A new survey showed that about half were operating in the red, and the share was even more dramatic for small rural hospitals. Driving that financial picture, says the Nebraska Hospital Association, which released the survey results, are rising workforce and pharmaceutical costs, along with reimbursement coverage gaps from Medicaid and Medicare. At risk if the trend continues unaddressed are cuts ranging from patient medical programs to staff support services such as child care, hospital representatives said during a news conference Monday.