A total of 50 hospitals in the rural U.S. have closed since 2010, and the pace has been accelerating, with more closures in the past two years than in the previous 10 years combined, according to the National Rural Health Association. That could be just the beginning of what some health care analysts fear will be a crisis.Other factors in Obamacare could be contributing, including a reduction in reimbursements for charity care and lining Medicare payments to quality standards and readmission rates. The populations in these communities also tend to be older and poorer, so the hospitals were already disproportionately treating patients through Medicaid and Medicare, which reimburse at lower levels than private insurance. The Medicaid expansion in Obamacare, however, was intended to help offset those cuts. Beyond a lack of Medicaid expansion, though, is the double whammy of fiscal austerity—federal assistance has been cut across the board—and the effects of the recession. High unemployment and higher rates of uninsurance mean rural hospitals are closing in states like California, too.
An additional 283 rural hospitals in 39 states are vulnerable to shutting down, and 35 percent of rural hospitals are operating at a loss, according to iVantage Health Analytics, a firm based in Portland, Maine, that works with hospitals.
Most of the rural hospital closures so far have occurred in the South and Midwest. Of those at risk, nearly 70 percent are in states that have declined to expand Medicaid under the federal Affordable Care Act, although some experts are hesitant to draw a cause-and-effect correlation.
What all this means is unnecessary deaths like this:
In rural North Carolina last summer, 48-year-old Portia Gibbs died from cardiac arrest after waiting 90 minutes for a medical helicopter to arrive. She could have been at a hospital in less than half that time, had not the Vidant Pungo Hospital in Belhaven closed just six days earlier.Or this one:
When 18-month-old Edith Gonzalez choked on a grape in August 2013, her parents rushed to Shelby Regional Medical Center in their hometown of Center, Texas, unaware that the hospital had closed several weeks earlier. Their daughter was dead by the time an ambulance brought her to the next nearest hospital, more than 45 minutes later.The last thing Congress should be doing is precisely what House Republicans are: trying to make even deeper cuts to Medicaid and to other safety net programs. It's not just the poor who are going to be suffering if this continues. Every shuttered hospital means lost jobs, which means lost revenue for localities and states which means economies that can't recover. And it means a lot more people dying.