When her severely allergic toddler, Josie, began gasping for breath in the middle of the night, Krissy Cunningham knew there was only one place she could get to in time to save her daughter\u2019s life.<\/p>\n
For 74 years, Pemiscot Memorial hospital has been the destination for those who encounter catastrophe in Missouri\u2019s poorest county, a rural stretch of farms and towns in its south-eastern Bootheel region. Three stories of brown brick just off Interstate 55 in the town of Hayti, the 115-bed hospital has kept its doors open even after the county\u2019s only Walmart closed, the ranks of boarded-up gas stations along the freeway exit grew, and the population of the surrounding towns dwindled, thanks in no small part to the destruction done by tornadoes.<\/p>\n
For many in Pemiscot county, its emergency room is the closest available without taking a 30-minute drive across the Mississippi river to Tennessee or the state line to Arkansas, a range that can make the difference between life and death for victims of shootings, overdoses or accidents on the road. In the wee hours of one spring morning, it was there that Josie received the breathing treatments and a racemic epinephrine shot that made her wheezing subside.<\/p>\n
\u201cThere is no way I would have made it to one of the farther hospitals, if it wouldn\u2019t have been here. Her airway just would have closed off, and I probably would have been doing CPR on my daughter on the side of the road,\u201d recalled Cunningham, a nurse who sits on the hospital\u2019s board.<\/p>\n
An empty bed in a shut down area of the 74-year-old Pemiscot Memorial hospital is seen in Hayti, Missouri. Photograph: Brad Vest\/The Guardian<\/p>\n
Yet its days of serving its community may be numbered. In May, the hospital\u2019s administration went public with the news that after years of struggling with high rates of uninsured patients and low reimbursement rates from insurers, they may have to close. And even if they do manage to navigate out of their current crisis, Pemiscot Memorial\u2019s leaders see a new danger on the horizon: the \u201cbig, beautiful bill\u201d Republicans pushed through Congress earlier this month, at Donald Trump\u2019s request.<\/p>\n
Centered around an array of tax cuts as well as funds for the president\u2019s mass deportation plans, the bill will mandate the largest funding reduction in history to Medicaid, the federal healthcare program supporting low-income and disabled Americans. That is expected to have ripple effects nationwide, but will hit particularly hard in Pemiscot county and other rural areas, where hospitals tend to have frail margins and disproportionately rely on Medicaid to stay afloat.<\/p>\n
\u201cIf Medicaid drops, are we going to be even collecting what we\u2019re collecting now?\u201d asked Jonna Green, the chairwoman of Pemiscot Memorial\u2019s board, who estimated 80% of their revenue comes from Medicaid as well as Medicare, another federal health program primarily for people 65 and older. \u201cWe need some hope.\u201d<\/p>\n
The changes to Medicaid will phase in beginning in late 2026, and require enrollees to work, volunteer or attend school 80 hours a month, with some exceptions. States are also to face new caps on provider taxes, which they use to fund their Medicaid programs. All told, the non-partisan Congressional Budget Office forecasts that 10 <\/strong>million people nationwide will lose their healthcare due to the bill, which is nonetheless expected to add $3.4tn to the federal budget deficit through 2034.<\/p>\n Trump carried Missouri, a midwestern state that has veered sharply away from the Democratic party over the past three decades, with more than 58% of the vote last November. In Pemiscot county, where census data shows more than a quarter of residents are below the poverty line and the median income is just over $40,000 a year, he was the choice of 74% of voters, and Republican lawmakers representing the county played a notable role in steering his tax and spending bill through Congress.<\/p>\n Senator Josh Hawley publicly advocated<\/a> against slashing the healthcare program, writing in the New York Times: \u201cIf Republicans want to be a working-class party \u2013 if we want to be a majority party \u2013 we must ignore calls to cut Medicaid and start delivering on America\u2019s promise for America\u2019s working people.\u201d He ultimately supported the bill after a $50bn fund to help rural hospitals was included, but weeks later introduced legislation<\/a> that would repeal some of the very same cuts he had just voted for.<\/p>\n \u201cI want to see Medicaid reductions stopped and rural hospitals fully funded permanently,\u201d the senator said.<\/p>\n Linda Sue Vaughn eats lunch and watches television at Pemiscot Memorial hospital. Photograph: Brad Vest\/The Guardian<\/p>\n Jason Smith, whose district encompasses Pemiscot county and the rest of south-eastern Missouri, oversaw the crafting of the measure\u2019s tax provision as chairman of the House ways and means committee, and has argued they will bring prosperity rural areas across the state. Like others in the GOP, he has said the Medicaid cuts will ferret out \u201cwaste, fraud and abuse\u201d, and make the program more efficient.<\/p>\n It\u2019s a gamble for a state that has seen nine rural hospitals close since 2015, including one in a county adjacent to Pemiscot, with a further 10 at immediate risk of going under, according to data from the Center for Healthcare Quality and Payment Reform policy group.<\/p>\n The Missouri Budget Project thinktank estimates that the bill will cost 170,000 of the state\u2019s residents their health coverage, largely due to work requirements that will act as difficult-to-satisfy red tape for Medicaid enrollees, while the cap on provider taxes will sap $1.9bn from the state\u2019s Medicaid program.<\/p>\n \u201cThere\u2019s going to be some really hard conversations over the course of the next five years, and I think that healthcare in our region will look a lot different than what it does right now,\u201d said Karen White, CEO of Missouri Highlands Health Care, which operates federally qualified health centers providing primary and dental care across rural south-eastern Missouri. She forecasts 20% of her patients will lose Medicaid coverage through 2030.