The article “From ‘rural’ Nantucket, a golden harvest for Mass.” (Page A1, Jan. 13) addresses the Medicare reimbursement formula, a complex subject of critical importance to Massachusetts hospitals that requires comment.

Nantucket Cottage Hospital has always been a rural hospital for as long as rural hospitals have been defined by the Centers for Medicare and Medicaid Services. Further, any implication that the “rural floor” adjustment to hospitals’ Medicare reimbursement is somehow unique in coming from “a national pool of money” is untrue. In fact, national budget neutrality is the norm, and has been since 1997. There are myriad other reimbursement adjustments under the Medicare program, which, all told, benefit about a third of all hospitals in the country. These Medicare adjustments are paid for — and have always been paid for — using a national allocation to which all hospitals contribute. Thus, there have always been winners and losers, and Massachusetts has been on both sides of that equation.