“Five-hundred and twenty-eight million dollars?” said Sen. Larry Crowder, a Republican from Alamosa. “Yeah, well, I imagine that’s where we’re heading.”

Crowder was digesting the news that state legislative budget writers are planning to unveil their draft version next week and that it will very likely include a $528 million cut to state hospital operating budgets.

When he first hears the figure, Crowder doesn’t move. He looks at the top of the committee table where he’s sitting and it’s a full second or two before he looks up. He mentions that he knew there would be cuts.

Crowder represents the poorest Senate district in the state, a vast swath of southeastern plains, drained of industry over the decades and losing more young people every day. The more than $500 million cut may well be devastating to hospitals Crowder’s district and in districts across rural Colorado, where health care is already notoriously underfunded and where Republican repeal of the federal Affordable Care Act will very likely end Medicaid payments that have started to deliver small but vital amounts of much-needed cash.

“It’s very difficult to plan right now,” Crowder said. “We have no idea what the federal government is going to do – we think we do, but we don’t really know, not until they gavel down a vote. We don’t know what’s going to happen.”

At the time of the interview on Thursday, the Republican health reform bill looked to be entering a death spiral on Capitol Hill. Frantic negotiations and redrafting efforts seemed unlikely to alleviate concerns expressed by hardline conservatives in the House and still deliver a bill that could pass in the Senate. Sometime after 2 p.m., House Speaker Paul Ryan pulled the plug on the planned introduction.

Crowder has sounded alarms at the Capitol about the state of rural health care for years as proposal after proposal to address the issue fail to gain traction. He talks at length about the need to treat escalating addiction and mental health issues. He was the only Senate Republican last year to say he supported reclassifying the state’s hospital provider fee – an accounting move that would have delivered millions more to hospitals but that Republicans resisted as an attack on the Taxpayer Bill of Rights and a mere temporary fix t a much larger problem.

“Rural hospitals are already looking to cut their budgets,” said Crowder. “They’re looking at closing doors. All I can tell you is that Alamosa’s hospital – they already projected a $4 million cut this coming year. That’s one of the hospitals that’s left out there.”

The San Luis Valley Health Regional Medical Center is home to 49 beds and the only hospital for 100 miles with a maternity ward. Its mostly impoverished patients either can’t pay for treatment or rely on Medicaid.

“The problems keep coming,” Crowder said.

– john@coloradostatesman.com