<\/p>\n As the bill was making its way through Congress, she contacted the offices of Smith, Hawley and Missouri\u2019s junior senator, Eric Schmitt, all politicians she had voted for, asking them to reconsider cutting Medicaid. She did not hear back.<\/p>\n \u201cI love democracy. I love the fact that we as citizens can make our voices heard. And they voted the way that they felt they needed to vote. Maybe \u2026 the larger constituency reached out to them with a viewpoint that was different than mine, but I made my viewpoint heard,\u201d White said.<\/p>\n Spokespeople for Schmitt and Smith did not respond to requests for comment. In response to emailed questions, a spokeswoman for Hawley referred to his introduction of the legislation to partially stop the Medicaid cuts.<\/p>\n Down the road from the hospital lies Hayti Heights, where there are no businesses and deep puddles form in the potholes and ditches that line roadways after every thunderstorm. Mayor Catrina Robinson has a plan to turn things around for her 500 or so residents, which involves bringing back into service the water treatment plant that is the town\u2019s main source of revenue. But that is unlikely to change much without Pemiscot Memorial.<\/p>\n \u201cHalf of those people that work at the hospital, they\u2019re my residents. So how they gonna pay their bills? How they gonna pay their water bill, how they gonna pay their light bill, how they gonna pay rent? This is their source of income. Then what will they do?\u201d Robinson said.<\/p>\n Viserion Grain Caruthersville is seen behind a new section of levee wall in downtown Caruthersville, Missouri, along the Mississippi River. Photograph: Brad Vest\/The Guardian<\/p>\n Trump\u2019s bill does include an array of relief aimed at the working-class voters who broke for him in the last election, including tax cuts on tips and overtime pay and deductions aimed at senior citizens. It remains to be seen if whatever financial benefits those provisions bring to the workers of Pemiscot county will outweigh the impact of the stress the Medicaid cuts place on its healthcare system.<\/p>\n \u201cThe tax relief of server\u2019s tips and all that, that\u2019s not going to change the poverty level of our area,\u201d said Loren Clifton, the hospital\u2019s administrative director. \u201cPeople losing their healthcare insurance absolutely will make it worse.\u201d<\/p>\n Work can be found in the county\u2019s corn, wheat, soybean and rice fields, at a casino in the county seat Caruthersville and at a shipyard along the banks of the Mississippi . But Green questions if those industries would stick around if the hospital goes under, and takes with it the emergency room that often serves to stabilize critical patients before transferring them elsewhere.<\/p>\n A soya bean field is seen in Pemiscot county, Missouri. Photograph: Brad Vest\/The Guardian<\/p>\n \u201cOur community cannot go without a hospital. Healthcare, employment, industry \u2013 it would devastate everything,\u201d Green said.<\/p>\n The board is exploring partnerships with other companies to help keep the hospital afloat, and has applied for a federal rural emergency hospital designation which they believe will improve their reimbursements and chances of winning grants, though that will require them to give up other services that bring in revenue. For many of its leaders, the stakes of keeping the hospital open are personal.<\/p>\n \u201cThis is our home, born and raised, and you would never want to leave it. But I have a nine-year-old with cardiac problems. I would not feel safe living here without a hospital that I could take her to know if something happened,\u201d said Brittany Osborne, Pemiscot Memorial\u2019s interim CEO.<\/p>\n One muggy Wednesday morning in July, Pemiscot\u2019s three county commissioners, all Republicans, gathered in a small conference room in Caruthersville\u2019s courthouse and spoke of their resolve to keep the hospital open.<\/p>\n \u201cIt\u2019s 50-50 right now,\u201d commissioner Mark Cartee said of the hospital\u2019s chances of survival. \u201cBut, as long as we have some money in the bank of the county, we\u2019re going to keep it open. We need healthcare. We got to have a hospital.\u201d<\/p>\n They were comparatively sanguine about the possibility that the Medicaid work requirements would harm the facility\u2019s finances down the line.<\/p>\n \u201cWe got a guy around here, I guess he\u2019s still around. He\u2019s legally blind but he goes deer hunting every year,\u201d commissioner Baughn Merideth said.<\/strong> \u201cThere\u2019s just so much fraud \u2026 it sounds like we\u2019re right in the middle of it.\u201d<\/p>\n A few blocks away, Jim Brands, owner of Hayden Pharmacy, the oldest in the county, had little doubt that there were those in the county who took advantage of Medicaid. He also believed that fewer enrollees in the program would mean less business for his pharmacy, and more hardship overall.<\/p>\n Jim Brands, second from left, owner of Hayden Pharmacy, the oldest in the county, fills pharmacy orders during a busy morning in Caruthersville, Missouri. Photograph: Brad Vest\/The Guardian<\/p>\n \u201cJust seeing this community, the situation it\u2019s in, the poverty, we\u2019ve got to get people to work. There are a ton of able-bodied people that could work that choose not to,\u201d he said.<\/p>\n \u201cTo me, there\u2019s got to be a better way to weed out the fraud and not step on the toes of the people who need it.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"When her severely allergic toddler, Josie, began gasping for breath in the middle of the night, Krissy Cunningham…\n","protected":false},"author":3,"featured_media":94377,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[51,50,52],"class_list":{"0":"post-94376","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-news","8":"tag-headlines","9":"tag-news","10":"tag-top-stories"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@us\/114920203506687567","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/94376","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/comments?post=94376"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/94376\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media\/94377"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media?parent=94376"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/categories?post=94376"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/tags?post=94376"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}