​2 Rural Hospitals In New Hampshire At 'Immediate Risk' For Closure, New Analysis Says

NEW HAMPSHIRE — Two struggling Granite State rural hospitals are among 300 nationwide that are at “immediate risk of closure,” a new report says.

The report comes as Medicaid changes are contemplated in the House Republican budget bill unveiled earlier this week.

The report from the Center for Healthcare Quality and Payment Reform said the proposed cuts threaten to upend health care in some of the nation’s most vulnerable communities. Some 66 million Americans live in rural areas, according to the 2020 Census, including about 42.4 percent of New Hampshire’s residents, according to American Community Survey data.

New Hampshire has 17 open rural hospitals. The two at immediate risk of shutting down represent 12 percent of the state’s rural hospitals. In all, three of New Hampshire’s rural hospitals are threatened by the proposed cuts, the report said. Nationally, about 700 rural hospitals — one-third of the total inventory of these institutions — are on unsure financial footing, according to the report.

Additionally, 38 hospitals, six in New Hampshire, have eliminated inpatient services since the beginning of 2023 in order to qualify for federal grants available only to Rural Emergency Hospitals, or REHs. Overall, 35 percent of them have cut services.

Nationally, nearly 200 rural hospitals have closed since 2005 but none of shuttered in New Hampshire. As a result, millions of Americans no longer have access to emergency rooms, inpatient care and other health care services taken for granted in other parts of the country, the report said.

In general, these institutions operate on narrow margins, and Medicaid funding is the backbone of their funding, especially in those areas with a high rate of participation in public insurance enrollment.

The report’s authors said most of the at-risk hospitals are in isolated communities, and their closure would mean residents would be required to travel long distances for emergency, obstetric or inpatient care. Additionally, these institutions are often the only places people can get lab tests or imaging studies and may be the principal source of primary care in the community.

Hospital closures could have far-reaching economic impacts beyond the loss of health care services, the report warned.

“As a result, closure of the hospital would cause a loss of access to many essential healthcare services,” the authors said. “In addition, rural hospital closures threaten the nation’s food supply and energy production, because farms, ranches, mines, drilling sites, wind farms, and solar energy facilities are located primarily in rural areas, and they will not be able to attract and retain workers if health care isn’t available in the community.”

In mid-April, several health care advocates spoke about the potential $80 billion annual reduction to Medicaid and how it could affect care in New Hampshire. The panel included Samuel Burgess, Health Care Policy Coordinator at New Futures; Tess Stack Kuenning, President and CEO of Bi-State Primary Care Association; and Ed Shanshala, CEO of Ammonoosuc Community Health Services.

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