A health center closure in New England town reveals toll of federal cuts on rural communities

FRANCONIA, N.H. (AP) — For more than two decades, Susan Bushby, a 70-year-old housekeeper from a rural ski town in New Hampshire's White Mountains, took comfort in knowing she only had a short drive to reach the community health center.

The lodge-like medical building, which sits on a hill overlooking town, was like a second home for Bushby and many other patients. The front desk staff knew their names and never missed a chance to celebrate a birthday or anniversary. Staff photos of the wilderness that makes the place such a draw hung on the walls, and bumping into a neighbor in the waiting room was routine.

But last month, the Ammonoosuc Community Health Services location in Franconia, a town of around 1,000 people, closed for good.

Officials blamed cuts in Medicaid, the federal program that millions of low-income Americans rely on for health care. The 1,400 patients, almost half of them older and some facing serious health challenges like cancer and early-stage dementia, must now drive at least 10 miles (16 kilometers) along rural roads to reach the nearest health center, which also is near a regional hospital. A second center is twice as far.

“I was very disturbed. I was downright angry,” said Bushby, who was brought to tears as she discussed the challenges of starting over at a new health center. “I just really like it there. I don’t know, I’m just really going to miss it. It’s really hard for me to explain, but it’s going to be sad.”

The closure of the Franconia center reflects the financial struggles facing community health centers and rural health care systems more broadly amid Medicaid cuts and a feared spike in health insurance rates. The government shutdown, which ended last week, was driven by a Democratic demand to extend tax credits, which ensure low- and middle-income people can afford health insurance through the Affordable Care Act, or ACA.

Marsha Luce, whose family moved from the Washington, D.C., area in 2000, is especially concerned about the impact on her 72-year-old husband, a former volunteer firefighter who has had his left ear and part of his jaw removed due to cancer. He also has heart and memory issues.

She worries about longer waits to see his doctor and the loss of relationships built up over decades in Franconia.

“It’s going to be hard,” she said. “But it’s a relationship that’s going to be missed. It’s a relationship that you can talk to people and you tell them something and you go, yeah, well, I’ve had cancer. Oh, let’s see. Oh, yeah. There it is in your chart. Do you know what I mean?”

More than 100 hospitals closed over the past decade, according to the Center for Healthcare Quality and Payment Reform, a policy and advocacy group, and more than 700 more hospitals are at risk of closure. A branch of the HealthFirst Family Care Center, a facility in Canaan, New Hampshire, also announced it was closing at the end of October due in part to “changes in Medicaid reimbursement and federal funding” for these facilities.

“Because of these Medicaid cuts, we’re going to see rural hospitals, in particular, hit hard,” New Hampshire Sen. Maggie Hassan, a Democrat, told The Associated Press. “And obviously, the failure to extend the ACA tax credits right now is going to compound the problem. … These providers are going to see more and more uninsured patients. And that means they’re going to have to make really difficult decisions.”

The sustainability of the centers is critical because they serve as the nation’s primary care safety net, treating patients regardless of insurance coverage or ability to pay.

Though federally-funded community health centers like the one in Franconia have expanded their reach in recent years, treating 1 in 10 Americans and 1 in 5 rural Americans, they’ve often done so in the face of major financial constraints, according to data from the National Association of Community Health Centers.

On average, the centers are losing money — relying heavily on cash reserves, making service changes and sometimes closing locations to stay afloat, NACHC found. Nearly half have less than 90 days' cash on hand, according to the association. The future is even more bleak, with at least 2 million community health center patients expected to lose Medicaid coverage by 2034 and 2 million more who are newly uninsured turning to the centers for care.

“There’s nothing left to trim without cutting into care itself,” said Peter Shin, the chief science officer at the association.

When President Donald Trump’s bill passed this summer, Ed Shanshala, the CEO of Ammonoosuc, knew he was in trouble.

A meticulous planner and strategist, Shanshala projected that his network of five New Hampshire health centers — which relies on more than $2 million in federal funding out of a $12 million budget — would face a $500,000 shortfall partly due to Medicaid funding cuts. He also expected work requirements in the bill and spikes in health insurance premiums to have an impact.

Shanshala knew he needed to make cuts to save his centers and zeroed in on Franconia because the building was leased, whereas Ammonoosuc owns the other facilities.

