Retired nurse defines rural health crisis

 

By Catherine Ferguson SNJM

The rural health care crisis is the same as the health care crisis in the rest of the country but worse, because the rural population is older and poorer, stated Cris Currie from his vantage point as a former Spokane County visiting nurse and an advocate with Health Care for All-Washington, a nonprofit promoting quality, sustainable, affordable, publicly funded health care for all state residents.

One aspect of the crisis is the risk of rural hospitals closing, which would mean the loss of inpatient care for people needing surgery and treatment, and fewer health care professionals.

In a 2026 report from Center for Healthcare Quality and Payment Reform (CHQPR), no rural hospitals in Washington and only one in Idaho closed inpatient services, but 64 percent of 38 critical access rural hospitals in Washington and 52 percent of 29 in Idaho lost some services. Of 11 percent in Washington, 4 percent are at immediate risk of closing.

"If closures occur it will dramatically affect the quality of life for people in the area," Cris said.

In a 2025 article on the possible closure of Dayton General Hospital, a resident expressed a common concern: if the hospital closed, the town would probably die with it.

Currently, Medicaid covers about 25 percent of Washington's rural population, slightly more than other states that did not expand it. As insurance premiums increase, Cris expects there will be more Medicaid recipients in rural areas, where there are fewer jobs to provide benefits. Rural residents will be greatly affected by Medicaid cuts and work requirements in the HR1 budget bill (One Big Beautiful Bill) Congress passed in 2025.

The nonprofit healthcare research organization KFF—formerly Kaiser Family Foundation—estimates total Medicaid cuts at an estimated $911 billion over 10 years. The Congressional Budget Office has estimated $1.124 trillion in cuts to federal health spending over the same period. To partially offset losses from these cuts, Congress passed a $50 billion, five-year Rural Health Transformation Program.

In an article in Health Affairs, Carole Johnson points to some shortcomings of the program. 1) States must apply for funds with a short window for planning its best use. 2) It expires in five years when the Medicaid cuts are permanent. 3) There is no requirement that the funds impact rural health care services. 4) It is administered at the discretion of federal Centers of Medicare and Medicaid administrators who can also approve the funds for non-rural activities.

Cris reported that Governor Ferguson said that for the first year Washington received $181 million of $200 million requested. The state expects to receive about $1 billion through 2030 for rural residents in all counties. 

"This won't come close to compensating for the federal cuts to Washington, which one estimate places at $36 billion over 10 years," he said.

Cris added that rural health care requires transportation. With fewer people needing services there, as hospital corporations take over local hospitals, and combine to be bigger, they focus on urban areas, so rural residents have long drives to urban areas for care.

He said this leaves a vacuum of care for ordinary care that needs immediate attention—an accidental cut with a knife, a broken leg or an accident with machinery.

Cris came to the Inland Northwest in 1979 after growing up in Indiana, earning bachelor's degrees in biology from Earlham College and nursing at Creighton in Nebraska, and a master's degree in conflict resolution from Antioch University in Ohio. Then he lived in Minnesota, where he canoed the lakes and met his future wife, Nora Searing.

 "I came here because of the mountains—I've climbed many—thinking it would be easy to find a job as a nurse, but when I came, Spokane had a glut of nurses. It took me months to find a job," he said.

Cris found a nursing job at Providence Sacred Heart Hospital when Sister Peter Claver was in charge.

"When she retired, she was afraid the values she and the hospital had maintained would be lost. She surveyed staff to find what values they found important to preserve," Cris said, noting that he felt the values shifted toward for-profit perspectives.

He left Sacred Heart and worked in conflict management for 10 years. Then, for financial reasons, he went back into nursing with the Visiting Nurses Association, Spokane's only nonprofit visiting nurse program.

After Cris retired, his concerns for health care in the U.S. continued. Now he advocates for solutions to America's rural healthcare crisis through Healthcare for All-Washington.

At a September 2026 conference on America's rural healthcare crisis in Tacoma, healthcare providers from Washington, Wyoming, Alaska, Montana, Idaho and Oregon met. They offered four recommendations for "a sustainable, practical approach for the future of rural healthcare:" 1) Make Rural Healthcare Available, 2) Make Rural Healthcare Affordable, 3) Utilize Science to Prepare for the Next Pandemic and 4) Organize for the Long Haul.

The recommendations detailed how to overcome the crisis. The full document is at vashonbeprepared.org/conferencedeclaration.

Cris' advocacy focuses on promoting the single-payer option to finance healthcare. That means one entity, usually the government, pays for health care for everyone. Patients still see doctors and go to private or public hospitals, but the bill goes to one single payer.

He has written papers on advantages of this approach for the Healthcare for All–WA website. He has also written and updates an e-book, "A Medicare for All Q & A" —available free online.

Chapter 55 explains how single payer could benefit rural hospitals and underserved areas. A single-payer Medicare for All system would require hospitals to operate on a budget and not mingle operational and capital funding. They would move from for-profit to nonprofit. Currently, hospitals pay for expansion and equipment from profits or operating margins with a minimal certificate of need process.

The new system would require hospitals to demonstrate the need before a new allocation is granted. Instead of basing decisions on competitive or profit interests, hospitals would have to study use trends and adapt to changing community needs.

Cris explained this could mean small hospitals would receive more federal funds to convert inpatient space to outpatient services or long-term care to address local needs. Single payer might facilitate telemedicine, partnering with regional medical centers, adding a pain clinic, drug and alcohol unit or dental services, and improving access to primary or urgent care.

If every resident has health care benefits, he said, people will not have to forgo care due to an inability to pay, so use should increase and it will be easier to recruit physicians and others to serve these communities.

States that expanded Medicaid have already experienced some of this, while those that refuse to expand Medicaid generally experience an ongoing rural healthcare decline, Cris said.

For information, email criscurrie22@gmail.com or visit hcfawa.org/important_resources_papers.