CHARLESTON, W.Va. -- Debbie Hill keeps an anxious eye on the debt ceiling standoff in Washington.
Medicaid funding cuts could literally shut down her hospital, Summersville Regional Medical Center, and other rural health sites across the state, she and other health-care experts say.
Hill is chief executive officer of the 105-bed hospital, which serves Nicholas and Webster counties. "We live very much paycheck to paycheck," she said last week. "The prospect of a cut in our federal funds is downright frightening."
More than half of the Summersville hospital's patients are insured by Medicaid and Medicare, Hill said, so funding cuts would affect the whole hospital. "It's frightening to ask, 'Will we still be here five years from now?'" she said.
Many health-care experts predict that Medicaid, in particular, is likely be cut as Congress and the White House struggle to reach a deficit-reduction deal.
Hospitals are already coping with the poor economy and the demands of health-care reform, Hill said. "It's terrible timing," she said. "If reimbursements are cut, too, what we're going to see, I do believe, is the closure of some of our hospitals -- and maybe even physician practices associated with hospitals -- because we can't operate in the negative."
Many of West Virginia's community hospitals are in the same situation, according to Tony Gregory, vice president of the West Virginia Hospital Association. In 2009, 36 West Virginia hospitals -- 58 percent of all those in the state -- lost money taking care of patients, he said.
They scramble to make up the difference with cafeterias, gift shops, vending machines, parking lots, new outpatient services and investments, Gregory said.
"Under those circumstances, any reduction in funds will have an impact," he said.
"It has to do with our ability to fund operations," Hill said. "We operate on a very slim margin, we serve a lot of low-income people in Webster and Nicholas counties, and we don't have large reserves like the larger hospitals do. We don't have grant funding or large donors."
Smaller hospitals get extra "critical access" funding, she said, "but hospitals of our size, in between small and big, are struggling from day to day to pay our bills and keep up the staffing levels we need to provide quality care, let alone replace equipment and keep facilities up to date."
"If they continue to cut reimbursements, they are going to see hospitals fail," agreed David Shaffer, CEO of Weston's Stonewall Jackson Memorial Hospital. "Hospitals that have no reserves will not be able to meet their expenses. It's that simple, like any business."
Stonewall Jackson has a fund intended to build a new hospital, he said. "We would have to eat into that, to buy time."
On average, statewide, 20 percent of hospital funding comes from Medicaid, and 36 percent from Medicare, Gregory said, "but that can be higher in rural communities."
Summersville is not in trouble if there are no new cuts, Hill said. "We have a modest bottom-line projected for this year," she said, "but a reduction in federal funding could change the picture."
"As the economy gets worse," she said, "we're also finding it harder and harder to get private-pay folks to pay what they owe, because they have so many other economic pressures."
The health-care reform law "requires us to do a lot of things that may well be positive in the long run," she said, "but they require resources we don't have right now."
Under the reform law, she noted, "disproportionate-share" funds her hospital depends on will disappear. That loss would be balanced by the fact that nonpaying patients become insured in 2014, she noted, "but that hasn't happened yet."
If a federal cut were added to this mix at this point, she said, it could be too much to handle.
"If the community hospital's in trouble, that has ripple effects," the hospital association's Gregory said. "Hospitals are often the largest area employer, so they are hubs of not only health care, but economic activity."