Scott Newton couldn’t escape the pull of Warren, where he was born, raised, and eventually returned. He went away for college at Duquesne University, earned a degree in pharmacy, and ended up back where he started, at Gaughn’s Drug Store.
Newton is the latest in a long line of Warrenites to guard the legacy of a pharmacy established in 1917. Between semesters in Pittsburgh, he made deliveries for the store, manned the register, swept the floor and learned all the ins-and-outs of filling prescriptions. Along the way, he fell in love with the independence and community that running a pharmacy offered.
In 2005, Newton, 48, became a part-owner of Gaughn’s, then in 2023, along with his wife, Kelly, full owner. In a nation dominated by chains like CVS and Walgreens, this family-operated, independent pharmacy is both a throwback and a linchpin for Warren’s increasingly fragile rural medical care.
In this idyllic enclave nestled in the Allegheny Plateau, days before the nation’s highly anticipated midterm election, residents are contemplating the latest injuries against the healthcare system. Rising costs, staff shortages and plummeting reimbursement rates have shuttered several of Pennsylvania’s rural hospitals, with nearly a third at risk of closure in the coming years. Warren General remains open, but operating at a fraction of its potential, cutting services and rearranging priorities to stay solvent.
The population in Warren has been in a steady decline for decades. It now stands at 37,038, down from its peak of 49,200 in 1972, now with half the population over the age of 50.
“We have to factor in that those folks are the ones that typically need more health care, so it’s a fine balance,” said Dan Grolemund, CEO of Warren General Hospital. “We’ve had to continually right-size our services to match what our community needs.”
According to KFF, a nonprofit health policy research organization, the vast majority of voters identify the cost of living (90%) and health care costs (82%) as “very” or “extremely important” issues for candidates to discuss in the final throes of their campaigns. Across the board, “affordibility” tops voters’ concerns as they head to the polls on Nov. 3. In remote places like Warren, they’ve been living the struggle in real time.
“With my patients, if they are cut out of Medicaid, they don’t have a way to pay for those medications, so I don’t see them,” Newton said. “What is the trickle-down effect from that? It’s going to increase the amount of emergency room visits, it’s going to increase hospital traffic, the workload of every [provider].”
The Republican’s “Big Beautiful Bill,” passed into law on July 4, 2025, made more than $900 billion in Medicaid cuts, beginning January 1, 2027. The bill reduced state contributions to Medicaid programs and implemented work requirements for some recipients. In Warren County, Grolemund estimated more than 1,100 people are set to lose their Medicaid eligibility. Pennie, Pennsylvania’s ACA marketplace, reports that 39% of those enrolled in Warren County have dropped their coverage since Congress failed to extend tax subsidies, increasing premiums by an average of 21.7%.
“I have big concerns that our hospital might go under because of reimbursements,” said Ruby Wiles, who’s lived in Warren for more than 20 years. “We have elected representatives and a president who don’t really value rural people.”
Wiles is the primary caregiver for her 27-year-old son, who is living with a chronic illness that’s taken them to hospitals in Pittsburgh, Cleveland and beyond, trying to identify and treat his condition. Near Warren, it’s slim pickings when it comes to specialty care, so almost everyone is required to travel to far-off places in search of diagnoses and treatments — not an easy ask for anyone, but especially fraught for senior citizens.
“We desperately need doctors willing to come to the rural area,” Wiles said, “we don’t have a neurologist here, we don’t have a rheumatologist…we don’t have a dermatologist.”
And in a region where 25% of residents are aged 65 and older, Warren General also doesn’t have a cardiologist (though, a UPMC outpatient center in Warren does offer cardiology). Bill Massa, 88, and his wife Mary Massa, 88, drive about 160 miles to the Cleveland Clinic for various health conditions, including Bill Massa’s heart surgery.
“My cardiologists are in Erie and my gastroenterologists are in Jamestown, New York,” Mary Massa said. “[Bill’s] a good driver, even at 88.”
Short staffed
Heading north on Route 6 in early October, through the Allegheny National Forest awash in vibrant reds and oranges, the Hickory Bridge crosses the Allegheny River into the Warren Historic District, leading straight to Gaughn’s Drug Store. The winding, uneven sidewalks, lined with Queen Anne-style architecture and wrought-iron lampposts, are relics amid a maze of churches and storefronts.
Gaughn’s is also a testament to Warren’s history. It’s every inch a mom-and-pop shop. The interior is wood paneled up to the ceiling with a thin brown carpeting that does little to muffle the creaking floors. Five small aisles make up the front room, arranged with greeting cards, hygiene items, novelty knick knacks, coffee grounds by a local high school teacher and a surprising array of Pokemon cards (the inventory managed by the Newtons’ 16-year-old son, Grant).
Independent, family-owned pharmacies make up roughly a third of all brick-and-mortar drug stores in the U.S. Pharmacy Benefit Managers (PBMs) — third-party companies setting prescription drug prices and reimbursement rates for pharmacies across the country — and the precarious healthcare landscape are forcing many out of business. Oftentimes, PBMs will set high drug prices and compensate pharmacies less than the cost of the medication.
During the COVID-19 pandemic it became clear to Newton that his services could — and should — extend beyond the traditional. Pharmacies were allowed to administer vaccines and provide other clinical services. It was a glimpse into the future and now Gaughn’s is at the center of the county’s grasp for resources in a growing healthcare desert.
“It put us on the map,” Newton said. “I think I had enough foresight to see that this COVID thing was going to be a major shift for pharmacy.”
