When you pull into Hugo, a town 100 miles east of Denver on Highway 287, you're greeted by one grocery store, one restaurant, one liquor store, one historic railroad roundhouse, two bars and a single antique store by the name of Main Street Mama's.
"I am the Main Mama, I am indeed," says Linda Orrell, who runs the shop.
Sitting on a bar stool in what used to be an old pool hall, Orrell says Hugo is pretty small — "about 825, or so, maybe 850 [people] on a good year."
The population has held steady for a long time, she says, because it's a good place to live.
"It's a town that people tend to come back to, to retire" Orrell says. "And it is home."
There's something else you'll find in Hugo: one regional hospital. Town residents are very proud of their hospital, but changes to the Affordable Care Act could reduce its funding and force it to cut back services.
From the outside, Lincoln Community Hospital looks more like a small 1960s-era apartment building. But it has all the essential high-tech health care equipment: modern imaging machines, tele-medicine links — even an AirLife helicopter. Rachel Smith, the assistant director of nursing, says the thing that really sets the hospital apart is the quality of its care.
"It's definitely not treat 'em and street 'em," Smith says. "It's definitely somebody you're going to see — maybe even later that day, later that week."
Smith grew up in Hugo. Her mom, Linda Messer, is the lab director and says what defines the hospital is the sense of community that comes with being in a small town. "The thing that I like best about rural health is that I get to take care of all my friends and family," Messer says. "So it's rare that I don't know everyone that I take care of."
The close connections are apparent throughout the hospital. In one room, recovering from back surgery, is 86-year-old retiree Ken Sterling. He was in the Navy, then did appliance repair and even served as mayor of Hugo. Sterling's dad edited the local paper, the Eastern Colorado Plainsman and helped build the hospital back in the '50s. There's a reason Lincoln Community is in Hugo — it's roughly 100 miles to Denver and roughly 100 miles to the nearest hospital near the Kansas-Colorado border.
"I don't know how much you've driven out in this part of the country," Sterling says, "but there's a whole lot of nothing. People have a tendency to get a lead foot — there are a lot of car accidents."
Officially there are a little over 5,500 residents in all of Lincoln County – that's a population density of about two people per square mile. But Interstate 70 is only about 15 miles north of town, so a lot of people in cars and trucks pass through the area.
"There are an awful lot of people that depend on this place," Sterling says of the hospital. "And I'm not talking of people that work here. I'm talking about people that get care here."
People like Ted Lyons, who had to be hospitalized because of an infection. Lyons is 69 and was a cattle rancher and a Republican county commissioner for more than a decade. He's been watching a lot of C-SPAN on TV recently, including the push to replace the Affordable Care Act. Lyons says he'd like President Trump to visit Hugo's hospital.
"I thought I'd write a letter to Trump and see if he was flying over in his helicopter," Lyons says. "He could land down on the helipad and come [see] what a real hospital is about."
Lyons agrees with Trump that Obamacare needs to change; that it "leaves too many loopholes." As the co-owner of one of the two bars in town, Lyons hears lots of stories from locals, including one couple who saw their insurance premiums skyrocket.
"They said their insurance went from $400 a month to $1,200 a month — and then that outfit quit," says Lyons. "So they were totally without insurance."
Like half of Lincoln Community Hospital's patients, Lyons is covered by Medicare. One chronic problem for the hospital is that its reimbursement from Medicare doesn't cover the full cost of the services it provides.
The hospital also receives — and depends on — Medicaid payments, and that program is facing deep cuts under the Senate health bill now under consideration.
Lyons was on the hospital's board when it nearly had to shut down a couple of decades ago. He says he wants lawmakers to work together to keep the parts of Obamacare that work and fix funding for hospitals.
"You don't drown the duck to get a feather out of him," Lyons says.
Sterling says he also supports whatever helps save his hometown hospital.
"Don't even talk about losing this place!" Sterling says. "That would be a tragedy. Really."
