David Usher, chief financial officer for a 12-bed rural hospital in western Kansas, is sitting on $1.7 million he's scared to spend.

The money lent from the federal government is meant to help hospitals and other health care providers weather the COVID-19 pandemic. Yet some hospital administrators have called it a payday loan program that is now brutally due for repayment at a time when the institutions still need help.

By this time next week, Decatur County, Tenn., will have lost its only hospital, Decatur County General, which has been serving the rural community of about 12,000 people along the Tennessee River since 1963.

The hospital's human resources director, Melinda Hays-Kirkwood, has already begun laying off people, and she says by next week only a skeleton staff will remain.

"It's hard on these employees that have been here a long time. I've got people who have been here for 30 years," Hays-Kirkwood says. "For some people, this has been their only job out of college."

Rural hospitals face “catastrophic cash shortages” brought on by the COVID-19 crisis and need congressional action to save them, according to a Leawood, Kansas, advocacy group that represents hundreds of rural hospitals.

In a letter Monday addressed to the leaders of the U.S. House and Senate, the National Rural Health Association asks that 20% of the $100 billion in funding for hospitals in the CARES Act, the $2 trillion coronavirus response bill passed by Congress last month, be set aside for rural providers.  

Dr. Max Self grabs a sanitary wipe and cleans off the small flashlight in his hands. More than 20 years as a family doctor in rural Fort Scott, Kan., has taught him a few tricks for dealing with little kids: "I've got my flashlight. See? Look, you want to hold it?"

Though its Medicaid contract is still at stake, Aetna Better Health is making progress, Kansas lawmakers and state regulators said this week. 

“There has been a good response from them,” Kansas Secretary of Health and Environment Lee Norman told a panel of lawmakers Tuesday.

Go here to subscribe to the My Fellow Kansans podcast. This season, we look at the prospects of rural places.

ANTHONY, Kansas — Few things signal a rural community’s decline more powerfully than the closure of its hospital.

Like shuttered schools and empty Main Streets, an abandoned hospital serves as a tangible reminder of the erosive power of decades of population loss and unrelenting economic trends.

In the central Idaho community of Arco, where Lost Rivers Medical Center is located, the elk and bear outnumber the human population of a thousand. The view from the hospital is flat grassland surrounded by mountain ranges that make for formidable driving in wintertime.

"We're actually considered a frontier area, which I didn't even know was a census designation until I moved there," says Brad Huerta, CEO of the hospital. "I didn't think there's anything more rural than rural."

One Monday in February, 65-year-old Karen Endicott-Coyan gripped the wheel of her black 2014 Ford Taurus with both hands as she made the hour-long drive from her farm near Fort Scott to Chanute. With a rare form of multiple myeloma, she requires weekly chemotherapy injections to keep the cancer at bay.

She made the trip in pain, having skipped her morphine for the day to be able to drive safely. Since she sometimes “gets the pukes” after treatment, she had her neighbor and friend Shirley Palmer, 76, come along to drive her back.

Three Kansas hospitals are among six hospitals once run by a North Kansas City-based company that have filed for Chapter 11 bankruptcy protection.

This story was updated to add the comments of Kansas Gov. Laura Kelly.

Oswego Community Hospital, a 12-bed critical access hospital in southeast Kansas, abruptly closed down on Thursday, citing insufficient revenue to cover its operating expenses.

The hospital’s board released a statement saying the hospital had “weathered low patient volumes; high number of uninsured patients; low reimbursement rates; difficulty in getting payment from private insurance providers; low Medicaid and Medicare rates; and the state’s refusal to expand Medicaid.”

Rural hospitals aren’t just providers of medicine and health care, but also are often major employers and a massive part of a town’s tax base. However, mounting challenges are forcing these hospitals to merge and close in droves.

This story was updated at 4:24 p.m. to include comments from the CEO of McPherson Hospital.

Two Kansas hospitals have been selected to take part in a federal demonstration program aimed at ensuring access to health care in underserved areas.

The two, McPherson Hospital in McPherson and Morton County Health System in Elkhart, were among 13 nationwide chosen for the demonstration project being conducted by the Centers for Medicare and Medicaid Services (CMS).

No one at the hospital in Fulton, Missouri (population 12,790) had ever heard of a management consultant named Jorge Perez until he showed up at its potluck in September.

$1.25 million.

That’s the size of the bill that could have shuttered the only public hospital in rural Pemiscot County, Missouri in August 2013.

$750,000 for payroll. $500,000 for a bond payment. $1.25 million total. One August day in 2013, the hospital’s CEO Kerry Noble had to face facts: The money just wasn’t there. It took an emergency bailout from a local bank to keep their doors open. For now.

When evening falls, Brian Hunt makes his way to a comfortable chair in a sun room on the south side of his house near La Cygne, Kansas. But he’s not settling in to relax. He’s going to work.