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Rural hospital closures mean poor health outcomes for rural Americans

In the last ten years, 124 rural hospitals have closed, and hundreds more are at risk of closing. According to a new report from Chartis Center for Rural Health, rural hospital closings are leading to poor health outcomes for many rural Americans. If Congress continues to let market forces determine which hospitals thrive and which go under, it will leave rural Americans at serious health risk.

Nearly 50 million people live in rural America, one in six Americans. Of the rural hospitals, Chartis reports that almost one in four (453) are at risk of closing. Nearly four in ten are unprofitable. Because many rural residents are uninsured and underinsured, rural hospitals deliver a significant amount of uncompensated care.

Over the last ten years, Texas saw 20 rural hospitals close and Tennessee saw 12 close.  Oklahoma and Georgia each saw seven hospitals close. And, these four states have the most rural hospitals at risk of closing in the next few years.

Medicare and Medicaid have helped rural hospitals over the last several decades. Rural hospitals are stronger in states that have expanded Medicaid than in states that have not expanded Medicaid. In states that have expanded Medicaid to people with incomes up to 137 percent of the Federal Poverty Level, the uninsured rate has dropped from 35 percent to 16 percent. Rural hospitals in these states are more often compensated for the care they provide than rural hospitals in states that have not expanded Medicaid

Rural hospitals in states that have not expanded Medicaid are serving more uninsured patients and delivering more uncompensated care. The uninsured rate in those states for people with incomes under 138 percent FPL is 32 percent. These rural hospitals struggle to remain profitable.

Not surprisingly, adequate health care is hard to come by for many rural Americans. People with chronic conditions in rural America are at greatest risk, particularly people with chronic obstructive pulmonary disease and diabetes.

Americans living in rural areas have worse health outcomes, are more likely to be hospitalized, and are significantly more likely to die than people living in cities and suburbs. 

Congress needs to step in to ensure that rural Americans are not forced to go without needed care. Medicare for All would ensure rural hospitals are paid for the care they deliver and guarantee rural Americans access to the health care they need.

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