“We’re really left with no choice,” Shanshala said, adding the closure would save $250,000. Finding additional cuts is hard, given that the centers provide services to anyone under 200% of the federal poverty line, he said. If he cuts additional services, Shanshala fears some patients will end up in a hospital emergency room or “stop engaging in health care period.”

“To have to pull out of a community is devastating on a relational level,” he said. “People still have access to health care. We’ll help them with transportation, but it’s clearly a grieving process. Whenever a business leaves a community, regardless if it’s health care or something else, there’s an emotional fabric tear.”

The closure has brought little controversy. Just a lot of grief.

Most of the patients come from the small towns of Franconia, Easton, Lincoln and Sugar Hill, communities whose economies rely on hikers, skiers and leaf peepers. Many are older, sicker and more spread out than the rest of the state.

Luce, who volunteers at the local Head Start program and delivers food to schools in Franconia, said the closure has her mostly frustrated with politicians, adding that she wished lawmakers in Washington could “just live the way regular people live” for a few months.

“They would have a much different idea of what goes on in the real world,” she added.

Patients like Jill Brewer, the chair of the Franconia Board of Selectmen whose family has been going there for decades, worry about the future and whether the closure signals the gradual collapse of the health care system in this part of the state.

“Is this kind of the first domino to fall?” said Brewer, noting how disbanding the town's volunteer ambulance service in 2023 angered many residents.

“It definitely leaves you feeling pretty anxious that this is going to continue to kind of snowball and become an even bigger issue,” she added.

On the clinic's last day, it was business as usual — no balloons, no cakes, no farewell speeches. The staff were stoic as they tended to patients, three of whom came in for their physicals and four for checkups. Bushby, who had come to have her blood pressure checked, hugged a staffer as crews dismantled the clinic and wheeled out exam tables.

“I'll come see you, honey. I will,” Bushby said, hugging Diane LaDuke, a patient access specialist. “It's been such a joy coming here.”

Shastri reported from Milwaukee, Wisconsin.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

An exam table is moved onto a trailer on the final day of operation at Ammonoosuc Community Health Services as the clinic closes for good, Thursday, Oct. 23, 2025, in Franconia, N.H. (AP Photo/Robert F. Bukaty)

Marsha, left, and Kirk Luce, both patients at Ammonoosuc Community Health Services, eat dinner, Thursday, Oct. 23, 2025, at their home in Franconia, N.H. (AP Photo/Robert F. Bukaty)

Fall foliage colors the scene near the Community Church, Tuesday, Oct. 21, 2025, in Sugar Hill, N.H., a rural area where the closure of a community health center is leaving residents without nearby medical care. (AP Photo/Robert F. Bukaty)

Dr. Melissa Buddensee, left, meets with patient Susan Bushby at Ammonoosuc Community Health Services, Tuesday, Oct. 21, 2025, in Franconia, N.H., in the final days before the clinic closes for good. (AP Photo/Robert F. Bukaty)

Employees at Ammonoosuc Community Health Services pack up the reception office as the clinic closes for good, Thursday, Oct. 23, 2025, in Franconia, N.H. (AP Photo/Robert F. Bukaty)

RHO, Italy (AP) — No ice is colder and harder than speedskating ice. The precision it takes has meant that Olympic speedskaters have never competed for gold on a temporary indoor rink – until the 2026 Milan Cortina Winter Games.

In the pursuit of maximum glide and minimum friction, Olympic officials brought on ice master Mark Messer, a veteran of six previous Olympic speedskating tracks and the ice technician in charge of the Olympic Oval in Calgary, Canada — one of the fastest tracks in the world with over 300 records.

Messer has been putting that experience to work one thin layer of ice at a time since the end of October at the new Speed Skating Stadium, built inside adjacent trade fair halls in the city of Rho just north of Milan.

“It’s one of the biggest challenges I’ve had in icemaking,’’ Messer said during an interview less than two weeks into the process.

If Goldilocks were a speedskater, hockey ice would be medium hard, for fast puck movement and sharp turns. Figure skating ice would be softer, allowing push off for jumps and so the ice doesn’t shatter on landing. Curling ice is the softest and warmest of all, for controlled sliding.

For speedskating ice to be just right, it must be hard, cold and clean. And very, very smooth.

“The blades are so sharp, that if there is some dirt, the blade will lose the edge,’’ Messer said, and the skater will lose speed.