But COVID also decimated the healthcare workforce, with doctors, nurses and technicians fleeing the profession at record rates, due to burnout. Rural areas have never recovered. At Warren General Hospital, just in the past year, full-time staff decreased by 7%, from 490 employees to 452.
The staffing shortages extend to other critical healthcare services too. Ken McCorrison, Warren County director of the Emergency Management Agency and Public Safety, said it’s not uncommon for residents to wait 20 or 30 minutes for an ambulance, depending on where they are. Most of the calls that EMS responds to, he said, are for falls and heart-related emergencies.
The county is one of many in Pennsylvania with a shrinking pool of emergency responders and dwindling financial support. Most rely on volunteers, but fewer younger people are stepping into positions left by aging workers. All while Warren’s EMS is also covering a wider geographical region as municipalities in neighboring counties close their departments.
“People get caught up in the money. That’s not what it’s all about. We’ll figure all that out,” McCorrison said. “What it’s really about is that somebody’s mom, somebody’s kid, somebody’s grandma that needs help.”
Grolemund, whose office sits in the wing of the hospital where he was born in 1976, names staffing as the challenge that keeps him up at night.
In 2025, the 85-bed hospital closed its labor and delivery unit, after Grolemund personally contacted 28 different residency programs and utilized 10 national recruiters to entice OB/GYN candidates to the position. He had no takers. Now patients must travel about 20 miles to Jamestown, New York, or more than 60 miles to Erie, to give birth. The region’s maternal health desert is bigger than the entire state of Connecticut.
Nurses, lab techs, radiology technicians, physical therapists, respiratory therapists — Warren General needs more of all of them. And Grolemund will go to great lengths to make them feel welcomed in a place that might feel isolated and foreign to many who consider an offer.
“The last doctor that signed with us, it was her birthday the next day,” Grolemund said. “And she came in, and we had balloons and everything. She said that feeling of ‘home’ made [her] want to be here.”
The local hospital in neighboring Bradford closed in May and Grolemund's mission is to make sure Warren doesn’t suffer a similar fate. This past year, he said, the hospital posted a $65,000 operating profit, which may seem meager until you factor that the previous three years had a combined $9.5 million loss.
Now Warren General is opening a Bradford County location, which Grolemund is expecting will offset losses from the Medicaid cuts that start in January. In February, Warren General also received designation as a Critical Access Hospital by the Centers for Medicare & Medicaid Services.
“That reimbursement makes the difference between a hospital being able to stay open or close, because they know that funding is going to be coming in at a much higher level for every service they provide that is Medicare and/or Medicaid,” said Lisa Davis, director at the Pennsylvania Office of Rural Health.
It gives Grolemund more confidence in his facility’s stability, too.
“We’ve been treating patients in Warren, Pennsylvania, since 1900,” he said. “It’s my goal to be around another 126 years.”
All roads lead to Gaughn’s
Clearly, in Warren, healthcare is very much a community endeavor. And Gaughn’s increasingly seems to serve as the glue trying to hold the operation together.
Newton and Justin Scholl, the pharmacy’s clinical manager, have dreamed up plans to keep pace with the evolving healthcare industry, but also do more to support the aging community. The next project is addressing the scarcity of specialists and gaps in patient care. Scholl applied for a $509,895 grant through the Rural Health Transformation Program, a $50-billion federal initiative meant to support projects that help sustain services through technology, innovation and new workforce models.
Gaughn’s plans to use the funds to renovate the store, creating several consultation rooms outfitted with iPads for patients to access telehealth services in a location with reliable broadband, have medication consults with pharmacists and receive vaccinations. A prescription dispensing robot will also lighten the load on technicians and staff.
It takes some of the stress off the already taxed providers, like the four local primary care physicians who are booked solid, at all times. The hope is that when doctors see patients in the ER or in their offices struggling with asthma, for example, they can refer them to Gaughn’s for help going over medications or how to use an inhaler.
“Let us take some of that off your plate,” Newton said.
The telehealth services could also be a godsend for providers like Amy Stanbro, who is an older adult care manager at the Area Agency on Aging for Warren and Forest County. She recalled a time not long ago when she and a coworker drove an elderly patient all over the region looking for a neurologist and psychiatrist for evaluations. Over the course of several days they were passed off to three different facilities, covering approximately 140 miles on the road.
“I spent my whole evening advocating for him because that’s what needed to be done,” Stanbro said.
Last year, the Area Agency on Aging’s 25-person staff served 5,000 people across the two counties. Over the past two years, the agency had a 25% increase in the number of people seeking its services while funding has remained flat, said Danell Sowers, director of the agency. Partnering with Gaughn’s for annual events like October’s vaccination clinic helps.
On that October day, less than a month until Election Day, Scholl set up shop at a long white table at the senior center to start administering vaccines. The broad windows were adorned with artwork, including an intricate sketch of a hunting cabin and flowers growing from twisted stems in the burnt oranges and yellows of fall.
Judy Davis, 83, a retired nurse and volunteer at the center, sat at one of the tables in the middle of the room, waiting to receive her flu shot. As election day drew closer, she reflected on how her vote is tied to her community’s health. She considers it when she casts her ballot.
“I am not as far down on the financial ladder as some are, but what affects my neighbors and the people I associate with indirectly affects me,” she said, adding, “It’s a blessing that we’re all living longer, but it’s also an issue.”
This story was produced by the News Lab at Penn State. Reporting by Avery McGurgan, Chayil Dozier, Esteban Marenco and Quinn O'Leary. Photos by Chayil Dozier and Esteban Marenco. This work was made possible by funding from the Arthur P. Miller Newsroom Fund and the Hearst Foundations.