CARVER, Minn. -- Access to health care when we need it most is something many of us have come to count on, but many communities are seeing cuts to services that limit that access.
Hillary Haskins, a young mother from Carver, told WCCO Investigates she felt the cutbacks personally during her most recent pregnancy.
"We just can't guarantee you're going to have a midwife at your birth," she recalled hearing from her provider. "It might just be the on-call OBGYN, and I didn't feel comfortable birthing with someone I had never met before. "
Haskins added she was confident that medically she'd be taken care of at the hospital, but her physical safety wasn't her family's only consideration.
"Would I feel safe in that environment with people I don't know, and people who don't know my intentions? Not necessarily," she explained. "When you're stressed in birth, it's a very physiological process. When you're stressed, your body can just kind of stop and stall."
Ultimately, Haskins opted for a home birth, and her experience is emblematic of a growing trend around the state and across the country where patients are having to make tough decisions based on a hospital's stability.
A months-long WCCO investigation found 19 hospitals in Minnesota slashing or relocating services since 2022, and they include everything from obstetrics to surgeries to mental health and beyond.
WCCO Investigates reviewed several years worth of public notices, company presentations and official transcripts to chart the different changes at hospitals around the state. Beginning in 2021, Minnesota law required hospitals and health systems to hold public hearings on any proposed closures or changes of services.
Our investigation found nearly every major health care company, including Allina Health, Health Partners, M Health Fairview and Mayo Clinic, reduced or relocated services. While some spokespeople offered written statements in response to our questions, they all declined our requests for interviews, and instead directed us to the Minnesota Hospital Association.
Joe Schindler, the association's finance director, spoke with WCCO for a nearly hour-long interview.
"We've been sounding the bell for several years that this whole system is upside down," Schinder explained to WCCO Investigates. "The finances aren't working."
According to Schindler, 67% of Minnesota's hospitals are operating in the red, with the median operating margin at -2.7%. A 2023 MHA survey from hospitals, moreover, estimated total losses of roughly $190 million.
"Hospitals are lucky to get paid 50% of what is on that bill, between what the health plan actually pays and/or what the patient will pay," Schindler said, responding to a question about the rising cost of medical care. "First and foremost it starts with Medicare and Medicaid programs. Unless they get fixed, we're going to see more closures of services, but not only that, more closures of hospitals."
Medicare and Medicaid are the two government-run health programs, the former for seniors and the latter for lower-income individuals and children. Schindler said roughly 64% of patients are covered by those programs, which he added only reimburse up to 30% below cost.
"If you really look at it, it's a hidden tax on everybody," he lamented. "If the government isn't paying its bills, then everyone pays through their health premiums one way or another. It's either pay me here or pay me there, but one way or another we are all paying the price of the government not paying its bills."
Administrators, then, are frequently left with painful financial decisions, especially when accounting for compounding factors like inflation, Schindler explained.
"If it comes down to a choice between you have to close one service to keep the whole enterprise open, that's sometimes what has to be done," he said. "It's a last resort, it's an unwanted last resort, but labor and delivery, skilled nursing facilities, mental health services are all being considered."
Debates and discussions about health care in the United States have long been pre-existing national conditions. WCCO Investigates dug into several other causes and effects contributing to a cutbacks in services, all of which lead to a unique set of challenges for providers and patients alike.
There are also service-specific consequences, including for obstetrics, which account for much of the attrition in Minnesota, including at facilities in Cambridge, Fosston, Fridley, Granite Falls, Hastings, New Prague and Olivia.
WCCO Investigates will cover all of it and continue to seek answers to our viewers' pressing questions on the near-term and long-term future of medicine.