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.
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