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Rural hospitals – and healthcare – are in deep trouble.

With the unwinding of Medicaid post-COVID emergency, rural healthcare is falling deeper into financial trouble.

Consulting form Chartis just published their review of rural healthcare…among the findings

The unwinding issue is exacerbating problems in states that failed to expand Medicaid…the vast majority of which are those with the most hospitals in financial distress.  Simply put – they have to deliver way more healthcare to people without health insurance.


Across the 10 remaining non-expansion states (Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming), the percentage of facilities with a negative operating margin increased year-over-year from 51% to 55%. These states are home to more than 600 rural hospitals…Several of these states are among the most severely affected by hospital closures and a loss of access to care.

The percentage of America’s rural hospitals operating in the red jumped from 43% to 50% in the last 12 months.

418 rural hospitals are “vulnerable to closure” according to a new, expanded
statistical analysis.

Healthcare deserts are a huge problem for rural America, especially in areas with lots of extractive industries (mining, energy, agriculture. Workers in those industries are much more likely to suffer severe occupational injuries, injuries that benefit greatly from care delivered in the “golden hour”.

What does this mean for you?

Not expanding Medicaid is killing rural healthcare.

2 thoughts on “Rural hospitals – and healthcare – are in deep trouble.”

  1. There need to be a new paradigm for the delivery of healthcare to rural America. Small hospitals will never have the volume of patients needed to provide the range and quality of services that communities need. As the conditions that require hospitalization diminish with advances in treatment, care, outpatient services increase, the closure of small hospital is inevitable. Funding to keep doors open to facilities that can’t maintain an adequate medical staff, provide more complex care is misleading the public that medical care is available.
    Needed is local immediate care, rapid transport for injuries, and an organized system for preventative/routine care in mobile form, visiting care givers and online, with organized paths for transport and care in adequate facilities. A big improvement in public health would also help. While closing a community resource/major employer is devastating, keeping an inadequate facility is not helping healthcare access or quality.

    1. Robert – thanks for the note.

      I agree. But politics will determine if/where this happens.

      be well Joe

Comments are closed.

Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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