While Congress is tied up with health care reform, rural hospitals across the nation are on edge as they await decisions that could push them closer to closure.
Hundreds of rural hospitals across the country are hanging on by a thread.
Hospitals are the pulses of rural communities.
But right now, many are close to flat lining.
"For those of us who chose to live in rural, we shouldn't have to necessarily have to sacrifice the quality of health care that we're receiving in the communities that we live," said Darrold Bertsch, CEO of Sakakawea Medical Center and Coal Country Community Health Center.
According to the Chartis Center For Rural Health, more than 600 rural hospitals across the nation are vulnerable to closure.
And 33 percent right here in North Dakota.
"The best part of a rural hospital is that a patient gets to get care close to home. We know the patients. We care for them just like our family," said Marcie Schulz, director of patient care at Sakakawea Medical Center.
Admins at Sakakawea Medical Center in Hazen say they haven't had any worries of closing.
But a hospital like Sakakawea shutting down could be catastrophic.
"We consider our service area population to be about 15 thousand. And it includes the geographic area of Killdeer, to Beulah, to Center, over to Hazen," said Bertsch.
If Sakakawea medical center were to close, patients would have to drive 55 miles up to Garrison, or 72 miles down to Bismarck.
It's more than an hour drive either way.
"They're able to leave here knowing that they have a local place to come to if they have a concern," said Schulz.
Bertsch says they do well because of the hospital's collaboration with coal country community health center and strong ties to the area.
But they know every hospital isn't as lucky.
"When healthcare presents a problem, it's not at a convenient time, so it's important for that access be available," said Bertsch.
Nationwide, about 80 rural hospitals have closed since 2010.