In recognition of the ongoing need of Pennsylvanians affected by loss of employment and income, the Department of Human Services (DHS) is extending the 2020-21 Low-Income Home Energy Assistance Program (LIHEAP) season. The LIHEAP season will now run through April 30, 2021. DHS does not want Pennsylvanians to be in a difficult position if the utility shut-off moratorium ends, and they are strongly encouraging individuals in need to apply at www.compass.state.pa.us.

President Biden was expected to release a top-line version of his discretionary funding request, including a breakdown of proposed funding levels for federal agencies and major priorities last week. The Administration has not committed to a new date for the “skinny” budget release. The delay comes as the Administration decides on defense spending figures. Biden was expected to keep defense spending level, but progressive Democrats are pushing to decrease the defense budget, a move Republicans and moderate Democrats are likely to oppose. The entire budget is expected to be released in May 2021. Administration officials have previously cited obstruction from the Trump budget office during the transition period and the lack of an OMB director as reasons for the delay.

The Senate parliamentarian ruled that a revised budget resolution can include reconciliation instructions, enabling Democrats to use the reconciliation process for Biden’s $2 trillion infrastructure bill. Budget reconciliation is usually only allowed to be used once a year. The reconciliation process makes it easier to pass bills related to spending, taxes and debt by limiting debate and allowing the legislation to pass on a simple majority vote. Negotiations on the infrastructure legislation will need to continue to reach a simple majority as centrist Democrats have already indicated they will not vote for the current package due to the high corporate tax hikes included.

Kathy Masisak, 68, doesn’t want to live in a community without robust medical care. But her local hospital in rural McKean County has been downsizing for years, and she said it’s affecting her family.

“They took a maternity ward away last year, and my granddaughter had to go to Olean — which is 35, 40 minutes away — in an emergency situation to deliver that baby,” Masisak said. “I was panicking the whole time going over there to see her.”

Masisak lives in Lewis Run, a borough seven miles south of Bradford, where the Bradford Regional Medical Center is about to lose even more services, including departments for acute care and surgery.

The COVID-19 era has created a paradox for hospitals. Even as medical needs related to the pandemic have grown — with so much focus on health care — other, less-essential hospital services were put under stress due to declining use. Hospitals across the country have been feeling the financial pain, but it’s hitting rural America especially hard.

‘Death by a thousand cuts’

Anne Hardy, 57, was the director of Bradford’s emergency department before retiring from three decades of service. She remembers the hospital’s heyday.

“We had a lot of young doctors, surgeons, medical guys, all starting their career,” said Hardy, who saw wide-ranging and robust options for patients. “I was impressed with the amount of young people in practice and what they were doing.”

But as more people moved away, and recruiting medical professionals got more difficult, cuts came faster. Bradford Regional merged with Olean General Hospital across the New York stateline in 2018. The following year, the OB-GYN department was cut.

And then, the pandemic hit.

“I’ll tell you, COVID killed us,” Hardy said. “I mean, we were seeing like 52 patients a day, averaging, and then COVID came and our volumes dropped in half. And that just really hurt the bottom line for so many hospitals.”

Starting in May, the hospital in Bradford will be left with just 10 inpatient beds.

Hardy, who retired in December, said the dwindling of services has been “like a death by a thousand cuts.”

Rural hospitals across the country have been facing struggles like this for years. Low patient volumes due to population loss plagues providers financially. According to a study by the University of North Carolina, since 2010, more than 130 rural hospitals have closed in the U.S.

A 2015 report on Pennsylvania found that 14% of people in the state live in medically underserved areas, including a significant portion of McKean County. In recent years, whole hospitals have closed in rural counties including Lawrence and Northumberland, with 10 others in danger of the same fate.

Jeff Zewe, President and CEO of Upper Allegheny Health System, which runs Bradford’s hospital, said the cuts boil down to basic supply and demand.

“Ten beds is a good fit,” Zewe said. “We’re just trying to get smarter and more efficient.”

Zewe also acknowledged the effects of the pandemic, which caused the health system to lose about $23 million in revenue last year.

“We lost a lot of revenue from shutting down those services that you can’t get back. So it certainly expedited things and pushed the need to do it sooner,” he said. “We needed to make an adjustment anyway.”

‘Big detriment’

Many in the community don’t see it that way.

State Rep. Martin Causer (R-McKean) said his phone has been ringing off of the hook with complaints.

“It’s hard to believe that we’re actually discussing this in the middle of a pandemic, when we’re talking about medical hospital resources, and making sure that we have resources to take care of patients,” he said.

Causer started a petition asking the health system to reconsider its move. More than 4,600 people signed it. In the letter to Upper Allegheny Health System leaders, he noted the move will have greater impact on low-income residents:

“Local residents understand that the proposed changes disproportionately affect people who are poor or have limited means of transportation,” he said. “Quite frankly, if one of your board members or I need health care services, we have the means to get ourselves to where we need to access services … that cannot be said for all residents of McKean County.”

The pushback over the downsizing is about more than lost medical services. The hospital is the third-largest employer in the county. Lifelong Bradford resident Sandra Hudspith said the decision is a “big detriment.”

“It isn’t just health care,” Hudspith said. “It is the welfare of our whole community. It is essential that we keep our health care system here or everything’s, I think, going to go down the tubes.”

But outside onlookers say these cuts may be necessary and could help small, rural hospitals avoid a worse fate.

“I would say, conversely, that having a hospital that has changed its capacity — gone down to 10 beds or 12 beds or whatever it might be — and is moving some services to the larger health system, is actually one way to make sure that that hospital can stay there in that facility,” said Lisa Davis, the director of the Pennsylvania Office of Rural Health, “because it then becomes more financially viable to keep it there.”

Upper Allegheny Health System said there will be layoffs resulting from the consolidation of services. A spokesperson said the numbers of jobs impacted “are looking very minimal.”

The intensive care unit at Bradford Regional Medical Center closed on April 1. Going forward, the health system said it will provide transportation for patients traveling between Bradford and Olean in New York.

A question lingering Anne Hardy’s mind is whether cuts to the hospital will create a vicious cycle, pushing more people to move away. At least in her case, the answer is ‘yes.’ She’s decided to leave the area when her husband joins her in retirement — a flight rooted in access to health care.

“As much as I love my little hospital, I don’t even know what the future holds for it. And I’ve got to go where the services will be there for me when I need them,” Hardy said. “The problem is, as small hospitals go away, there goes your community. Do you want to move to a community that doesn’t have a hospital?”

Listen to the broadcast here.

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Min Xian produced this story as part of the America Amplified initiative, using community engagement to inform and strengthen local, regional, and national journalism. America Amplified is a public media initiative funded by the Corporation for Public Broadcasting. Keystone Crossroads and WPSU are part of the America Amplified network. Reporter Min Xian is following stories that community members identify as deserving of more coverage in McKean County, Pennsylvania.