The future of health care has been in the news a lot recently. The intended repeal of the Affordable Care Act, commonly called “Obamacare” has generated more questions than answers.

However, one thing is for certain. The upcoming plight of Colorado’s rural hospitals is not in question. Last year, the state Legislature voted not to set up the Hospital Provider Fee as a separate enterprise fund that would provide vital funding to the state’s hospitals, many of which are already operating at a loss.

To put this situation in perspective, you must first understand the history of the issue. In 1986, President Reagan signed the Emergency Medical Treatment and Labor Act into law. The law stipulates that all hospitals must provide life-saving care to patients, regardless of their ability to pay for the services. While well-intentioned, the EMTLA became an unfunded mandate for hospitals.

However, the law was abused. Many people without insurance, either by choice or by circumstance, sought emergency care at hospitals and therefore had no ability to pay for the services rendered. This left hospitals to pick up the costs with no hope of reimbursement.

The Hospital Provider Fee – or tax if you prefer – originated in 2010. It meant that hospitals were eligible to receive not more than 6 percent of their net revenue in the form of a matching grant paid by the federal government. The HPF essentially provided reimbursement to hospitals for the indigent care they provide.

By combining the HPF along with Medicaid reimbursements, our rural critical access hospitals were reimbursed 110 percent by the federal government. Hospitals without the critical access designation were reimbursed 57 percent from the HFP and 37 percent from Medicaid.

Without this funding, critical access hospitals simply can’t operate. These are small, rural hospitals with low bed counts that operate on very thin margins. But the funding is just as important for large hospitals in the metro area too, since they also provide their fair share of indigent care.

Currently, Gov. Hickenlooper has requested $194 million out of the HPF to reimburse hospitals. The failure to place the HPF with an enterprise fund has greatly diminished the reimbursement rate to hospitals. In a nutshell, that’s why all hospitals are cutting their budgets to bare bones.

The situation is worse for small, rural hospitals. Many are in jeopardy of closing their doors. Not only does that take away life-saving health care services for people who live in their areas, but it eliminates much-needed jobs.

Along with the repeal of the ACA (Obamacare), there are also expected cuts to Medicaid reimbursements. Even so, EMTALA remains the law of the land, and hospitals – by law – must provide lifesaving care for anyone who enters the building, regardless of their ability to pay.

There’s no doubt in mind the system is broken. The system forces hospitals to provide care just like it forces insurers to offer coverage to very sick people. It’s simply not sustainable and it will result in the closure of hospitals across Colorado without an intervention.