Wayne Memorial Hospital is the sole hospital serving Wayne and Pike Counties and one of Wayne County's largest employers, CEO Jim Pettinato said.
Without that hospital, he said, there would be no accessible emergency services for the region.
“[Patients] can travel an hour to get to an emergency room, but I think most folks in the room would recognize that an hour, when you're having an emergency, is not the time that you have,” Pettinato said.
He is among those who fear that Medicaid cuts proposed under federal Republicans' spending bill could put hospitals like his at risk and devastate healthcare in rural areas.
Pennsylvania Health Secretary Dr. Debra Bogen echoed those concerns for a gathering of local leaders at the hospital on Friday, discussing anticipated impacts of the "One Big Beautiful Bill Act."
“Pennsylvania's rural hospitals, which rely heavily on Medicaid funding, are already operating in the red, and they could face potential closures in already underserved rural communities,” Bogen said.
The act took a significant step toward passage over the weekend.
Senate Republicans late Saturday night advanced the bill by a 51-49 vote, but potentially extensive debate and amendments still lie ahead, the Associated Press reported, possibly going late into the night on Sunday.
If the Senate does eventually pass it, the bill would return to the House for a final round of votes before it could reach the White House, according to the AP.
President Donald Trump is pushing lawmakers to get the legislation to his desk by July 4, although the bill has faced many setbacks and a vote might not happen by then.
As NPR pointed out, the bigger fight may rest back in the House, which holds a razor-thin majority and will need to agree to the same bill if it passes the Senate.
Worries about how the outcome will affect Wayne Memorial Hospital were not limited to those who took part in the formal presentation.
“We cannot watch this ship go down,” Wayne County Commissioner Chairman Brian Smith said from the audience during public comment.
“It will hurt people of every political belief that there is out there. This is not a political battle. This is a battle for everybody," said Smith, a Republican.
"We have common ground here. We need to work together for the good of everyone in our community, to keep this healthcare facility here and to keep all healthcare facilities healthy,” Smith said.
Who would be affected?
Medicaid provides health insurance to nearly 78 million Americans, including low-income families, older adults and people with disabilities. Nearly 3 million Pennsylvanians are covered by Medicaid.
The Congressional Budget Office estimates that the proposed changes would reduce federal Medicaid spending by $793 billion, decrease enrollment by 10.3 million people and increase the number of uninsured Americans by 7.8 million, according to KFF Health News.
Gov. Josh Shapiro’s administration estimates the changes could strip coverage from more than 300,000 Pennsylvanians.
House vs. Senate versions
The House of Representatives passed its version of the bill on May 22.
The Senate version of the bill includes work requirements and more frequent eligibility checks for Medicaid enrollees.
But the updated version of the bill also includes a $25 billion fund to support rural hospitals, a provision Senate GOP leaders included to alleviate concerns about how those facilities would be impacted, NPR reported.
That fund would compensate for the bill’s reduction on the tax that states can impose on Medicaid providers, which is a major funding stream for rural hospitals.
The program would begin in 2028 and funds would be spread out over five years, according to NPR.
ACA changes and Pa. impact
The bill also includes changes to the Affordable Care Act (ACA).
Pennsylvania Insurance Commissioner Michael Humphreys highlighted the bill’s failure to extend enhanced tax credits, which are set to expire at the end of this year.
KFF Health News found that the enhanced tax credits, “both increased the amount of financial help for those already eligible under the ACA and expanded eligibility to those making more than four times poverty.”
“It's those individuals that go and buy individual market coverage that we're talking about that are also significantly impacted by this bill,” Humphreys said. “The bill will make coverage for these individuals more expensive by failing to extend enhanced premium tax credits that have made coverage more affordable than ever before. As many as 150,000 Pennsylvanians could lose affordable health insurance if Congress lets these expire at the end of the year.”
He said Pennsylvania would not be able to pick up the slack left by the estimated losses.
“Governor Shapiro has been clear, Pennsylvania cannot fill the costs of this legislation,” Humphreys said.
Pa.'s rural hospital system and its reliance on Medicaid
KFF estimates rural Medicaid spending could decrease by $119 billion over the next ten years if the bill passes. In Pennsylvania, KFF estimates that number to be about $4.2 billion, with rural Medicaid enrollment estimated to drop by nearly 60,000 in that timeframe.
There are 18 rural hospitals, including Wayne Memorial, participating in Pennsylvania’s rural health model. The model was launched in 2019 to address payment gaps for rural hospitals and transitioning from “fee-for-service to global budget payments,” according to the state’s Department of Health.
Still, the Hospital and Health System Association of Pennsylvania found, “Through fiscal year 2022, more than one-quarter of Pennsylvania’s rural hospitals were operating with a negative margin. Another 14 percent were operating with margins under 4 percent, meaning they have little to no room to maintain infrastructure and long-term sustainability. Without specific policy and payment supports, it will become increasingly difficult for rural hospitals to remain viable.”
Wayne Memorial’s Pettinato said the hospital cannot afford another financial hit.
“While we might all operate in a negative operating margin, only bailed out by philanthropy and bailed out by investments, these cuts that are being proposed will significantly strain what are already negative operating margins,” he said.
“Access to quality health care is essential for both physical health and economic health. Without them, both will suffer,” Pettinato added.
Patient impacts of proposed changes to Medicaid and ACA
Pettinato also fears a potential closure would make access difficult for patients seeking care from specialty units like labor and delivery.
“Wayne is one of the few rural hospitals still delivering babies. We deliver about 475 babies a year,” Pettinato said. “The majority of those deliveries are covered by medical assistance. If it was not for our obstetric program, mothers would have to travel at least an hour to get to a hospital that provided delivery services.”
Losing coverage also might cause patients to go without preventive care, according to Wayne Memorial Community Health Center’s chief quality officer, Kara Poremba.
“Patients will delay care, skip appointments and stop treatment altogether, not because they want to, but because they simply can't afford to come,” said Poremba.
Speakers at Friday's event urged those who share their concerns about its impact to contact Pennsylvania’s senators to vote against the bill and advocate for Medicaid protections.
But also Bogen said the resulting burden on the health system could increase healthcare prices for privately insured Pennsylvanians.
“When people don't have access to health insurance, they're forced to forego preventative care and rely on emergency care. This, in turn, leads to not only worse health outcomes, but it also increases uncompensated health care services, increases insurance premiums and increases health care costs for all Pennsylvanians,” Bogen said.
Shapiro administration’s efforts to protect rural healthcare
Bogen also highlighted the Shapiro administration’s loan repayment program, which his 2025/26 budget proposes expanding by $5 million. She said the program currently assists eight healthcare providers in Wayne County and more than 200 healthcare professionals in the state.
"The primary care loan repayment program provides opportunities and resources to rural health care providers like Wayne Memorial Hospital to attract providers to this community,” Bogen said. “We have learned that the financial incentives of the loan repayment program gets health care professionals into the door, but it is their love for these communities that gets them to stay for the long term.”
Uncertainty at the federal level is making this year’s state budget negotiations even more difficult, said Bogen.
She said the state’s efforts to bolster and support rural healthcare still need the help of federal money.
“The Shapiro administration is working hard to improve access to care in rural areas like Wayne and Susquehanna counties,” Bogen said. “But we cannot do it alone. The federal government needs to do its part. Drastically cutting the Medicaid program is very much the opposite of doing its part.”
