Jar of IOUs According to thenonprofit National Rural Health Association, bad debt for ruralhospitals has gone up about 50 percent since the passage of theAffordable Care Act in 2010. (Photo: Shutterstock)

Kristie Flowers had been sick with the flu for four or five daysin July before the 52-year-old registered nurse from Genoa,Colorado, acknowledged she needed to go to the ER.

At Lincoln CommunityHospital, about 10 miles from her home on the Eastern Plains ofColorado, doctors quickly diagnosed her with pneumonia and sepsis.Her right lung had completely filled with fluid, and Flowers neededmuch more intensive care than the 15-bed hospital couldprovide.

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