Obamacare survives — but some rural Michigan hospitals may not

Mackinac Straits is one of 36 critical-access hospitals in rural Michigan, a federal designation for facilities with 25 beds or fewer that are located at least 35 miles from another hospital. By comparison to sprawling medical complexes in Detroit or Grand Rapids, these are humble facilities. But in sparsely settled regions where a large hospital may be 50 or 100 miles away, they are the lifeblood of basic health care.

Rural hospitals are especially vulnerable because they tend to run on thin profit margins and shoulder a larger share of poor patients whose coverage was projected to shrink under health care changes recently pushed in Washington.

"There would be significant loss of insurance in rural Michigan," said IHPI member Margaret Greenwood-Ericksen, a national clinician scholar and clinical lecturer at U-M Medical School. She co-authored a January analysis of ways that repeal of the ACA could impact rural America.

"That means people can't get access to primary care, which is critical to preventing chronic conditions from getting worse. You have conditions like diabetes and high blood pressure, which puts you at risk for stroke and heart attack," Greenwood-Ericksen said.