"The pace of closures has escalated in recent years, hastened by a series of budget control measures passed by Congress that reduced Medicare payments and by the Affordable Care Act, which is slowly restructuring the health care industry," she writes. "The law rewards scale and connectivity—difficult goals for rural hospitals that are, by their geographic nature, low-volume and remote. Compounding their financial troubles, 19 states have not taken advantage of a key provision in the health law to expand their Medicaid programs. That’s left many rural hospitals with uninsured patients just as federal subsidies for taking care of the uninsured are being reduced."
"For pregnant women in rural Georgia, the hospital closures can mean dwindling access to prenatal care and longer trips when labor begins," Varney writes. "In Waynesboro, Ga., Dr. Frank Carter, a prenatal specialist, said after the troubled local hospital there closed its labor and delivery unit, his patients—largely poor women with little money for transportation—face an hour’s drive to deliver their babies."
"But while hospital closures in rural areas can unsettle residents’ nerves and force them to travel farther distances, the effect on health outcomes remains unclear," Varney writes. "Researchers have found that closing down a rural hospital does not increase the chance of death, and, an investigation by The Wall Street Journal found surgeries at many rural hospitals carried a greater risk of complications. Indeed, for some emergencies, patients can receive better quality care at larger hospitals that treat more cases."