Speedskater Enrico Fabris, who won two Olympic golds in Turin in 2006, has traded in his skates to be deputy sports manager at the speedskating venue in Rho. For him, perfect ice means the conditions are the same for all skaters — and then if it's fast ice, so much the better.

"It's more of a pleasure to skate on this ice,'' he said.

Messer’s first Olympics were in Calgary in 1988 — the first time speedskating was held indoors. “That gave us some advantages because we didn’t have to worry about the weather, wind blowing or rain,’’ he said. Now he is upping the challenge by becoming the first ice master to build a temporary rink for the Olympics.

Before Messer arrived in Italy, workers spent weeks setting up insulation to level the floor and then a network of pipes and rubber tubes that carry glycol — an antifreeze — that is brought down to minus 7 or minus 8 degrees Celsius (17.6 to 19.4 degrees Fahrenheit) to make the ice.

Water is run through a purification system — but it can’t be too pure, or the ice that forms will be too brittle. Just the right amount of impurities “holds the ice together,’’ Messer said.

The first layers of water are applied slowly, with a spray nozzle; after the ice reaches a few centimeters it is painted white — a full day’s work — and the stripes are added to make lanes.

“The first one takes about 45 minutes. And then as soon as it freezes, we go back and do it again, and again and again. So we do it hundreds of times,’’ Messer said.

As the ice gets thicker, and is more stable, workers apply subsequent layers of water with hoses. Messer attaches his hose to hockey sticks for easier spreading.

What must absolutely be avoided is dirt, dust or frost — all of which can cause friction for the skaters, slowing them down. The goal is that when the skaters push “they can go as far as possible with the least amount of effort,’’ Messer said.

The Zamboni ice resurfacing machine plays a key role in keeping the track clean, cutting off a layer and spraying water to make a new surface.

One challenge is gauging how quickly the water from the resurfacing machine freezes in the temporary rink.

Another is getting the ice to the right thickness so that the Zamboni, weighing in at six tons, doesn’t shift the insulation, rubber tubing or ice itself.

“When you drive that out, if there’s anything moving it will move. We don’t want that,’’ Messer said.

The rink got its first big test on Nov. 29-30 during a Junior World Cup event. In a permanent rink, test events are usually held a year before the Olympics, leaving more time for adjustments. “We have a very small window to learn,’’ Messer acknowledged.

Dutch speedskater Kayo Vos, who won the men’s neo-senior 1,000 meters, said the ice was a little soft — but Messer didn’t seem too concerned.

“We went very modest to start, now we can start to change the temperatures and try to make it faster and still maintain it as a safe ice,’’ he said.

Fine-tuning the air temperature and humidity and ice temperature must be done methodically — taking into account that there will be 6,000 spectators in the venue for each event. The next real test will be on Jan. 31, when the Olympians take to the ice for their first training session.

“Eighty percent of the work is done but the hardest part is the last 20 percent, where we have to try to find the values and the way of running the equipment so all the skaters get the same conditions and all the skaters get the best conditions,’’ Messer said.

AP Winter Olympics: https://apnews.com/hub/milan-cortina-2026-winter-olympics

Serpentines are set on the ice of the stadium where speed skating discipline of the Milan Cortina 2026 Winter Olympics will take place, in Rho, outskirt of Milan, Tuesday, Nov. 11, 2025. (AP Photo/Luca Bruno)

Ice Master Mark Messer poses in the stadium where speed skating discipline of the Milan Cortina 2026 Winter Olympics will take place, in Rho, outskirt of Milan, Tuesday, Nov. 11, 2025. (AP Photo/Luca Bruno)

Workers clean the ice surface during a peed skating Junior World Cup and Olympic test event, in Rho, near Milan, Italy, Saturday, Nov. 29, 2025. (AP Photo/Luca Bruno)

Ice Master Mark Messer poses in the stadium where speed skating discipline of the Milan Cortina 2026 Winter Olympics will take place, in Rho, outskirt of Milan, Tuesday, Nov. 11, 2025. (AP Photo/Luca Bruno)

Ice Master Mark Messer poses in the stadium where speed skating discipline of the Milan Cortina 2026 Winter Olympics will take place, in Rho, outskirt of Milan, Tuesday, Nov. 11, 2025. (AP Photo/Luca Bruno)