FRANCONIA, N.H. (AP) — For over twenty years, Susan Bushby, a 70-year-old housekeeper from a scenic ski town in New Hampshire’s White Mountains, had found solace knowing the community health center was just a short drive away.
The rustic medical facility, which perched on a hill overlooking town, felt like a second home for Bushby and many others. The staff were familiar faces, often celebrating patients' birthdays and anniversaries, with local wilderness photos adorning the walls. Running into a neighbour in the waiting room was commonplace.
However, the Ammonoosuc Community Health Services in Franconia, a town of approximately 1,000 residents, closed its doors for good last month.
Closure Raises Concerns
Officials attributed the closure to cuts in Medicaid, a federal program critical for millions of low-income Americans. The approximately 1,400 patients, nearly half elderly or with significant health issues like cancer and early-stage dementia, are now forced to drive at least 10 miles (16 kilometers) down rural roads to reach the next nearest health center, which is also near a regional hospital. A second health facility is even further away.
“I was outraged and deeply saddened,” said Bushby, in tears as she recalled the daunting prospect of starting afresh at a new health center. “I truly loved it there. I’m going to miss it immensely, it’s hard to express, but it feels like a huge loss.”
The closure exemplifies the financial difficulties besieging community health centers and rural health care systems, exacerbated by Medicaid cuts and the anticipated increase in health insurance costs. The recent government shutdown stemmed from a demand by Democrats to extend tax credits crucial for affordable health insurance under the Affordable Care Act.
Patients Rattled by Closure
Marsha Luce, who moved with her family from Washington, D.C. in 2000, is concerned about the effects on her 72-year-old husband, a former volunteer firefighter whose cancer treatments have resulted in significant medical challenges.
She is anxious about longer wait times for medical appointments and the loss of the long-standing relationships forged with healthcare providers in Franconia.
“This is going to be tough,” she noted. “These are relationships that have developed over years; it’s not just about the medical care, it’s the trust and understanding built up over time.”
The Demise of Rural Health Care
In the last decade, over 100 hospitals closed, with more than 700 additional hospitals potentially at risk, according to the Center for Healthcare Quality and Payment Reform. The HealthFirst Family Care Center in Canaan, NH, also announced its closure due to “changes in Medicaid reimbursement and federal funding.”
“These Medicaid cuts will have a particularly harsh impact on rural hospitals,” remarked New Hampshire Senator Maggie Hassan. “The failure to extend ACA tax credits only worsens this reality.”
The survival of community health centers is crucial as they act as a primary care safety net, providing treatment regardless of insurance status. While federally funded centers like the one in Franconia have expanded their reach, they often grapple with severe financial pressures. On average, these centers are operating at a loss, relying heavily on cash reserves, and nearly half have less than 90 days of cash on hand.
As projected, 2 million community health center patients may lose Medicaid coverage by 2034, with another 2 million fatalities due to loss of coverage adding further strain on these centers.
Tough Choices for Ammonoosuc
After the passage of Trump's bill earlier this summer, Ammonoosuc’s CEO Ed Shanshala anticipated trouble. He calculated that his network of health centers in New Hampshire, dependent on over $2 million in federal funding from a $12 million budget, was poised to face a $500,000 shortfall due to the Medicaid funding cuts.
Seeking solutions, Shanshala had to make cuts to keep the centers afloat, deciding to close the Franconia location due to its leased status compared to the owned facilities. “It pains me to have to make such a decision,” he expressed. “This closure will save us $250,000, but it feels like a loss for the entire community.”
A Sense of Loss
The closure has evoked little controversy but has caused overwhelming grief among the townspeople. Many patients come from the small nearby communities, primarily comprising older, sicker individuals than the rest of the state.
Luce, who volunteers locally and delivers food to schools, expressed frustration with politicians, wishing they could experience life in the shoes of regular citizens for a few months, which might change their perspectives on pressing real-world issues.
More Closures on the Horizon?
Patients like Jill Brewer, chair of the Franconia Board of Selectmen, fear this closure could signal a decline in the regional health care system. “Is this the first domino falling?” she questioned, recalling the resentment stirred by the town's volunteer ambulance service disbandment in 2023. “Clearly, it creates an atmosphere of anxiety regarding whether this is just the beginning.”
On the clinic's last day, operations continued as normal without celebration. Staff members maintained their composure as they attended to patients—the community's emotional fabric felt the wrenching of relationships due to this closure. Bushby expressed a heartfelt goodbye to a familiar staff member while the clinic was dismantled around her. “I’ll come see you, I promise,” she assured. “Meeting with you has brought me so much joy.”
