Texas legislature looks to help rural hospitals struggling to stay open
LA GRANGE, Texas (Nexstar) — Right on Highway 77, a few miles from downtown La Grange, sits a hospital that once provided emergency services and orthopedic surgery. Now, the St. Mark's Medical Center is an empty building with a sign on the front door that reads, 'Sorry, we're closed.'
The hospital closed in October 2023 because of 'ongoing inability to meet its financial obligations,' according to a news release that announced the closure.
St. Mark's was the only hospital in Fayette County.
About a mile from the empty hospital is the building that houses Fayette County's EMS fleet and personnel. Josh Vandever, the EMS Chief for the county, said he and his team cover 960 square miles and respond to about 4,000 calls a year. Before St. Mark's closed, Vandever said his team would transport between 50% and 60% of their calls to the local hospital.
Now, Vandever said he and his team are taking patients to emergency rooms in Smithsville and Columbus, both about 20 minutes away in either direction. But sometimes Vandever's team is making the hour-long trip to Austin for some patients.
Vandever said the patient outcome has not suffered, but what has suffered is the wear-and-tear on his vehicles and the distance for families in the community.
'You can't just go down the street to check on mom or dad at the hospital. Now they have to drive to Columbus, Smithville, or even in to Austin,' Vandever explained.
St. Mark's story is not unique. In the past 15 years, more than 20 rural Texas hospitals have closed because of financial issues. The most recent closure will happen this week after the Mid Coast Health System announced it is closing a hospital in Trinity.
John Henderson, the President of the Texas Organization of Rural and Community Hospitals (TORCH) advocates for hospitals in vulnerable communities that need financial assistance. He said problems can be contributed to a combination factors, including a low patient volume and a high percentage of Medicaid and Medicare customers.
'Which is such a tough recipe for survival,' Henderson explained.
Henderson said Medicaid does not pay the full cost of the services provided by the hospital, which leads to many hospitals operating with revenue shortfalls.. He said there are fewer commercially insured patients in rural areas.
'Rural hospitals are underwater when they treat Medicaid patients,' Henderson said.
A new push at the Texas Capitol will infuse almost $50 million over the next two years into rural hospitals and provide new training opportunities for hospital administrators. House Bill 18, authored by State Rep. Gary VanDeaver (R – New Boston) would create the State Office of Rural Hospital Finance to assist rural hospitals gain financial stability.
The bill would also require an assessment from rural hospitals that will help state officials determine which hospitals are most vulnerable and may need additional or immediate assistance.
The bill received unanimous support from the House Committee on Public Health and is expected to be voted on by the full House floor on Wednesday.
Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
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The Wyoming Hospital Upending the Logic of Private Equity
The Atlantic Daily, a newsletter that guides you through the biggest stories of the day, helps you discover new ideas, and recommends the best in culture. Sign up for it here. After years of trying to improve his hospital in Riverton, Wyoming—first as a doctor, then as a board member and volunteer activist—Roger Gose was ready to give up. Gose, a Texas native, had been in Wyoming since 1978, when he saw an ad in a medical journal looking for a small-town internist. Ever since he was a kid, he had wanted to be a community doctor, the kind who made house calls and treated his neighbors from birth into adulthood. He found his calling in Riverton, a town of 10,000 people in one of the state's poorer counties. For 35 years, he ran a private practice and worked shifts at Riverton Memorial Hospital, even serving for a time as the chief of medicine there. After retiring from his practice in 2012, he joined the hospital board, still eager to do whatever he could to help. 'You want to leave a place better than you found it,' he told me. And for a long time, he felt like he had. But that was before LifePoint Health, one of the biggest rural-hospital chains in the country, saw his hospital as a distressed asset in need of saving through a ruthless search for efficiencies, and before executives at Apollo Global Management, a private-equity firm whose headquarters looms above the Plaza Hotel in Midtown Manhattan, began calling the shots. That was before Gose realized that, in the private-equity world, hospitals were just another widget, a tool to make money and nothing more. In late 2018, Gose and a group of his neighbors decided that trying to save their hospital was futile. It had already lost its maternity ward, leaving pregnant people to drive nearly 30 miles to deliver a baby. Data from the Wyoming Department of Health show that the number of air-ambulance flights from the county where Riverton sits to hospitals elsewhere in the state rose from 155 in 2014 to 937 in 2019. By the time I spent several days with Gose and a dozen other Rivertonians in the spring of 2023, they didn't even have a hospital anymore, they told me; they had a 'Band-Aid station.' The only way to ensure that their town had a real hospital, they decided, was to build one themselves. The conventional wisdom about rural hospitals in the 21st century is that they are, in a word, screwed. Young people move away; older residents left behind need more expensive care and are less likely than urban and suburban residents to have private insurance, which is more lucrative for providers than Medicare and Medicaid. A 2018 report from the U.S. Government Accountability Office found that twice as many rural hospitals closed from 2013 to 2017 than in the five years prior, and the ones that remained were in much worse financial shape than their nonrural counterparts. Emergency funding during the coronavirus pandemic improved the financial health of rural hospitals, but after that funding dried up, many were left facing labor shortages and supply-chain problems that increased prices. House Republicans' proposed