Recent proposed cuts to federal health care spending, including to Medicaid and Medicare, could potentially impact the services provided by Monadnock Community Hospital, according to hospital leadership. 

MCH’s leadership team met with U.S. Rep. Maggie Goodlander Tuesday morning at the hospital to discuss how the hospital can prepare for future cuts. 

“These cuts are devastating, and frankly, they are unnecessary, because what they are funding is tax breaks for billionaires. We are seeing tax cuts for the biggest corporations and for billionaires, ” Goodlander said. “When you are looking at what would look like for these small rural hospitals to close, you are talking about people’s lives.” 

In February, the U.S. House of Representatives passed a resolution proposing $880 billion in Medicaid cuts over a decade, which would affect nearly 80 million Americans. The U.S. Senate would also need to pass the measure.

“I’m asking our hospitals all over the state: ‘Have you mapped out a plan for the worst-case scenario, which is a very plausible one?’” Goodlander asked a group including hospital CEO Cynthia McGuire, CFO Richard Scheinblum, Chief Nursing Officer Vicki Campanile and Chief Medical Officer Dr. Daniel Perli. 

McGuire said the hospital “has a plan A, B, and C.”

“And we’re joking about plans D, E, and F, ” she said. 

Scheinblum said the hospital was prepared to look at alternative revenue sources, including grant-eligible programs, local philanthropy and adding high-demand services.

“Everything would be on the table,” he said. 

Monadnock Community Hospital is one of 13 rural hospitals in New Hampshire which is designated as a Critical Care Access hospital by Medicare and Medicaid services.  Critical Care Access hospitals currently receive cost-based reimbursement for Medicare services, but the recent cuts to the federal healthcare budget could change this. 

“If Medicare goes away, that is one of our biggest payers,” Scheinblum said.

McGuire said losing Medicare funds could make certain aspects of the hospital unsustainable in the long term. 

“I’m not sure we would be able to sustain all of our physician practices,” she said. 

Campanile said that recent changes in immigration and other policies have affected her ability to hire nurses. 

“We used to hire a lot of nurses from Canada, but they no longer want to come here,” she said. 

Goodlander said she has seen some rural hospitals in the state “which are not going to make it.”

“These cuts are coming and they are coming fast. I want to know what I can do, what information I can share with my colleagues to make our best case against these cuts,” Goodlander said. “I’m having these conversations wherever I go in the state. My fear is that we have not gone far enough in our planning.”

Goodlander praised MCH’s financial model, saying the hospital is “kind of the gold standard for a rural hospital.” 

Perli said if Medicaid sees deep cuts, the obstetrics and gynecology department would be the hardest hit, as the vast majority of obstetrics and birthing patients are on Medicaid. Campanile said the department is already seeing “more and more premature babies who have to be transported,” as many mothers lack prenatal and preventive care.

“If Medicaid keeps getting cut, we will not be able to afford all of these services,” Scheinblum said. “OBGYN is very expensive to run.” 

Campanile said mental health services are also already underfunded, with some patients spending over a week in the ER waiting for services because their is no psychiatric facility available. 

“They live in ER,” she said. 

Scheinblum and McGuire also cited the negative impacts of the growing Medicare Advantage program, which does not provide cost-based reimbursement.

“Medicare Advantage makes our Critical Care Access status irrelevant,” Scheinblum said, adding that MCH is “probably losing $1.5 to $3 million a year due to Medicare Advantage.” 

Goodlander called the federal cuts to health care “completely unprincipled.” 

“If we see this $880 million in cuts pass, this will be devastating for the work that you do, ” Goodlander said. “What we are going to see is that nursing homes are going to turn people away, and that they will have no place to go. We can’t say with clarity that when there is an emergency call, there will always be someone there to respond.”