2019 was the worst year for rural hospital closures this decade, a new report finds

According to a new report from the Chartis Center for Rural Health, 19 rural hospitals closed across America in 2019. Almost one out of every four open rural hospitals are at risk of closing in the near future.

States like North Carolina, that have chosen not to expand Medicaid have experienced the most rural hospital closures over the last 10 years, according to the report.

From Vox:

Since 2010, 120 rural hospitals have closed, according to University of North Carolina researchers. And today, 453 of the 1,844 rural hospitals still operating across the country should be considered vulnerable for closure.

The Chartis researchers sought to identify key risk factors that precipitated rural hospital closures and then used those indicators to project which hospitals are at risk of closing soon. Some of the criteria was obvious, like changes in revenue or how many beds are occupied on average.

But there was one other leading indicator that has an obvious political explanation and which should be entirely avoidable: whether the hospital is in a state that expanded Medicaid under Obamacare.

According to Chartis, being in a Medicaid expansion state decreases by 62 percent the likelihood of a rural hospital closing. Conversely, being in a non-expansion state makes it more likely a rural hospital will close.

Of the 216 hospitals that Chartis says are most vulnerable to closure, 75 percent are in non-expansion states. Those 216 hospitals have an operating margin of negative 8.6 percent. 

Research has consistently shown Medicaid expansion improves hospitals’ financial performance by reducing the amount of uncompensated care.

States had a choice about expanding Medicaid, and so far, 14 states have rejected the offer. They’ve left 2.3 million people uninsured.

Since 2010, over six rural hospitals have closed in North Carolina, and others are at high risk of financial stress due to lack of funding. 

With Medicaid expansion, over 13,000 jobs could be added to North Carolina’s 80 rural counties and would help keep rural hospitals afloat, connecting people to the care they need and boosting the well-being of families and communities.

Without Medicaid expansion, North Carolina holds the 10th highest uninsured rate in the nation with over one million — 10.7 percent of the state’s population — uninsured in 2017.

And yet, state lawmakers refuse to push for coverage that would help children and their families, seniors and disabled persons whose income are below certain financial thresholds.

For states like North Carolina that have decided not to expand Medicaid, rural hospitals, which already operate with the slimmest of margins, continue to be deprived of resources that could be the difference between survival and closure. State lawmakers are putting the health care of people living in rural areas at risk as they refuse to expand Medicaid.