cuts to Medicaid could drive even more hospitals out of business, the American Hospital Association argued in a letter to congressional leaders this April. The ability to stave off closure has been the chief value proposition that private-equity firms offer to rural hospitals. In my reporting on private equity's growing dominance in health care, I heard versions of the story that LifePoint and Apollo told Riverton residents again and again: Without us, you will be left with no hospital at all. Yours is running out of money, and our ability to consolidate and find efficiencies across our ever-growing system is the only thing that can keep it alive. Your community is too small and poor to support an obstetrics department, or general surgery, or mental-health services, so you won't have those anymore, but isn't something better than nothing? Accepting that private equity is the only option for rural hospitals, though, requires accepting that rural Americans deserve less access to care than their urban and suburban counterparts, and that the care they do receive will be measurably worse. A landmark 2023 study found that in the three years after a private-equity acquisition, the rate of serious preventable medical complications increased significantly. (LifePoint hospitals were not included in the study, which focused on acquisitions made before 2018.) Patients were more likely to fall in the hospital and more likely to acquire infections at the site of a surgical incision. The number of central-line infections, which often result from improper insertion or cleaning, rose 38 percent. Though the study didn't delve into the reasons for the increases, the implication was clear: Focusing on short-term profits was leading to cost cutting that could be dangerous for patients. In Riverton, the hospital's owner was cutting costs aggressively, while also raising prices. In 2014, LifePoint formally merged the hospital with one in wealthier Lander, a town 25 miles away, and renamed them SageWest Riverton and SageWest Lander. In 2017, the year before Apollo bought LifePoint, researchers examined hospital data for 14 individual Wyoming facilities and found that SageWest charged the highest relative prices; data from 2020 show that SageWest maintained the largest price disparity of any general hospital in the state after the Apollo acquisition. (LifePoint referred questions about the Riverton and Lander hospitals to SageWest; SageWest leaders did not respond to several requests for comment.) At the same time, the Riverton hospital was shrinking. In quick succession, SageWest suspended its obstetrics services, closed its inpatient mental-health unit, and shrunk other basic services. By 2022, the last year for which Centers for Medicare and Medicaid Services data are available, SageWest employed 227 people across its two campuses, nearly 40 percent fewer than before the Riverton-Lander merger. According to Gose, the number of physicians based in Riverton had dwindled from 20-something to just seven. If they were going to build a new hospital, Gose and his neighbors first needed to know whether it could theoretically be financially viable. By 2018, they had formed a nonprofit, Riverton Medical District, and one of the board members, Vivian Watkins—the former head of commercial lending for U.S. Bank's 14 branches across Wyoming, and the kind of person who can't leave the grocery store without stopping four times to ask about someone's kids or their neighborhood drama—began cold-calling hospital CEOs across Wyoming, looking for advice on where to start. One told her that she should go straight to Stroudwater Associates, a Maine-based consultancy with a specialty in rural-health-care finances. The Riverton nonprofit was not Stroudwater Associates' typical client. The company's chairman, Eric Shell, and his team usually work directly with rural hospitals, or occasionally with a larger chain looking for system-wide strategic planning. Gose, Watkins, and their allies didn't have a hospital, didn't have concrete plans for a hospital, didn't even have any money for a hospital. Still, Shell was intrigued by the brazenness of what they were dreaming up. After nearly 30 years working with rural hospitals, Shell believed that rural hospitals could survive, but that too few hospital executives think creatively about solutions. Over and over, he's seen cuts damage a hospital's business further: 'You win the battle, but you lose the war,' he told me. Instead of cutting costs by 'doing more with less' (to use the corporate jargon for layoffs and overworking employees), making rural hospitals run in the 21st century means increasing profits by expanding a hospital's business. One of Shell's go-to examples is Mahaska Health in Oskaloosa, Iowa, a nonprofit hospital in a city slightly bigger than Riverton. When the pandemic hit in 2020, hospitals across the country were overwhelmed with critically ill COVID patients, but also saw a decline in other types of cases. The result was a huge, unexpected loss of revenue for many hospitals, and a correspondingly huge number of layoffs: 1.4 million health-care workers lost their jobs in April 2020 alone. At Mahaska, though, CEO Kevin DeRonde—a former NFL linebacker—ran in the opposite direction: He hired many of the providers who had been laid off from other area hospitals, Shell said. His hospital took a short-term financial hit, but DeRonde wagered that patient volume would recover once the worst of the pandemic eased up. The bet paid off. After the drop in 2020, the number of non-COVID patients skyrocketed. Now many hospitals were understaffed, but not Mahaska. The hospital hadn't been doing well even before the pandemic, losing more than $5 million in 2017. By 2023, it made $7.5 million in net income, according to Shell and Mahaska Health officials. Growth, though, is more difficult at hospitals owned by private-equity firms, because of the need to keep shareholders happy through quick returns. 'When I look at what they're doing in Lander and Riverton, I shake my head and say, 'That's not the way I'd be running the company,'' Shell told me. 