These closures, which are the result of economic decline, in turn exacerbate economic decline. When a local hospital closes, unemployment rises, and income falls by as much as $700 a person.
The math here is not complicated: Hurst’s patients are old and lower income than most of America. From Medicare reimbursements to food stamps, every cut to government care can add to a hospital’s budget. We can see proof of this when some states cut social services while others expand them. The Affordable Care Act (ACA) offered funding for states to expand Medicaid access to nearly all low-income people, including anyone at or below 138 percent of the federal poverty line. But twelve states refused to participate in protest of the legislation, which meant that in those states, access to Medicaid remained limited to low-income people at or below 41 percent of the poverty line. That’s an annual income of $8,905 for a family of three in 2020 dollars—make more than that, and you get no medical assistance in these twelve states. Researchers tracked rural hospitals in the decade after this decision and found that those in states that expanded Medicaid were 62 percent less likely to shut down. The researchers also ranked the 216 rural hospitals most vulnerable to closure—three out of every four were in a state that refused to expand Medicaid. The nine states with the greatest number of rural hospital closures since 2010 all refused to expand Medicaid in protest of the Affordable Care Act (ACA). Texas and Tennessee top the list of rural hospital closures, with 21 and 16 closings, respectively, since 2010. Both refused to expand Medicaid.
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