NOEL KING, HOST:
A problem that was happening even before the pandemic - a lot of rural hospitals are broke or they make very little money. And still, they have to get ready for COVID-19. Stacey Vanek Smith and Cardiff Garcia from our daily econ podcast The Indicator talked to the CEO of a hospital in rural Texas.
STACEY VANEK SMITH, BYLINE: Adam Willmann has lived in Clifton, Texas, all his life.
ADAM WILLMANN: You travel one mile outside of Clifton city limits and you can be on gravel roads in the middle of pastures.
VANEK SMITH: Adam is the president and CEO of the hospital in Clifton, Goodall-Witcher Healthcare. Adam's ties to the hospital go deep.
WILLMANN: I actually was born here. The current mayor of Clifton is the physician that delivered me. My mom and dad live here. My grandmother is a resident of our nursing home.
CARDIFF GARCIA, BYLINE: Adam says he knows almost everyone and their families, too. The hospital is the No. 1 employer in Clifton.
VANEK SMITH: Goodall-Witcher is small. But they are a full-service hospital - open 24/7, emergency room, births, surgeries, two clinics.
GARCIA: Like hospitals all across the country, Goodall-Witcher has redirected all of its resources to the coronavirus pandemic. They've essentially stopped doing elective surgeries - things like knee and hip replacements and procedures like colonoscopies.
VANEK SMITH: No one is coming in right now. And Goodall-Witcher is totally focused on things like amassing resources - masks and ventilators and hand sanitizer and gowns. All of this has been enormously expensive. And rural hospitals, like Goodall-Witcher, tend to operate on extremely thin margins. Right now, there's almost no income. And there are a lot of expenses. And many rural hospitals have seen almost no coronavirus cases at all. They're just empty.
WILLMANN: Waiting on a surge.
VANEK SMITH: Meanwhile, their financial situation gets worse and worse and worse.
WILLMANN: You go out and spend $20,000 on N95 masks. Or you keep that $20,000 so you can make payroll in two to three weeks.
JOHN HENDERSON: That's hard to sustain as you go from two weeks to a month, and a month to two months.
VANEK SMITH: That's John Henderson, the president of TORCH - the Texas Organization of Rural and Community Hospitals. John says, in the last 10 years, more than 100 rural hospitals have closed their doors. He worries that the coronavirus pandemic could wipe out hundreds more, which would leave huge swaths of the population with no immediate access to health care.
GARCIA: Even before the coronavirus pandemic, nearly 1 in 4 rural hospitals was in danger of shutting down. And now, a lot of them either do not qualify for the federal aid that's provided in the recent CARES Act. Or if they do qualify for the aid, they are likely to lose out on the billions of dollars going to hospitals because they are not as connected or influential as larger urban hospitals.
VANEK SMITH: The way the CARES Act seems to be set up, Goodall-Witcher might actually need a surge to happen in order to survive because it might help get them some of the government money they're counting on.
WILLMANN: I'm here waiting for patients, praying we don't have any because you don't want to wish this on anybody. But you're not getting any of the additional reimbursement for taking care of those patients. So where do you go with it?
GARCIA: For now, Adam and Goodall-Witcher are waiting, along with hundreds of other small hospitals in Texas.
VANEK SMITH: Stacey Vanek Smith.
GARCIA: Cardiff Garcia, NPR News.
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