A ballot measure in one southeast Missouri county will determine if there’ll be a replacement hospital for one closed there this summer.

Twin Rivers Regional Medical Center in Kennett shut down in June after proving to be a money loser for Community Health Systems, its for-profit owner.

The Fortune 500 company merged its operation into a sister hospital, Poplar Bluff Regional Medical Center, 48 miles and about an hour’s drive away.  259 employees were laid off with the closure although some were able to transfer to the Poplar Bluff location.

As a result, two measures will be included on Tuesday’s ballot in Dunklin County where Kennett is located that that’ll ask voters to spend tax dollars to build a new hospital.

Proposition Health is a half-cent sales tax which would be used to construct a new hospital, which would have 10-12 beds and an emergency room.  Proposition Care is a 50-cent property tax increase, which would help operate the hospital and about 100 employees.  Both measures would require a simple majority vote.

In addition, they would both raise about $1 million per year.  The cost to build the hospital is roughly $12 million.  The county would sell bonds to finance the expense as funding through Proposition Health would build over time.  Proposition Health would also sunset after 30 years.

Proposition Care, being earmarked for operation of the facility, could be ended much earlier if the hospital is successful and becomes debt-free with its day-to-day expenses. St. Bernards Medical Center in Jonesboro, Arkansas, which is 53 miles from Kennett, has expressed interest in partnering with Dunklin County to run the new hospital if it’s built.

The facility that closed has 120 beds, which is 10 times the size of the planned hospital.  But the model for newer, and especially rural hospitals is toward fewer beds as modern technology and practices have sharply reduced the need for inpatient care with overnight stays.

Community Health Systems experienced a loss of $121,443 at the Kennett hospital in 2016.  It’s expected that a smaller facility would help avoid such a deficit because of its reduced operating costs.

Jim Grebing, Director of Economic Development for the city of Kennett, points out that the biggest problem with the loss of a local hospital in Dunklin County is the lack of an emergency room.  When it was open, Twin Rivers Regional Medical Center in Kennett had 24,000 emergency room visits a year.  Grebing says the absence of an ER means more people will die.  “The ambulances operating in Dunklin County, when they go transport someone to an emergency room, they’re going to wind up being gone a longer period of time,” said Grebing.  “So, the ambulance coverage in the county is reduced because of that distance.”

Some of the doctors who worked at the Kennett hospital have opened-up a 24-hour urgent care center in Kennett, but such facilities don’t offer the range of services available in an emergency room.

Grebing says the passage of the ballot measures would address several local issues, including the economic pain of losing a hospital.  “From an economic development standpoint, a public safety standpoint, a quality of life standpoint, and the piece of mind of having an emergency room nearby that you could go to if you needed, all those things factor in,” Grebing said.

In 2016, Twin Rivers Medical Center in Kennett experienced $1,679,017 in uncompensated care, largely due to its medical treatment of people without health insurance.

Dave Dillon with the Missouri Hospital Association thinks Twin Rivers, like many other hospitals in the state, would have been less burdened by uncompensated care if the legislature had expanded Medicaid.  He says most of the people who didn’t pay would have been covered under the federal healthcare program.  “They would have at least received a payment for those services,” said Dillon.  “And so, what you get is basically zero instead of something.”

Medicaid expansion, which provides medical coverage to low-income, able-bodied people, was an original component of the Affordable Care Act that was thrown out by the U.S. Supreme Court in 2012.

Since then, states have had the option to expand the federal program that covers individuals with income levels between 0% and 138% of the poverty level.  Many Republican-controlled states, including Missouri, have rejected the option, often claiming it would be too expensive to maintain.

32 percent of the population of Dunklin County, one of the 10 poorest in the state, is on Medicaid as it exists today.

Dillon thinks the ballot effort to construct a new hospital reflects a resiliency on the part of the community which is located in the Missouri Bootheel.  “As sad as the way as it had unfolded has been, the recognition that this is an important component of their community is quite inspiring actually,” Dillon said.