Many hospitals are disappointed in Governor Jan Brewer’s decision to not set up a state health care exchange, and rather have Arizona use the federal one. And, as KJZZ’s Mark Brodie reports, rural hospitals may be especially concerned.

MARK BRODIE: Part of that worry is the same as for urban hospitals: How much input will they have in the creation and operation of the federal exchange? Pete Wertheim of the Arizona Hospital and Healthcare Association says while his group was disappointed in the governor’s decision, it echoes some of her questions about how the exchange will be implemented.

PETE WERTHEIM: For example, if we have a concern about a rural payment issue, or a network adequacy, or who the exchange allows to contract with, how do we influence that policy? How do we work with the federal government on that? We don’t have those answers at this time.

BRODIE: Wertheim says rural hospitals face narrow profit margins as it is, and are more vulnerable to changes in health care policy. Doctor Howard Eng, with the Center for Rural Health at the U of A College of Public Health, says rural areas have unique needs, including more low-income patients, and fewer doctors.

HOWARD ENG: In addition to the issue of having physician care in rural Arizona, for example, there’s also the question of whether or not there’s gonna be timely hospital services provided, as well.

BRODIE: Eng says, for example, if the U.S.-Mexico border region was considered its own state, it would have the fewest physicians per 100,000 people in the country.