Mountain Town in Crisis: How 1 Health Center’s Sudden Closure Leaves 1,000 Residents in Limbo!

FRANCONIA, N.H. (AP) — For over two decades, Susan Bushby, a 70-year-old housekeeper from this rural ski town nestled in New Hampshire's White Mountains, found solace just a short drive from the community health center. The quaint, lodgelike building, perched on a hillside, was more than a medical facility for Bushby and many others; it felt like a second home. The front desk staff knew patients by name and always took the time to celebrate birthdays and anniversaries. The walls adorned with stunning photos of the surrounding wilderness created a familiar and welcoming atmosphere, where running into a neighbor in the waiting room was a common occurrence.

However, last month, this beloved center—Ammonoosuc Community Health Services—closed its doors for good, leaving behind a community grappling with the consequences of its loss.

Closure Raises Concerns

Officials attributed the closure to cuts in Medicaid, the vital federal program that millions of low-income Americans depend on for healthcare. With the clinic shuttered, approximately 1,400 patients—almost half of whom are elderly and many facing serious health issues like cancer and early-stage dementia—must now travel at least 10 miles along rural roads to seek care at the nearest health center, which is also close to a regional hospital. An alternative facility is twice as far.

“I was very disturbed. I was downright angry,” Bushby shared, her voice breaking as she reflected on her struggles to start over at a new health center. “I just really like it there. I don’t know; I’m just really going to miss it. It’s really hard for me to explain, but it’s going to be sad.”

The closure of the Franconia center underscores the broader financial difficulties facing community health centers and rural healthcare systems amid ongoing Medicaid cuts and projected increases in health insurance rates. The recent government shutdown, which ended last week, stemmed from a Democratic push to extend tax credits that make healthcare more affordable for low- and middle-income Americans under the Affordable Care Act, or ACA.

Patients Rattled by Closure

Marsha Luce, who relocated to Franconia from the Washington, D.C. area in 2000, expressed deep concern about the impact of the closure on her 72-year-old husband, a former volunteer firefighter who has undergone serious medical procedures due to cancer and suffers from heart and memory issues. Luce fears the longer wait times to see his doctor and the loss of longstanding relationships that had developed over the years in Franconia.

“It’s going to be hard,” she said. “It’s a relationship that’s going to be missed. You tell them something, and they go, yeah, well, I’ve had cancer. Oh, let’s see. Oh, yeah. There it is in your chart. Do you know what I mean?”

The closure is part of a troubling trend; more than 100 hospitals have closed across the country in the past decade, according to the Center For Healthcare Quality and Payment Reform. More than 700 additional hospitals are now deemed at risk of closure. Similarly, a branch of the HealthFirst Family Care Center in Canaan, New Hampshire, announced it would also shut down at the end of October due to “changes in Medicaid reimbursement and federal funding.”

“Because of these Medicaid cuts, we’re going to see rural hospitals, in particular, hit hard,” warned Sen. Maggie Hassan, a Democrat from New Hampshire, in an interview with the Associated Press. “And obviously, the failure to extend the ACA tax credits right now is going to compound the problem. These providers are going to see more and more uninsured patients, and that means they’re going to have to make really difficult decisions.”

The Demise of Rural Health Care

The sustainability of community health centers is crucial, as they serve as the primary care safety net for the nation, treating patients regardless of insurance coverage or ability to pay. Federally funded community health centers like the one in Franconia have expanded their reach in recent years, serving one in ten Americans and one in five rural Americans. However, they have done so under severe financial constraints, according to the National Association of Community Health Centers (NACHC).

Many centers are financially struggling, with an average loss reported and a heavy reliance on cash reserves. Nearly half of these centers have less than 90 days’ cash on hand, the NACHC found. The future looks even bleaker, with an estimated 2 million community health center patients expected to lose Medicaid coverage by 2034, and another 2 million newly uninsured individuals likely turning to these centers for care.

“There’s nothing left to trim without cutting into care itself,” cautioned Peter Shin, chief science officer at NACHC.

When a bill supported by former President Donald Trump passed this summer, Ed Shanshala, the CEO of Ammonoosuc, understood the impending challenges. He calculated that his network of five health centers in New Hampshire, which relies on over $2 million in federal funding out of a $12 million budget, was on track for a $500,000 shortfall, largely due to Medicaid cuts. To mitigate losses, Shanshala targeted the Franconia location for closure, as it was a leased facility, while the others are owned. “We’re really left with no choice,” he stated, noting that the closure would save approximately $250,000.

Shanshala acknowledged the emotional toll, saying, “To have to pull out of a community is devastating on a relational level. People still have access to healthcare. We’ll help them with transportation, but it’s clearly a grieving process. Whenever a business leaves a community, regardless of whether it’s healthcare or something else, there’s an emotional fabric tear.”

The closure has sparked little controversy but generated widespread grief. Most patients come from small towns such as Franconia, Easton, Lincoln, and Sugar Hill, where the economy relies heavily on tourism from hikers, skiers, and leaf peepers. Many elderly residents are sicker and more spread out than those in other regions of the state.

Luce, who volunteers at a local Head Start program, shared her frustration with politicians, expressing a desire for lawmakers to experience life from the perspective of regular people. “They would have a much different idea of what goes on in the real world,” she added.

As concerns grow about the future of healthcare access in the area, patients like Jill Brewer, chair of the Franconia Board of Selectmen, are anxious about whether this closure marks the beginning of a broader decline in the healthcare system. “Is this kind of the first domino to fall?” Brewer asked, reflecting on recent community setbacks, including the disbanding of the town’s volunteer ambulance service earlier this year. “It definitely leaves you feeling pretty anxious that this is going to continue to kind of snowball and become an even bigger issue.”

On the clinic's final day, operations proceeded without fanfare: no balloons, no cakes, and no farewell speeches. Staff members remained stoic as they cared for patients, including Bushby, who visited for a routine blood pressure check. As she hugged a staff member, she expressed her sorrow, “I’ll come see you, honey. I will. It’s been such a joy coming here.”