Rural hospitals and dental care

More dispatches from the health care beat

When I think of shuttered rural hospitals, I usually picture dilapidated, dirty buildings like something you’d see in a National Geographic photo shoot. But I recently visited a brand-new rural hospital in Alabama that closed after only four years and it looked nothing like I thought.

The Surprising Reason Rural Hospitals Are Closing

I was in Alabama for another story that I’ll write about soon, but decided to add a little more reporting onto the trip. And the more I read about health in Alabama, the more I learned about how many rural hospitals have closed in recent years. Across the country, more than 100 rural hospitals have closed in the past decade and 23 in Alabama—about half of all of them in the state—are at immediate risk of closing.

The reason, though, is surprising. You might think the problem is that they serve a lot of Medicaid or Medicare patients, and because Medicaid pays very poorly, they’re losing money on that. But the reality is that rural hospitals are losing money on private insurers. Urban hospitals lose money on Medicare and Medicaid but can make up the difference in what they charge private insurers. Rural hospitals don’t have the leverage to do that.

I made a chart that kind of helps explain:

But you can see that small, rural hospitals lose money on private insurers, while the other types of hospitals make money.

This was an interesting story to report because the town and its dynamic mayor had tried to get the hospital to open for decades, even coughing up a city tax to help pay for it. And it opened in March 2020, just as COVID-19 was shutting down the country.

It’s a beautiful facility, with state-of-the art equipment that most rural hospitals don’t have, like a 3D mammogram, an MRI, and a bone density machine. But the owners couldn’t make the finances work, in part because of the pandemic, but also because of the private insurer problem.

I also wrote a story about the sad state of the nation’s oral health, which I did not know about at all until I started looking into whether places with flouride bans had good dental health care for kids and adults (spoiler: they do not.)

America’s Dental Health is In Trouble

Side note: one of my first journalistic experiences was when a dentist came to my kindergarten or first-grade classroom to tell us to brush our teeth, and I raised my hand and asked why they were lecturing us about brushing our teeth when all the adults we know had cavities. And then the dentist explained that we have flouride in the water now, and adults didn’t when they were little, and thats why adults have bad teeth and we don’t.

Lastly, I wrote about the health insurance time tax, which is all the time you spend on the phone with your insurance company arguing and checking and making sure they didn’t overcharge you, and what it costs the economy. The person I mention in the story’s lede was constantly getting denied coverage for her medication until i called Cigna and asked about it, and without responding to me, they immediately told her they were going to cover the medication. Which is great but obviously not everyone has a journalist available to call an insurance company and ask about them (though maybe if they did, we’d have a lot fewer health care problems.)

When Fighting With Your Insurance Company Becomes a Full-Time Job

Books to Fall Asleep To

I just listened to Erik Larson’s The Splendid and the Vile, which is about Winston Churchill, his family, and his aides in the first year that England was in World War II. It’s very impressive that England lasted as long as it did and all that, but my favorite part was when Churchill was visiting FDR at the White House and answered the door to his room butt-naked and invited FDR in. Which is a scene I would not liked to have seen in person, but would have liked to hear about afterwards. Which, I guess, i did.