” Brewer said, noting that the dissolution of the city’s volunteer ambulance service in 2023 has angered many residents.
“It certainly makes you very concerned that this is going to continue to kind of snowball and become a bigger problem,” she added.
On the last day of the clinic, it was business as usual: no balloons, no cake, and no farewell letters. The staff were composed while caring for patients, with three coming in for check-ups and four for check-ups. Bushby, who came to have her blood pressure checked, hugged a staff member as crews dismantled the clinic and took out exam tables.
“I’ll come see you, honey. I will,” Bushby said as he hugged Diane LaDuke, a patient access specialist. “It was a pleasure coming here.”
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Shastri reported from Milwaukee, Wisconsin.
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