Both men know that making the finances work for rural hospitals is tricky. As Congress works to change the health system once more, many small town facilities like Lincoln Community Hospital are on thin ice.
This story is part of NPR's reporting partnership with Colorado Public Radio and Kaiser Health News.
SCOTT SIMON, HOST:
A third of the nation's 1,800 rural hospitals are at risk of going under. John Daley of Colorado Public Radio visited one on the eastern plains of Colorado and found that, in many ways, it is at the core of small-town life. But its dependence on federal funding means its future uncertain.
(SOUNDBITE OF FREEWAY NOISE)
JOHN DALEY, BYLINE: When you pull in to Hugo 100 miles east of Denver, you're greeted by one grocery store, one restaurant, one liquor store, one historic railroad roundhouse, two bars and an antique store.
LINDA ORRELL: Main Street Mama's.
DALEY: You're the Main Street mama?
ORRELL: I am the main mama. I am indeed.
DALEY: That's Linda Orrell. She sits on a bar stool in what used to be an old pool hall. She says Hugo is pretty small.
ORRELL: It's about 825 or so - maybe 850 on a good year.
DALEY: Just up the hill is Hugo's hospital, Lincoln Community Hospital and Care Center.
RACHEL SMITH: Hello, good sir. Rachel.
DALEY: From the outside, it looks more like a small, 1960s-era apartment building.
SMITH: So this is the two-bed bed emergency room.
DALEY: But it has all the essential, high-tech health care equipment, modern imaging machines, telemedicine, even an AirLife helicopter. Rachel Smith is the nursing director. Smith gives me a tour of the 15-bed critical access facility.
SMITH: You know, it's not treat them and street them. It's definitely somebody you're going to see maybe even later that day, later that week.
DALEY: In one room at the hospital, there's retiree Ken Sterling.
KEN STERLING: This is my hometown.
DALEY: Sterling is in his mid-80s. He was in the Navy, then did appliance repair and even served as mayor. He was recovering from back surgery when I visited. Sterling's dad edited the local paper and helped build the hospital back in the '50s.
STERLING: I don't know how much you've driven out in this part of the country, but there's a whole lot of nothing. And people have a tendency to get a lead foot. There are a lot of car accidents.
DALEY: The interstate is about 15 miles away, so a lot of people pass through the area. But, officially, there are just 5,500 people in all of Lincoln County. Sterling says the hospital is vital.
STERLING: There are an awful lot of people that depend on this place.
DALEY: People like Ted Lyons down the hall, who was recovering from an infection. Lyons was a cattle rancher and a Republican county commissioner for more than a decade in a county where 4 of 5 residents voted for Donald Trump. He's been watching a lot of C-SPAN, hearing a lot about the push to replace the Affordable Care Act. Lyons says he'd like Trump to visit Hugo's hospital.
TED LYONS: He could land out here on this helipad and come visit - what a real hospital is about.
DALEY: Lyons agrees with President Trump that Obamacare needs to change. Medicare is his insurance, like half the hospital's patients. And many also depend on Medicaid or both. But government payments from those programs don't pay the hospital enough to cover the full cost of their health care. Lyons was on the hospital's board when it nearly shut down a couple of decades ago. He wants lawmakers to work together to keep the parts of Obamacare that work and fix funding for hospitals.
LYONS: You don't drown the duck to get a feather out of him.
DALEY: Down the hall, Ken Sterling, too, supports whatever helps save his hometown hospital.
STERLING: Don't even talk about losing this place. That would be a tragedy, really.
DALEY: But if the GOP bill becomes law, it would make dramatic cuts to Medicaid and other reductions in federal contributions to consumers and insurers alike. That would put small-town facilities like Lincoln County Hospital on thin ice. For NPR News, I'm John Daley.
SIMON: And that story's part of a partnership with NPR, Colorado Public Radio and Kaiser Health News.
(SOUNDBITE OF WINTERLIGHT'S "BETWEEN JOY") Transcript provided by NPR, Copyright NPR.