At least 95 rural hospitals have closed since 2010, according to the Center for Health Services Research at the University of North Carolina. Another 600 or more are at risk of closing, "according to an oft-cited 2016 report by iVantage Health Analytics," Ollove notes. The center told Kentucky Health News that 35 to 38 percent of rural hospitals are losing money.
Medicaid has been expanded in 36 states and Washington, D.C. About 4 million more people would qualify if the program were expanded in the remaining states, according to a 2018 Kaiser Family Foundation analysis. That includes 1.2 million in Texas alone, and rural hospitals in Texas are especially endangered; 21 have closed in the past six years, leaving 160 still open. "An Urban Institute study in 2014 estimated that not expanding Medicaid would deprive Texas hospitals of $34.3 billion in federal reimbursements over 10 years," Ollove reports.
But expansion is not a silver bullet. It could "prop up inefficient and wasteful hospitals," said Michael Cannon, director of health policy studies at the Libertarian-leaning Cato Institute. And some rural hospitals could stay solvent if locals approve increased property taxes, Ollove reports. Moreover, rural America would still face many health care issues even if Medicaid were expanded in all states, since rural areas tend to have an older, sicker and less-insured populace.