'But I'm not running the company, and they're driven by an external force. If they're not beating the market rate of compensation for their investors, their investors are going to walk.' Shell agreed to conduct a feasibility study for Riverton Medical District, and Stroudwater spent months digging into every aspect of Riverton's economy, population, and existing health-care options. Just 44 percent of Medicare recipients in the area who needed hospital treatment got it at either Riverton or its sister hospital, leaving an opening for a new hospital to quickly capture market share. The presence of the Wind River Reservation, which surrounds Riverton, boosted the financial case: The Eastern Shoshone and Northern Arapaho Tribes, which share the reservation, both provide private insurance to their members. In June 2019, Shell's firm handed over its report. Its takeaway: The area had the ability to 'support a financially viable rural health system with a range of medical, surgical, and specialty services.' The Riverton Medical District team had the answer they wanted, from a company with real bona fides in the rural health-care world. Gose and Watkins were jubilant. They were going to build a hospital—if they could find the money, that is. Friends and neighbors had banded together to cover the $150,000 Stroudwater study, but a whole new hospital was going to cost tens of millions. Shell didn't think they could pull it off. He told them so outright. He's an accountant, which means always assuming the worst. He couldn't fathom why a bank or a government would give Riverton Medical District a loan, considering the competition risk. The group, though, was unanimous: Shell's fears weren't going to stop them. They were the ones who lived there; they were the ones who, in Gose's words, felt an obligation to leave Riverton better than they found it. After months of looking into every other source of funding they could think of, Riverton Medical District turned to what the group considered the 'lender of last resort'—the U.S. Department of Agriculture, the primary government funder of projects affecting rural Americans. A community hospital in an underserved rural area fit the portfolio, which could qualify Riverton Medical District for low-interest loans. Applying for government money, however, required navigating government bureaucracy. In an email exchange that stretched over months, the USDA rural-development regional director for Wyoming, Lorraine Werner, was encouraging but exacting. Every time Werner needed more documents, including a third-party audit that cost an additional $50,000, the group would scramble to get them to her. Then she would ask for even more. It took Riverton Medical District more than a year to have its application accepted—not for funding, just for consideration. Yet somehow, Riverton residents never seemed to grow tired of what looked to many outsiders like a quixotic scheme. To house the hospital, the Eastern Shoshone Tribe agreed to sell eight acres on the north end of town and donated four more acres outright. People kept handing over money, frequently $5 or $10 at a time. Finally, after an application process that took nearly two years, USDA announced its ruling. The federal government agreed that a new hospital in Riverton could be financially viable, committing to fund the lion's share of the costs—more than $37 million. It was the largest USDA rural-development loan ever awarded in the state of Wyoming. The money would fund a hospital offering every routine service Rivertonians had lost. It would have 13 inpatient beds, a full surgical department, two labor-and-delivery rooms, two rooms equipped for intensive care, and space for physical and speech therapy. It would be staffed to perform surgery and deliver babies 24 hours a day. And the building would be designed to accommodate future growth, with the potential to add 11 new patient rooms, additional surgery space, and more parking, board members told me. In its report, USDA was more bullish than Shell and Stroudwater had been; the agency's official assessment of the project barely referenced the threat of competition from the existing hospitals. Citing numbers provided by the Riverton Medical District board, USDA found that the hospital could break even with just 30 percent market share, far less than SageWest's 44 percent. The Riverton Medical District project, evaluators wrote, had generated a remarkable level of local support; the agency noted donations from individuals and businesses that added up to more than $1 million, and more than 200 letters of support. Several of the letters said that without a new hospital, they would move out of Riverton. Multiple business owners wrote that the lack of a fully functioning hospital left them unable to recruit and retain workers. Most of the USDA report was written in bureaucracy-speak, but at one point the author slipped into first person: 'The applicant started a true grassroots movement to bring back essential services to the community and has exhibited a level of community support, both monetarily and otherwise, that is unseen in my experience.' In December 2024, just before the soil froze for the season, work crews broke ground on Riverton's new community hospital. In early June, 400 people turned out for a community celebration, cheering for state-government officials and Riverton Medical District board members and signing a beam that will be installed into the new facility. Building a new, locally owned hospital isn't a scalable way to help every community where hospitals owned by private-equity firms are providing less health care. The particular combination of ingredients in Riverton Medical District's recipe baked into something resembling a miracle. But to Gose's mind, following Riverton's example doesn't require building a community hospital in every rural county in the country. What it requires is people with knowledge of, and investment in, one specific community making decisions for that community—the exact opposite of the private-equity ethos of consolidation at all costs. 'Often you'll see a lot of people get excited and involved in something for two or three months or six or whatever, but then they get disillusioned and quit,' Gose told me. 'And I think that's what LifePoint thought we were doing. And they underestimated that failure was not an option.' This article has been adapted from Megan Greenwell's forthcoming book, Bad Company: Private Equity and the Death of the American Dream. Article originally published at The Atlantic
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Which US States Have the Highest Risk of Dementia?
