Oklahoma's rural hospitals have been paying for a decision made almost a decade ago by our state leaders to decline Medicaid expansion funds made available through the Affordable Care Act. 

The impact of that politically motivated decision became even more pronounced as the novel coronavirus spread around the globe. In addition to the loss of revenue that would have been available had the state expanded its Medicaid program, studies show rural hospitals in states like Oklahoma bore the brunt of providing care for populations less likely to have private insurance. 

Rural hospitals able to navigate those financial hardships collided this year with the COVID-19 pandemic, which forced the suspension of all elective procedures. Policymakers shut the valve to that critical revenue stream to protect health care providers, their patients and the public from the disease caused by the coronavirus — a coordinated response by the federal government to secure and distribute personal protective equipment to states and local governments might have cured that problem.

Now we have reached the point where eight nurses at the Haskell County Community Hospital fill in as the facility's cleaning crew when they aren't treating patients. The Frontier and ProPublica reported the 25-bed hospital in Stigler "has been whittled down to operating only an emergency room" as it navigates bankruptcy and awaits a buyer. 

State Rep. Lundy Kiger, R-Poteau, pointed to a hospital in Le Flore County facing similarly tragic circumstances after an 80% loss of revenue due to the suspension of elective surgeries. He said if Eastern Oklahoma Medical Center and other rural hospitals located in Oklahoma's border counties close, the state will lose patients and millions of Medicaid dollars to bordering states. 

While some hospitals are eligible for federal funds made available through the $2.2 trillion CARES Act or supplemental funds approved this past week for the Small Business Administration's Paycheck Protection Program, that money is limited. Eligibility may prove to be another hurdle for other rural hospitals.

Kiger floated the idea the state loaning EOMC some money from the state's tobacco settlement trust fund to help it recover from losses due to the pandemic. TSET funds, which total about $1.3 billion today, are earmarked and doled out for smoking cessation and other programs intended to promote health for generations to come.

A bill was filed earlier this year that would allow TSET funds be used to support rural health care. It would require the support of voters to make that happen — the time for that appears to be now.

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