By Talia Lissauer, The Berkshire Eagle
PITTSFIELD — Berkshire County’s already stretched health system faces mounting pressure from federal funding uncertainty and the One Big Beautiful Bill Act, according to local health providers.
“Whenever there’s a cut, the first thing we do is we tighten our belts,” Berkshire Health System CEO Darlene Rodowicz said. “And then we start looking at services and hours of operation, because the dollars are tightening up.”
The changes in federal funding, including cuts and stricter requirements under the One Big Beautiful Bill Act, threaten to reduce reimbursements for Berkshire County’s hospitals and clinics as the region continues to face workforce shortages. Local providers warn that these pressures could force clinics to cut services or hours, shift costs to other payers and push patients into more expensive emergency care — potentially destabilizing an already strained rural health system.
Rodowicz recently discussed the impact of the One Big Beautiful Bill Act and the state of health care in Western Massachusetts with U.S. Rep. Richard Neal at a community panel on March 11 at the Berkshire Innovation Center.
The One Big Beautiful Bill Act slashed more than $1 trillion from programs like Medicaid and introduced tougher work requirements, including six-month eligibility checks. As a result, roughly 10 million people could lose coverage as the changes take effect.
“The first round, it’s a small number of changes, so we’re not feeling it, to me, by design,” Rodowicz said. “But the part that bothers me the most about this bill is the majority of the cuts don’t happen until the midterms are done.”
Berkshire County’s three largest health providers — Berkshire Health Systems, Community Health Programs and the Brien Center — rely heavily on insurance reimbursements from Medicaid and Medicare. The changes will reduce a key source of revenue for local care, which is already strained by national workforce shortages and financial pressures.
At the same time, losing insurance can also change how patients seek care. They often delay routine care and instead seek treatment in the emergency room, where care is far more expensive.
“They stop showing up anywhere until they have an emergency,” Neal said. “Then they end up in the emergency room with a much bigger problem.”
When those bills go unpaid or are not fully reimbursed by insurers, hospitals must absorb the cost or shift it elsewhere.
“When there’s no payment, I will transfer that, ultimately, in some way, to the commercial payers,” Rodowicz said. “That’s the reality of how you sustain the health system. So that’s the trickle down we’re going to see in our community.”
But access to primary care is difficult to find, and wait times are long, a problem not exclusive to the county. Rodowicz said Berkshire Health Systems’ workforce isn’t quite stabilized, but progress has been made in terms of workforce development and career pathways.
“There are issues with adequacy of primary care throughout this country,” Rodowicz said. “We are doing a lot of work in that area. For us, it’s about making sure we have an adequate workforce at the lowest cost.”
BHS is also using telehealth to reach more patients, but many virtual visits are only reimbursed because Medicare temporarily expanded coverage during the pandemic. Congress recently approved a three-year extension allowing providers to continue billing for many of those visits.
Short extensions of federal telehealth coverage also create uncertainty for private insurance plans, which often follow the federal government’s lead, Rodowicz said.
“So, it impacts all of us, not just those who are on Medicare,” she said.
Programs that rely on grants, including services that help pregnant and postpartum women with substance use disorders receive treatment while caring for their children, could also face uncertainty.
“So the idea that it could at any moment be chopped off is the cloud we live under right now, and that we just don’t know where these cuts are coming from,” she said. “And I recognize that we’re trying to balance the federal budget and the deficits that we have, but these are real lives at the other end.”
The federal 340B Drug Pricing Program allows hospitals and clinics to buy prescription drugs at steep discounts and use the savings to support care for low-income and uninsured patients. Cancer programs rely heavily on high-cost drugs, making oncology one of the areas where hospitals often depend on savings from the program.
Rodowicz said the program is critical to BHS, and that without it the organization would likely have to eliminate other services to continue supporting oncology care.
Massachusetts operates the Health Safety Net, which helps hospitals cover the cost of care for uninsured patients, but Rodowicz said that is nowhere near big enough.
“The impact of the One Big Beautiful Bill is going to drive those people who don’t have coverage to the Health Safety Net for their coverage, which is essentially just a paper pushing mechanism to say that the shortfall hasn’t gotten any larger,” she said.
Rodowicz said she, along with Diana Knaebe, CEO of the Brien Center, and Bethany Kieley, CEO of CHP, are in constant communication about navigating funding shortfalls with the lowest impact to community care, but there’s so much unknown.
Rodowicz pointed to the reopening of the North Adams Regional Hospital as an example of how BHS is still moving forward. BHS is also working on an expansion of South County’s Fairview Hospital, which will include the long-awaited MRI machine.
“We are still one of the few places, I think, in the country that has actually reopened a hospital,” Rodowicz said. “A lot of them are doing standalone emergency services, but not full hospital care.”
She warns that the demand for health care, especially in the aging Berkshire County, is only going to grow.
“I think about it like, someday I’ll be one of those people in bed. Who’s going to be caring for us?” she said. “That’s how we should all think about that. Is there an adequate workforce?”