Based on facts, either observed and verified firsthand by the reporter, or reported and verified from knowledgeable sources. Newsweek AI is in beta. Translations may contain inaccuracies—please refer to the original content. Your risk of developing dementia may be more closely tied to your ZIP code than you think, according to a large-scale study of U.S. military veterans aged 65 and older. Analyzing health data from over 1.2 million veterans who received care through the Veterans Health Administration (VHA) between 1999 and 2021, researchers found that where someone lives can significantly influence their chances of developing dementia—even after accounting for age, race, heart disease, diabetes, and whether they lived in rural or urban areas. The study revealed stark regional differences. Veterans living in the Southeast faced the highest risk, with dementia rates 25 percent higher than those living in the Mid-Atlantic, the region with the lowest rates. Other high-risk areas included the Northwest and Rocky Mountains, where dementia risk was 23 percent higher than in the Mid-Atlantic. The South, Southwest and South Atlantic also showed elevated rates. The researchers measured how many new cases of dementia were diagnosed each year per 1,000 people. In the Southeast, that number was 14 cases per 1,000 person-years, while in the Mid-Atlantic it dropped to just 11.2. Even after adjusting for factors like demographics, rurality and cardiovascular conditions, the regional patterns remained consistent. "The study underscores the need to understand regional differences in dementia and the importance of region-specific prevention and intervention efforts," said senior author Dr. Kristine Yaffe, also of the San Francisco VA Health Care System, in a statement. What Might Be Driving the Regional Differences? Researchers explored why dementia rates varied so widely across regions, and several key factors may help explain the gap. Although health, age, and environment clearly play a role, the data showed that geographic location remained a strong predictor even after accounting for those variables, suggesting there's more going on beneath the surface. Potential Factors Influencing Dementia Risk: Education: Lower educational attainment was more common in regions with higher dementia rates. Health Conditions: Chronic illnesses such as stroke, high blood pressure, diabetes and obesity were more prevalent in higher-risk areas like the Southeast. Lifestyle and Environment: Smoking and other regional lifestyle patterns may contribute. Access and Quality of Health Care: While the VHA generally offers more equal care across regions, differences in resources and specialty care at individual VA centers may affect how—and whether—dementia is diagnosed. Diagnosis Practices: Studies using Medicare data suggest that how often and how well dementia is diagnosed can vary, not just because of patient health but also due to how local health systems operate. Hidden Variables: Some important influences—such as quality of early-life education or early signs of cognitive decline not captured in health records—may not show up in administrative data but could still drive long-term risk. A stock image of a doctor visiting a senior man to check his health. A stock image of a doctor visiting a senior man to check his health. Photodjo/iStock / Getty Images Plus All-in-all, the study makes one thing clear: location matters. While individual lifestyle choices and genetics remain important, where you live could shape your brain health more than previously understood. These findings underscore the need for more localized research and targeted interventions, especially in regions facing higher dementia burdens. Understanding why dementia hits harder in some areas than others is essential—not only for treating the disease but also for preventing it in the first place. Do you have a tip on a health story that Newsweek should be covering? Do you have a question about dementia? Let us know via science@ Reference Dintica, C. S., Bahorik, A. L., Xia, F., Boscardin, J., & Yaffe, K. (2025). Regional differences in dementia incidence among US veterans. JAMA Neurology.
