Twenty-six percent of rural hospitals in Texas are at risk of closure, according to a report issued late last year by the firm Kaufman Hall. The number is up 10% from 2021 and the risk is due in part to pandemic relief money running out.

The Texas Organization of Rural and Community Hospitals defines a rural hospital as one in a community of fewer than 60,000 people. Henderson pointed to a closure in Bowie as an example of how important hospitals are not just to a city's health care, but to its economy.

"It wasn't just that the hospital closed and you lost access and lost 100 or more good jobs. It's that local sales tax revenue dipped by a third the following year, school enrollment dropped. They went through around a teacher layoffs," TORCH president and CEO John Henderson said. "So you see all those cascading economic impacts that are all negative and harmful to a community."

Dr. Kristie Loescher, assistant dean for instructional innovation for the McCombs School of Business at the University of Texas and the academic director for the Healthcare Innovation Initiative, said one of the ways rural hospitals can make smart decisions by limiting the services it offers.

For example, she pointed to an emergency room. Due to a federal law, a hospital is required to treat any patient who walks through its emergency room doors -- whether or not they can pay for services.

"In Austin or Dallas, if a hospital sees a few patients like that, they can absorb it. They can absorb the bad debt. But in a rural situation, they're living so close to the wire, they don't have that extra margin to be able to provide the amount of charity care required," she said.

Host Baylee Friday also speaks with the CEO of Muenster Memorial Hospital, Marion Bruce, about the challenges facing her hospital in recent years.