Roger Knak has made some especially tough decisions in the past few years.
Knak, CEO of Fairview (Okla.) Regional Medical Center in the northwest part of the state, had to lay off one of the center's three staff physicians. The rest of the employees haven't gotten a raise in three years.
But the past month has been especially hard. As Senate GOP lawmakers worked toward passing a bill to replace the Affordable Care Act that would have severely cut back Medicaid and tax subsidies to purchase individual health insurance plans, Fairview's leadership had been preparing for what they feared to be the inevitable—a loss of revenue from cuts to federal healthcare programs.
Consequently, Fairview Regional had started slashing its non-essential services, which could put its Medicare eligibility at risk.
Fairview, a 25-bed critical-access hospital that serves a patient population of roughly 9,000, is just one of the many rural hospitals in Oklahoma and across the country that has been operating on slim margins for some time.
"I don't know what the next cut would be without taking a drastic action to revisit us as being licensed as a medical-surgical hospital and changing our licensing to some other form," Knak said.
The latest Republican effort to replace the ACA failed to garner enough vote to pass the Senate, leaving Medicaid programs as they are, for now.
But rural healthcare providers such as Fairview remain concerned that the partisan wrangling over the healthcare law's future will just perpetuate the inertia over addressing the financial problems most rural hospitals now face.