Health Center Closure in Rural New Hampshire
FRANCONIA, N.H. — Concerns are growing over planned cuts to Medicaid, as they seem to be impacting local health services already. Just last month, the Regional Medical Service in Ammonoosuc, a small town with around 1,000 residents, closed its doors for good.
Local officials and Democratic senators link the facility’s closure to Medicaid reductions. This center catered to about 1,400 patients across Franconia, Easton, Lincoln, and Sugar Hill—all small towns in the White Mountains area, where the patient demographic tends to be older and typically in worse health than elsewhere in the state.
Challenges Facing Rural Healthcare
The shuttering of the Franconia regional center highlights the broader financial troubles confronting community health centers. Rising health insurance costs and fears surrounding Medicaid cuts are causing local health systems to contract. Recently, a government shutdown was averted, partly due to Democratic demands for extensions on tax credits that support low- and moderate-income individuals in purchasing health insurance through the Affordable Care Act (ACA).
According to the Center for Healthcare Quality and Payment Reform, over 100 hospitals have closed in the last decade, with another 700 potentially facing the same fate. A HealthFirst Family Care Centers facility in Canaan, New Hampshire, also plans to close at the end of October, citing “changes in Medicaid reimbursement and federal funding” as contributing factors.
The National Association of Community Health Centers notes that federally funded community health centers, like the one in Franconia, are generally operating at a loss. Many are relying heavily on dwindling cash reserves and may have to scale back services or close to stay afloat. Alarmingly, nearly half have enough cash to last less than 90 days. Looking forward, estimates predict that at least 2 million patients could lose Medicaid coverage by 2034, leaving many uninsured individuals turning to these centers for care.
Leadership Struggles
Ed Shanshala, CEO of Ammonoosuc, stated that Medicaid cuts were the driving force behind the closure of the Franconia center. He manages a network of five health centers throughout New Hampshire, depending on over $2 million in federal aid out of a total $12 million budget. Facing a $500,000 deficit resulting from the cuts, he realized he could save about half that by closing the Franconia location, which was also the only place he rented space.
“We really don’t have a choice,” Shanshala remarked, adding that the closure would save $250,000. Finding additional savings is challenging, especially as the center primarily serves individuals living below 200 percent of the federal poverty level. Shanshala expressed concern that cutting more services could lead patients to emergency rooms or disrupt their healthcare journey.
Patient Concerns
Susan Bushby, a 70-year-old housekeeper, shared her distress over the closure, expressing fear about transitioning to a new health center. The thought of navigating a larger facility and losing her familiar staff was daunting.
“I was really upset. I was truly angry,” Bushby said, tearing up as she described the emotional weight of starting over elsewhere. “I really like it there. I don’t know—I’m just going to miss it. It’s hard to explain, but it’s going to be sad.”
Marcia Luce, who moved with her family from the Washington, D.C., area in 2000, voiced her worries for her 72-year-old husband, a former volunteer firefighter who has dealt with serious health issues, including cancer. She is apprehensive about increased wait times and losing the long-standing relationships they’ve built in Franconia.
“It’s going to be tough,” she acknowledged. “It’s the kind of relationship you miss. You can share your history, and they understand, looking at your chart. You know what I mean?”
