The study looked at the 2015 closures of non-profit Mercy Hospital in Independence, Kansas; for-profit Marlboro Park Hospital in Bennettsville, South Carolina; and Parkway Regional Hospital in Fulton, Kentucky. Only the latter was located in a state that expanded Medicaid, but much of the for-profit hospital's service area was in Tennessee, which is still debating expansion.
Besides Medicaid expansion, the study said the closures stemmed from "aging, poor, and shrinking populations;" high rates of uninsured patients, creating bad debts; heavy reliance on Medicare and Medicaid; economic challenges in the communities; "aging facilities, outdated payment and delivery system models, and business decisions by corporate owners and operators."
The study said the closures led to the departure of health-care professionals and made specialty care all the more difficult to access. "Elderly and low-income individuals were more likely than others to face transportation challenges following the closures, and were thus more likely to delay or forgo needed care," the study said.
It said more rural hospitals can be expected to close, but others "may be able to adapt, and new models may be created to address changing demographics and delivery systems. Such reconfiguration may require federal support and assistance as well as regional planning efforts. A state’s decision about the Medicaid expansion has an important impact on hospital revenues and access to care, but the sustainability of rural hospitals depends on a broader set of factors."