“Rural communities… where 39 percent of the folks who have a stroke or have a heart attack die."

[McCamy Taylor]

I write a lot about health care for the urban poor, because that is what I know. But there is something much worse than being sick and poor and living in a major metropolitan area in the United States. That is being sick and living in the country.

In the past year alone, more rural hospitals closed than in the prior 15 years combined. This is a staggering fact, which is under reported by national media.

http://blog.ruralhealthweb.org/2014/05/rural-hospitals-closing-at-alarming-rate/

You can’t blame the press for ignoring the plight of rural America. The press lives in the Big City. To them, the country is what you travel through to get from one urban area to another. It probably never occurs to them that people live there and work there and go to school. And get sick there.

In the city, there are lots of rich people and lots of insured people who can keep doctors and hospitals in business. In the city, there is a big tax base that can pay for health care for the poor. But, in the country, where there are not so many rich folks and not so many insured folks and not nearly as big a tax base, it may be hard to keep a doctor and a hospital in business. Oh, the local folks can keep the hospital busy. But they may not be able to pay their bills. And if no one else---meaning the state or federal government---is willing to step in, then the doctors and the hospital will leave, and the small town will find itself with no health care at all.

This problem is most acute in the 24 states which have rejected the Medicaid expansion.

Vidant Health, which announced last year that it was closing its hospital in Belhaven, is coming under renewed fire from town officials and the NC NAACP for its decision as the deadline for its closing draws nearer.
The hospital is the only emergency care provider in the rural area and provides services to 25,000 residents of Beaufort and Hyde Counties. The nearest hospital is in Washington, more than 30 miles away.
snip
Vidant, which is affiliated with East Carolina University, has said the state’s refusal to expand Medicaid put it in financial dire straits.
According to the latest census data, 28 percent of Belhaven lives in poverty. The hospital is the only one in the area required by federal law to provide care to all, regardless of insurance status or ability to pay. Vidant has proposed to build an urgent care center in Belhaven that will not be under the same care provision obligations.

http://www.newsobserver.com/2014/03/05/3676270/rural-hospital-to-close-naacp.html

Note that Emergency Rooms must treat anyone who shows up at the door regardless of ability to pay. A minor emergency center can turn you away for lack of money. If your town loses its ER and you are broke and uninsured, you could end up dying of a treatable disease, like an infected tooth. And even if you have insurance and/or money, if the closest ER is an hour away, that may be too far if your life is in danger.

Rural hospitals in Red states did not just miss out on extra Medicaid funding. They are being hit with a federal funding cut. Since all 50 states were slated to receive Medicaid money, the federal government predicted that it would not have to subsidize rural hospitals as heavily as it has done in the past.

A rural hospital located in Brownsville, Tennessee is ending its inpatient and emergency services this summer because it can’t afford to keep operating them. Instead, the facility will become an urgent care clinic dealing with minor illnesses. W. Larry Cash, the chief financial officer for the community health group that operates the hospital, told the Tennessean that his state’s refusal to expand Medicaid was a “contributing factor” in the move.
Providers that serve a high number of poor and uninsured Americans, technically called “Disproportionate Share Hospitals,” often operate on a loss because their patients can’t always pay for their care. To compensate, the federal government offers reimbursements for those hospitals — but the Affordable Care Act changes the way the payments are structured. Because the health law intended every state to expand Medicaid, and therefore reduce the number of uninsured people who can’t pay their bills, the reimbursements for DSH hospitals have been reduced.
But if hospitals are located in states that continue to refuse Obamacare’s Medicaid expansion, that puts them in a difficult spot. They’re losing out on some of the federal government’s funding without making up the difference with an influx of insured patients.

http://thinkprogress.org/health/2014/04/30/3432599/tennessee-medicaid-hospital/

Ouch. Some things just aren't fair.

The people who wrote the Affordable Care Act could not have planned for the Supreme Court, which said, in effect, states have a right to deny their poorest citizens health care. And they could not have anticipated the Congressional gridlock that has prevented anyone from amending the ACA. However, people like Texas Governor Rick Perry surely knew that the people they were going to hurt the worst when they said “No” to all that free money were the same salt of the earth rural voters whom they hold up so proudly as their base.

For the fourth time in two years, a rural hospital in Georgia is shuttering its doors over a dearth of patients who can pay for their medical services, the Albany Herald reports. An increasing number of hospitals that serve large numbers of poor and uninsured Americans are being forced to close in states that are refusing the Affordable Care Act’s Medicaid expansion.
The Lower Oconee Community Hospital, a so-called “critical access” hospital in southeastern Georgia with 25 beds, will close down and possibly re-open as an urgent care center that provides services that aren’t quite serious enough to necessitate an emergency room visit. Patients in the Wheeler County region who need more extensive medical care after the hospital closes will need to travel upwards of thirty miles in order to receive it.
snip
Last fall, Bloomberg reported that at least five public hospitals in Georgia, North Carolina, and Virginia — including three in Georgia alone — were cutting staff and services in the wake of their refusal to expand Medicaid. These hospitals are so-called “Disproportionate Share Hospitals” — providers that serve a disproportionate number of poor and uninsured Americans, and as such don’t always receive payments for the care they give patients.
About one in four people in Wheeler County, where the latest hospital is shutting down, is uninsured. About one in ten residents are unemployed and over 40 percent of children live in poverty.

http://thinkprogress.org/health/2014/02/18/3299961/fourth-georgia-hospital-shuts/

To put the numbers in terms that may be easier to understand:

A young woman in Georgia was immersed in flames after a four-wheeler accident. At one point, there had been a hospital only nine miles from the accident. Due to GA Governor Nathan Deal refusing Medicaid expansion, however, that hospital had been closed down only weeks earlier.
So what happened to this poor young lady, suffering from second- and third-degree burns? It took a full two hours before she was flown to a hospital in Florida.

http://www.addictinginfo.org/2014/01/10/gop-refuse-medicaid-expansion/

Why did this young woman have to suffer? Because of people like Jason C. Spencer of Georgia:

“By the way, many hospitals are addicted to the current reimbursement structure in Medicine (the main problem with the healthcare). They are like addicts on crack. They don’t want to give up the money or move to a different solution. They benefit off the current system."

http://www.addictinginfo.org/2013/12/28/republican-fighting-obamacare-calls-hospitals-crack-addicts-photo/

Benefit? That's an interesting way to describe the massive closure of rural hospitals and the genocide being waged against rural citizens of the 24 states which refused the Medicaid expansion. Someone may be benefiting from that decision, but I don't think it is the hospitals or the people they used to serve.

[GeorgeGist]

1. Thank you for all that you do.