Listed: 80 rural hospitals that have closed since 2010; mainly in states that didn't expand Medicaid

Researchers at the University of North Carolina-Chapel Hill have charted the 80 rural hospitals that have closed since 2010. It's no coincidence that many of them are in the South, largely in states that refused to expand Medicaid under federal health reform. Texas leads the way with 13 rural hospital closures since 2010, Ayla Ellison reports for Hospital CFO. Eight have closed in Tennessee, six in Georgia and five in Alabama and Mississippi. None of those states expanded Medicaid.

A UNC study published in September in the journal Health Affairs found that rural hospitals are more likely to turn a profit in states that expanded Medicaid. For example, rural hospitals in non-expansion states had mean operating margins of − 0.18 percent, compared to 1.03 percent in states that expanded Medicaid. "In contrast, urban hospitals in non-expansion states were, on average, more profitable than those in expansion states, with mean operating margins of 6.92 percent and 3.51 percent, respectively." (UNC graphic: Operating margins for hospitals)

The study backs the long-standing complaint of rural hospitals that "they were hurt by the lack of Medicaid expansion, which leaves many of their patients without insurance coverage and strains the hospitals’ ability to better serve the public," Shefali Luthra reports for Kaiser Health News. The study shows that "all hospitals generally fared better under the larger Medicaid program, but there’s more at stake for rural hospitals when the state expands coverage." 

"Rural hospitals serve more low-income people—who weren’t eligible for insurance before, but who got covered after the health law took effect," Luthra writes. "And rural hospitals are historically more likely to operate at a loss than are urban ones. So the chance to see increased revenue is greater than in a city-based hospital."