What one rural hospital means to a community’s survival

A little more than 350 miles north of New York City, on the U.S.-Canadian border, sits New York's largest county by area, framed by the St. Lawrence River to the north, the Adirondacks to the southeast and the Thousand Islands to the west. Locals call it simply the North Country. About 40 people live per square mile here, compared with roughly 29,000 in New York City. Many working families, including AFT members, have put down roots in the North Country for generations.

But that kind of rooted life feels less certain as North Country residents worry they may lose access to healthcare they rely on. Claxton-Hepburn Medical Center, one of the region's key hospitals, is struggling to stay afloat.

"I was born in that hospital," says Mary Wills, executive director of the St. Lawrence County People Project, a grassroots initiative supported by the New York State United Teachers and the AFT whose mission is to strengthen education, the economy, health and wellness in the county. "My kids and my grandkids were born there. I don't know what we're going to do if we lose it," says Wills. "Honestly, I don't see my family staying here. We've come to rely on having quality care close to home."

In January, after struggling to make payroll, North Star Health Alliance, the system that operates Claxton-Hepburn, announced layoffs of 120 positions split between two of its North Country hospitals. About half of the positions came from Claxton-Hepburn. A few days later, NSHA's CEO resigned. A few weeks later, NSHA filed for bankruptcy. What's at stake is more than one hospital-it's whether families can access healthcare at all.

If Claxton-Hepburn is no longer an option, residents like Wills could face a roughly 45-minute drive to reach the nearest emergency, maternity and inpatient care. The trip could take even longer depending on where they live in the county and whether winter roads are clear.

The cloud hanging over the North Country is not unique. Across the U.S., diminishing access to healthcare in rural areas is reaching a crisis point. In northern and western New York, which account for the majority of the AFT's rural membership, 16 counties are either losing entire healthcare centers or experiencing workforce shortages that limit everything from the kind of care they can receive to when they can receive it.

Nationwide, rural hospital closures outpaced openings from 2017 to 2024, and hundreds more rural hospitals are at risk of closing. For the AFT, that means rural members-who account for more than 20 percent of the union-may be at risk of losing local providers or critical services.

Recent federal legislation exacerbates the crisis. The reconciliation bill Congress passed last year slashed Medicaid funding by an estimated $911 billion over the course of 10 years. The result will be an additional 10 million people without health insurance, most of whom live in rural areas, where Medicaid covers 25 percent of residents. The Rural Health Transformation Program, a $50 billion fund also created by the bill, doesn't come close to softening the estimated $137 billion reduction in federal Medicaid spending in rural areas.

At both the federal and state levels, bills are moving to address the chronic underfunding and workforce shortages driving rural healthcare closures. In New York, proposed legislation focuses on increasing reimbursement rates for rural providers and creating tax credits and student loan forgiveness programs to recruit and retain rural healthcare workers. While important, these bills would provide only a temporary patch for the much larger structural problem, leaving rural hospitals like Claxton-Hepburn more likely to find themselves cutting services or closing.

Claxton-Hepburn's reach alone demonstrates the importance of rural hospitals: Wills and Emily Kimble, the community schools coordinator for the Massena Central School District and a member of the St. Lawrence County People Project, both rely on Claxton-Hepburn for care-yet they live an hour apart.

Kimble, who delivered both of her children at Claxton-Hepburn, paints a picture of how deeply the community depends on the hospital.

"Claxton-Hepburn is the only place to have babies here," she says. "So what happens if we lose that? And what about emergencies? We are already three hours away from a major trauma center."

When Kimble's father suffered heart complications, staff at Claxton-Hepburn stabilized him and arranged transport to Upstate University Hospital in Syracuse, 165 miles away.

The possible loss of Claxton-Hepburn can feel like the final blow to a community where healthcare access has been dwindling for years. A local labor and delivery unit closed in 2020 after 60 years, leaving Claxton-Hepburn as the sole provider of maternity services.

In 2024, Claxton-Hepburn split into a two-part system in an attempt to wipe out more than $30 million in debt. One facility now operates as a standalone psychiatric hospital and the other as a separate acute-care medical campus. The new configuration reduced the number of available hospital beds from 90 to 25 and sent residents to a patchwork of outpatient clinics across the North Country for everyday care.

Wills says she has already had to hunt for a new primary care doctor.

"Many physicians were not taking on new patients, or maybe you might be able to get an appointment but it wouldn't be for another six, eight or 12 months," she says. "If we lose more doctors, this is going to add even more stress to an already very frail system."

And others might be left hunting for both a doctor and a job.

"Those folks that got laid off are being forced to look for employment elsewhere and move their children out, move their families away-which is going to hurt the community and the economy," Wills says.

The local Service Employees International Union affiliate, which represents workers at Claxton-Hepburn and other area hospitals, collected more than 1,600 signatures on a letter to New York state's deputy secretary of health asking for an "immediate resolution by any means necessary" because rural hospitals are a "lifeline."

Kimble recalls Claxton-Hepburn patching up her daughter after she injured her finger in a doorjamb. A few years later at a spring festival, she says, her family ran into the nurses who cared for her daughter. They remembered her and asked how she was doing.

That is why Kimble lives in the North Country, and why she wants to stay.

"You have to choose rural life; at the end of the day, this is a choice that I have made for myself and my family," she says. "I'm raising my children on the same farm that my dad was raised on. My kids are skipping rocks in the brook that I skipped rocks in growing up. To see them being able to play here and grow here and have that family connection-it's irreplaceable."

[Melanie Boyer]