A community health center in Franconia, New Hampshire, has closed its doors permanently, leaving 1,400 patients, many of whom are elderly or have serious health conditions, without local medical care. Officials attribute the closure to significant cuts in Medicaid funding, a federal program crucial for low-income Americans.
Key Takeaways
- Franconia's Ammonoosuc Community Health Services location closed due to Medicaid cuts.
- 1,400 patients, nearly half seniors, must now travel at least 10 miles for care.
- The closure highlights broader financial struggles for rural healthcare amid funding reductions.
- Many community health centers nationwide are operating at a loss, relying on reserves.
Rural Communities Face Healthcare Crisis
The closure of the Franconia health center marks a critical loss for residents in New Hampshire’s White Mountains. For over two decades, patients like Susan Bushby, a 70-year-old housekeeper, relied on the center for convenient and personalized care. The lodge-like medical building was a familiar place where staff knew patients by name.
Now, these patients face drives of at least 10 miles to the nearest health center, with a second option twice as far. These rural roads can be challenging, especially for older individuals or those with health issues.
"I was very disturbed. I was downright angry," said Susan Bushby, expressing her distress over the closure and the prospect of starting over at a new facility.
Impact on Patients
- 1,400 patients affected by the Franconia closure.
- Almost 50% of these patients are older adults.
- Some patients manage serious conditions like cancer and early-stage dementia.
Medicaid Cuts and Financial Strain
The financial struggles driving the Franconia closure are not isolated. They reflect a wider crisis affecting community health centers and rural healthcare systems across the nation. Medicaid cuts, alongside concerns about rising health insurance rates, are putting immense pressure on these vital facilities.
New Hampshire Senator Maggie Hassan, a Democrat, highlighted the severity of the situation. She stated that rural hospitals, in particular, will be hit hard by Medicaid reductions. The failure to extend Affordable Care Act (ACA) tax credits further compounds the problem, potentially leading to more uninsured patients and difficult decisions for providers.
The Role of Community Health Centers
Community health centers serve as a crucial primary care safety net. They treat patients regardless of their insurance status or ability to pay. Federally funded, these centers have expanded their reach, now treating 1 in 10 Americans and 1 in 5 rural Americans.
Wider Trend of Closures
The Center for Healthcare Quality and Payment Reform reports that over 100 hospitals have closed in the past decade. More than 700 additional hospitals are currently at risk of closure. This trend underscores the fragility of healthcare access in many communities.
Another facility, a branch of HealthFirst Family Care Center in Canaan, New Hampshire, also announced its closure for similar reasons: changes in Medicaid reimbursement and federal funding.
Difficult Decisions for Healthcare Leadership
Ed Shanshala, CEO of Ammonoosuc Community Health Services, faced a difficult choice. His network of five health centers relies on over $2 million in federal funding out of a $12 million budget. He projected a $500,000 shortfall due to Medicaid funding cuts, work requirements in a recent bill, and expected spikes in health insurance premiums.
To save the other centers, Shanshala made the strategic decision to close the Franconia location. This site was leased, unlike the other facilities which Ammonoosuc owns. The closure is expected to save $250,000.
"We’re really left with no choice," Shanshala explained, adding that further cuts would impact patient care directly. He fears some patients might end up in emergency rooms or stop seeking healthcare altogether.
Financial Realities for Centers
- On average, community health centers are losing money.
- They often rely on cash reserves and service changes to survive.
- Nearly half have less than 90 days' cash on hand.
Emotional Impact on Patients and Staff
The closure has caused significant grief within the community. Patients from small towns like Franconia, Easton, Lincoln, and Sugar Hill, many of whom are older and sicker, are particularly affected. These communities rely on tourism, attracting hikers, skiers, and leaf peepers.
Marsha Luce, whose husband battles cancer, heart, and memory issues, worries about longer wait times and the loss of long-standing relationships with doctors and staff. "It’s a relationship that’s going to be missed," she said, emphasizing the comfort of familiar faces and shared history.
Jill Brewer, chair of the Franconia Board of Selectmen, expressed anxiety about the future. She questions whether this closure is the "first domino to fall," potentially signaling a broader collapse of healthcare in the region. The town previously disbanded its volunteer ambulance service in 2023, causing similar concerns.
A Quiet Farewell
On the clinic's final day, there were no grand ceremonies. Staff members remained stoic, attending to patients for physicals and checkups. Susan Bushby, after having her blood pressure checked, shared a hug with Diane LaDuke, a patient access specialist, as crews began dismantling the facility.
"It’s been such a joy coming here," Bushby told LaDuke, reflecting the deep personal connections formed within the center's walls.
The National Association of Community Health Centers projects a bleak future. At least 2 million community health center patients are expected to lose Medicaid coverage by 2034, with another 2 million newly uninsured individuals seeking care at these centers. Peter Shin, chief science officer at the association, warned, "There’s nothing left to trim without cutting into care itself."
